Humanitarian Situation Update #239 | Gaza Strip

The Humanitarian Situation Update is issued by OCHA Occupied Palestinian Territory twice a week. The Gaza Strip is covered on Tuesdays and the West Bank on Thursdays. The Gaza Humanitarian Response Update is issued every other Tuesday. The next Humanitarian Situation Update will be issued on 21 November.

Key Highlights

• For over 40 days, people besieged in North Gaza governorate have been facing diminishing conditions for survival.
• All attempts by the UN to support people in North Gaza have been denied or impeded: bakeries and kitchens have shut down, nutrition support has been suspended, and the refuelling of water and sanitation facilities remains restricted.
• Efforts are ongoing to scale up services in Gaza city, where more than 100,000 people displaced from North Gaza have relocated.
• There is a stark increase in the number of households experiencing severe hunger in central and southern Gaza, Food Security Sector partners warn.
• Eight children were medically evacuated outside the Gaza Strip, bringing to 329 the number of patients who have been exceptionally evacuated abroad since early May.

Humanitarian Developments

• Israeli bombardment from the air, land and sea continues to be reported across the Gaza Strip, resulting in further civilian casualties, displacement, and destruction of civilian infrastructure. In the North Gaza governorate, following military operations that began in October 2023, the Israeli military has been carrying out a ground offensive since 6 October 2024, with fighting reported between Israeli forces and Palestinian armed groups. Israeli forces have continued to impose a tightened siege on the area and humanitarian assistance has been largely denied; between 1 and 18 November, 27 out of 31 coordination requests by the UN to access the besieged areas were denied and the remaining four were initially approved but then impeded on the ground. No fuel was let in for water, sanitation and hygiene (WASH) facilities (see more below).
• Briefing the Security Council on 12 November, then Acting Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator (ERC), Joyce Msuya, described the latest offensive in North Gaza as “an intensified, extreme and accelerated version of the horrors of the past year.” The Acting ERC stated: “Shelters, homes and schools have been burned and bombed to the ground. Numerous families remain trapped under rubble, because fuel for digging equipment is being blocked by the Israeli authorities and first responders have been blocked from reaching them… Supplies to the north are being cut off and people are being pushed further south.” Highlighting the scale of death, destruction and suffering throughout the Strip, the UN official warned that “[c]onditions of life across Gaza are unfit for human survival,” with food being insufficient, shelter items extremely scarce and violent armed lootings of humanitarian convoys becoming “increasingly organized along routes from Kerem Shalom [crossing], driven by the collapse of public order and safety.”
• Between the afternoons of 12 and 19 November, according to the Ministry of Health (MoH) in Gaza, 307 Palestinians were killed and 932 were injured. Between 7 October 2023 and 19 November 2024, at least 43,972 Palestinians were killed and 104,008 were injured, according to MoH in Gaza.
• Between the afternoons of 12 and 19 November, three Israeli soldiers were killed in Gaza, according to the Israeli military. Between 7 October 2023 and 19 November 2024, according to the Israeli military and official Israeli sources cited in the media, more than 1,576 Israelis and foreign nationals were killed, the majority on 7 October 2023 and its immediate aftermath. The figure includes 376 soldiers killed in Gaza or along the border in Israel since the beginning of the ground operation. In addition, 2,440 Israeli soldiers were reported injured since the beginning of the ground operation.
• Due to the suspension of the Palestinian Civil Defense (PCD) services in North Gaza governorate, community responders with limited expertise have reportedly been trying to recover casualties using available unsuitable tools, with limited success. The following are some of the deadliest incidents reported between 11 and 18 November:
  • On 11 November, at about 20:45, 11 Palestinians, including two children were reportedly killed and others injured when a tent, reportedly operating as an internet service point and café, was hit on the coastal road in Al Mawasi area, west of Khan Younis.
  • On 12 November, at about 11:30, at least 15 Palestinians were reportedly killed, with corpses remaining under the rubble and in the street, when two houses were hit in Beit Hanoun, in North Gaza.
  • On 12 November, at about 10:45, at least six Palestinians, including two girls and an elderly man, were reportedly killed and several others, including children, injured when a group of Palestinians was hit near the UNRWA clinic on the coastal road west of Deir Al Balah.
  • On 13 November, at about 9:00, six Palestinians were reportedly killed and others injured when a group of people was hit at the gate of Kamal Adwan Hospital, in North Gaza.
  • On 15 November, at about 13:20, at least seven Palestinians including five females were reportedly killed and others injured when a tent used by internally displaced persons (IDPs) was hit near Al Eqlimi Park near Pier 19 in Al Mawasi area, in western Khan Younis.
  • On 16 November, at about 16:35, 10 Palestinians, including at least one girl and two women, were reportedly killed and others injured when Abu Asi School was hit in Ash Shati (Beach) refugee camp, in western Gaza city.
  • On 17 November, at about 0:30, 15 Palestinians were reportedly killed and others injured when a house, hosting IDPs, was hit near Al Shawa clinic in Beit Lahiya Project area in North Gaza. Injured people reportedly remained under the rubble.
  • On 17 November, at about 8:00, approximately 50 Palestinians, including women and children, were reportedly killed and others injured when a five-storey building hosting tens of IDPs was hit in Beit Lahiya Project, in North Gaza.
  • On 17 November, at about 15:25, six Palestinians were reportedly killed and others injured when a group of people was hit near Al Fizab Market in Qizan an Najjar village, in southern Khan Younis.
  • On 18 November, over 20 people were reportedly killed by armed men in an operation said to be led by the Gaza Ministry of Interior to target alleged looters of humanitarian aid.
• The UN and its partners estimate that between 100,000 and 131,000 people have been displaced since 6 October 2024, arriving at various locations in the west and north of Gaza city, where essential resources such as shelter, water, and health care are severely limited. This influx has raised the population in Gaza governorate from around 250,000 estimated to have been present as of the end of September 2024 to approximately 375,000 people. Movement towards southern Gaza remains limited, with about 700 people having moved southward since 6 October 2024. It is estimated that only 65,000 to 75,000 people remain in North Gaza governorate, less than 20 per cent of the population on the eve of 7 October 2024. On 17 November, Israeli air forces dropped leaflets in Beit Lahiya, ordering an immediate evacuation and reportedly triggering further displacement.
• On 15 November, Israeli forces released 20 Palestinian detainees through Kerem Shalom Crossing, most of whom had been reportedly detained from North Gaza since 6 October 2024, according to media sources. The detainees were subsequently transferred to the European Hospital in Khan Younis for medical evaluation and care. Some of the detainees reported to the media that many children, older people, and seriously injured individuals taken from hospitals in North Gaza remain in Israeli custody. Detainees reported being subjected to systematic torture within Israeli prisons, including physical assault, sleep deprivation, prolonged periods of handcuffing and blindfolding, and severe deprivation from food, water, and medical care, as media highlighted. On 15 November, the Palestinian Prisoner’s society announced the death of a detainee from Gaza on 14 November while being transferred from a prison in southern Israel to Soroka Hospital in Beersheba after his medical situation deteriorated. The society added that the prisoner had been detained since December 2023 and was in good health according to his family. As of November 2024, according to data provided by the Israel Prison Service (IPS) to Hamoked, an Israeli human rights NGO, there are 10,091 Palestinians in Israeli custody, including 3,443 administrative detainees held without trial, 1,997 sentenced prisoners, and 1,627 people held as “unlawful combatants”. These figures do not include Palestinians from Gaza who have been detained by the Israeli military since 7 October 2023 and their number remains unknown.
• Humanitarian operations across Gaza have continued to be significantly hampered by ongoing access restrictions, severely limiting the critical delivery of food, medical aid, and fuel supplies and exacerbating already dire humanitarian conditions. Between 1 and 18 November, out of 319 planned aid movements across the Gaza Strip that were coordinated with the Israeli authorities, 41 per cent (132) were facilitated, 33 per cent (105) were denied, 16 per cent (51) were impeded, and 10 per cent (31) were cancelled due to logistical and security challenges. This includes 120 coordinated aid movements intended to provide humanitarian assistance in governorates north of Wadi Gaza, of which 65 needed to pass through the Israeli military-controlled Al Rashid or Salah Ad Din checkpoints. Of those using the checkpoints, only 24 per cent (16) were facilitated by the Israeli authorities, 32 per cent (21) were impeded, 34 per cent (22) were denied, and nine percent (six) were cancelled. Aid missions to the North Gaza Governorate were particularly disrupted. Between 1 and 18 November, 85 per cent of* 41 coordination requests for humanitarian missions in North Gaza governorate were either denied (17) or impeded (18), while seven per cent (3) were facilitated. Specifically, 31 of these 41 requests were made for the besieged areas of Jabalya, Beit Hanoun, and Beit Lahya, with all but four* attempts being denied during this period. These four attempts were severely impeded and could only accomplish limited objectives. Coordinated aid missions to areas in the southern, western, and central Rafah governorate, which has been under an ongoing Israeli military operation since early May, have faced similar challenges, with 26 of the 63 coordinated missions (41 per cent) either denied or impeded between 1 and 18 November.

Health

• In North Gaza, where mass casualty incidents and bombardment continue to be reported, access to the Kamal Adwan, Al Awda and Indonesian hospitals remains severely restricted amid severe shortages of medical supplies, fuel and blood units. All attempts by the Health Cluster to deploy an international Emergency Medical Team (EMT) to scale up capacities continue to be blocked by the Israeli authorities. On 17 November, the World Health Organization (WHO), jointly with OCHA, the UN Mine Action Service (UNMAS), the International Committee of the Red Cross (ICRC) and the Palestine Red Crescent Society (PRCS), reached the Kamal Adwan Hospital in North Gaza, delivering 10,000 litres of fuel to the facility and transferring 17 patients, three unaccompanied children, and their 22 caregivers to Al Shifa Hospital in Gaza city. Overall, between 1 October and 17 November, WHO and its partners planned 10 missions to the Kamal Adwan Hospital but were only allowed to reach the facility on five occasions, under restrictive conditions. On 18 November, the unaccompanied children were further transferred, with the support of the UN Children’s Fund (UNICEF), to the Nasser Medical Complex in Khan Younis, where they were reunited with their families. While the WHO-led mission was also meant to deliver food and medical supplies to Kamal Adwan, Israeli forces compelled aid workers to offload the food at an Israeli military checkpoint, before reaching the patients and medical staff at the hospital, and only some of the medical supplies could be handed over to the facility, according to the hospital’s director Dr. Husam Abu Safiyeh and the Health Cluster. On the evening of 18 November, the Director of Kamal Adwan reported that the facility had once again been hit, with shrapnel hitting personnel in the intensive care unit. In a separate mission, the ICRC and PRCS reached the Al Awda Hospital in Jabaliya, delivering fuel and medical supplies, and transferring 15 patients to Al Shifa Hospital. The Israeli authorities, however, blocked the provision of food and water to the facility. In a statement, Al Awda Health and Community Association warned that Al Awda Hospital is operating only four hours a day to continue providing essential health services despite the critical shortage of fuel and is in dire need of food, water, blood units, and oxygen supplies.
• In Gaza governorate, efforts by the Health Cluster are ongoing to scale up health services given the continued influx of displaced people from North Gaza. Between 27 October and 9 November, two new surgical Specialized Care Teams were deployed to the Public Aid and Al Ahli Arab hospitals in Gaza city. Sexual and Reproductive Health supplies and equipment, as well as individual kits, were also delivered to support 15 health facilities and serve 20,000 people. On 18 November, ICRC and PRCS transferred antibiotics, emergency medications and other medical supplies to Al Shifa, Al Ahli and Al Hilu hospitals in Gaza city, with additional missions planned by the Health Cluster to the area to further increase capacities.
• In central Gaza, with support from Germany, WHO has expanded inpatient capacity at Nasser Medical Complex in Khan Younis, setting up 13 specialized tents with 88 additional beds in the hospital’s backyard. This extension is expected to ease congestion in the emergency room, enhance trauma care for complex cases, and improve the management of mass casualty incidents. The hospital, however, continues to face shortages of blood units and on 14 November, it organized an urgent blood donation campaign jointly with Médecins Sans Frontières (MSF) and Doctors of the World. Meanwhile, Emergency, an international NGO, reported that its team has started providing healthcare services in a field clinic set up by a local association in Al Mawasi, receiving an average of 160 patients a day, more than a third of whom are children, and finding that one in ten patients is malnourished.
• On 14 November, WHO and its partners supported the medical evacuation of eight children suffering from conflict injuries and metabolic conditions, alongside their six companions, from Gaza to Jordan, for onward travel to the United States to receive advanced medical treatment. Four days earlier, MSF reported that the Israeli authorities had blocked, without explanation, the medical evacuation to the MSF hospital in Jordan of eight children and their caretakers, including a two-year-old with leg amputations. MSF added that it had applied for 32 children and caretakers to be medically evacuated from Gaza to Jordan in recent months, but only six have reportedly been allowed to leave. In total, according to the Health Cluster, since the closure of Rafah Crossing on 7 May, only 329 patients have been exceptionally evacuated outside Gaza, while all regular evacuations of critically ill and injured patients remain suspended.

Food Security

• The food security situation continues to worsen by the day across the Gaza Strip. More than one million people have not received any food parcels since July or earlier, with the majority being in central and southern Gaza. Many kitchens have already closed, none are operational in North Gaza governorate, only 18 in the Gaza governorate, and approximately 120 remain open throughout central and southern Gaza, of which 100 are producing about 330,000 meals per day but face the constant threat of shutdown amid persistent and increasing shortages of supplies. As of 18 November, only eight out of 19 bakeries supported by WFP remained operational across the Strip – four in Gaza city, three in Deir al Balah and one in Khan Younis; none in Rafah or North Gaza. The deepening energy crisis is only exacerbating this dire situation across the Strip, with no cooking gas having entered northern Gaza for more than 13 consecutive months, and firewood or wood logs being increasingly scarce in highly congested areas of central and southern Gaza, forcing people to continue relying on burning waste to cook and venture into high-risk areas in search of firewood.
• Access to North Gaza continues to be heavily restricted, with all except two missions by Food Security Sector (FSS) partners to deliver food aid (both missions were also rendered incomplete) consistently denied since 6 October and kitchen and subsidized bakeries having completely shut down. Moreover, all Nutrition Cluster partner activities remain suspended, including the treatment of children with acute malnutrition, as well as supplementary feeding for children and pregnant and breastfeeding women. Briefing the Security Council on 12 November, the Director of the Food and Agriculture Organization’s (FAO) Office of Emergencies and Resilience, Rein Pulsen, stressed that “men, women, boys and girls are effectively starving as the conflict rages, with humanitarian organizations blocked from delivering assistance to those in need,” warning that the window of opportunity to save people’s lives is now – tomorrow will be too late. He explained that people would have already been dying from hunger by the time famine is declared and this would have “irreversible consequences that can last generations.” In a video statement issued on 15 November and in a subsequent update provided on 18 November, the Director of the Kamal Adwan Hospital warned that signs of famine are being recorded in North Gaza, with acutely malnourished children and adults arriving to the hospital and four children being now in critical conditions at the facility.
• In Gaza city, FSS partners are doing their utmost to support the increasing number of people displaced from further north. So far in November, more than 200,000 people have received at least one food parcel, with many having also received one 25-kilogram bag of wheat flour, which continues to enter almost regularly through the Erez West Crossing. About 10,000 cooked meals prepared in 18 kitchens are distributed daily to households, alongside 9,800 bread parcels produced by the four subsidized bakeries.
• Food security conditions are alarmingly deteriorating in the central and southern governorates of Gaza, with a limited amount of food aid trickling through the Kerem Shalom crossing, a high rate of convoys being looted, and a near halt to commercial supplies. On 16 November, a UN convoy comprising 109 trucks of food supplies was violently looted by Palestinians, with 97 trucks lost and drivers forced at gunpoint to unload aid. As of mid-November, only some 270,000 people - 16 per cent of the estimated 1.7 million people in Deir al Balah, Khan Younis and Rafah - had received their reduced monthly food rations. Dire shortages of wheat flour have forced the closure of four bakeries in Deir al Balah in the space of one week, with only three bakeries in the governorate and one in Khan Younis remaining operational as of 18 November. Many community-led baking initiatives have equally been forced to suspend their activities since early October. The four still functional bakeries are operating at 100 per cent of their capacity, but risk shutting down if no additional flour is received within five days.
• A remote monitoring exercise conducted by FSS partners in central and southern Gaza in October revealed a stark increase in the number of households experiencing severe hunger, with people increasingly relying on the most severe coping strategies to survive, such as reducing adults’ food intake in favour of children. Wheat flour is also extremely scarce, with the price of a 25-kilogramme bag of flour having skyrocketed to 400 NIS (over US$100), compared with 40 NIS (about $10) prior to October 2023. The situation on the ground is “unbearable,” highlighted UNRWA, with “people fighting over bags of flour and surviving on tinned food” and protests demanding the entry of flour and food supplies being increasingly frequent. The Nutrition Stabilization Centre operated by the International Medical Corps (IMC) in Deir Al Balah has also reported to the Nutrition Cluster an increase in admissions of children with oedema, a sign of worsening malnutrition, with six boys and four girls admitted between 10 October and 12 November.

Water and Sanitation

• WASH conditions remain critical across Gaza, particularly in the North Gaza governorate, where approximately 65,000 - 75,000 people face immense challenges in securing access to clean drinking water and where no fuel has been allowed into the area, halting the operation of the remaining water wells, amid ongoing power cuts from Israel and the Gaza power plant. According to the WASH Cluster, since the onset of the Israeli military operation in North Gaza on 6 October 2024, all requests submitted by aid partners for the delivery of supplies and fuel to operate WASH facilities were denied*, heightening the risks of dehydration and disease outbreaks while about half of Gaza city wells have been inaccessible. In southern Gaza, fuel and equipment shortages are also having a detrimental impact on WASH conditions. Calling for the urgent delivery of fuel ahead of the winter season, on 16 November, the Municipality of Khan Younis reported that the lack of fuel is severely hindering its ability to collect and transport waste as well as clear stormwater trains in over 60 identified locations at high risk of flooding, among other essential services, further exacerbating the challenges faced by residents in these vulnerable areas.
• On 13 November, the Coastal Municipalities Water Utility (CMWU) said that it has received from UNICEF a shipment of 20,000 litres of chlorine for drinking water and necessary chemicals, which are sufficient for one month to operate seawater desalination plants and water wells in southern Gaza. Chlorine stocks had been depleted for months, leaving the water supply system vulnerable to contamination and public health risks, while the destruction of water and sanitation infrastructure, particularly water networks and distribution systems, has resulted in unprecedented levels of water pollution, CMWU highlighted. While none of these supplies have yet been authorized for delivery to WASH facilities in North Gaza, received supplies are expected to help mitigate the risk of water contamination and alleviate parts of the public health concerns including at displacement sites.
• On 14 November, the Israeli authorities enabled power through a single electricity line dedicated to the UN-supported southern Gaza central seawater desalination plant, connecting it to Israel’s power grid, which is anticipated to contribute to improving the water supply. However, the overall amount of water produced and pumped remains unclear, as water pumping continues to be severely hindered by the ongoing destruction of WASH infrastructure. This marks the first time the Israeli authorities have allowed any electricity connection to Gaza since it cut off all the supply from Israel of approximately 120 Megawatts in October 2023. Combined with the forced shutdown of Gaza's sole power plant, Gaza has been suffering from a near complete blackout, and full reliance on alternative power sources such as backup generators or solar panels, severely disrupting the provision of basic services and aid operations.

Funding

• As of 19 November, Member States have disbursed about US$2.12 billion out of the $3.42 billion (62 per cent) requested to meet the most critical needs of 2.3 million* people in Gaza and 800,000 people in the West Bank, including East Jerusalem, between January and December 2024. For funding analysis, please see the Flash Appeal Financial Tracking dashboard. (*2.3 million reflects the projected population of the Gaza Strip upon issuance of the Flash Appeal in April 2024. As of July 2024, the UN estimates that about 2.1 million people remain in the Gaza Strip, and this updated number is now used for programmatic purposes.)
• The oPt Humanitarian Fund (oPt HF) is currently managing 90 ongoing projects, totalling $79.6 million. These projects aim to address urgent needs in the Gaza Strip (91 per cent) and the West Bank (nine per cent) and are strategically focused on education, food security, health, protection, emergency shelter and non-food items, WASH, coordination and support services, multi-purpose cash assistance and nutrition. Of these projects, 49 are being implemented by international non-governmental organizations (INGOs), 29 by national NGOs and 12 by UN agencies. Notably, 32 out of the 61 projects conducted by INGOs or the UN are being implemented in collaboration with national NGOs. Moreover, in addition to the four other reserve allocations for 2024, the oPt HF is currently finalizing its critical and time-sensitive First Standard Allocation of $30 million, aligned with the 2024 oPt Flash Appeal, aiming to rapidly scale up relief efforts to meet the immediate needs of affected people in Gaza and the West Bank. The allocation includes 16 fast-tracked projects, prioritizing critical winterization preparedness and addressing urgent shelter, WASH, and other emergency needs of IDPs and other vulnerable groups in Gaza. Monthly updates, annual reports, and a list of all funded projects per year, are available on the oPt Humanitarian Fund webpage, under the financing section.

* Asterisks indicate that a figure, sentence, or section has been rectified, added, or retracted after the initial publication of this update.