Humanitarian Situation Update #243 | 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 5 December.

Key Highlights

• An Emergency Medical Team was successfully deployed to Kamal Adwan hospital, in North Gaza, for the first time in 60 days. 
• A severe shortage of medical supplies and consumables is hindering the provision of essential healthcare across the Gaza Strip, and UNRWA warns that at least 60 medications will be depleted at its health facilities by the end of the year.  
• Water production decreased by nine per cent in November, mainly due to critical fuel shortages that have resulted in a 43-per-cent drop in production by groundwater wells across Gaza.   
• Humanitarian access continued to be partly denied or impeded during November, and UNRWA had to suspend the collection of aid supplies from Kerem Shalom crossing due to insecurity and looting of humanitarian cargo.

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, 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 Beit Lahiya, Beit Hanoun and parts of Jabalya and humanitarian assistance has been largely denied for about 60 days (see data below), leaving between 65,000 and 75,000 people without access to food, water, electricity or reliable health care, as mass casualty incidents continue. 
• Between the afternoons of 26 November and 3 December, according to the Ministry of Health (MoH) in Gaza, 253 Palestinians were killed and 708 were injured. Between 7 October 2023 and 3 December 2024, at least 44,502 Palestinians were killed and 105,454 were injured, according to MoH in Gaza. 
• Between the afternoons of 26 November and 3 December, two Israeli soldiers were killed in Gaza, according to the Israeli military. Between 7 October 2023 and 3 December 2024, according to the Israeli military and official Israeli sources cited in the media, more than 1,580 Israelis and foreign nationals were killed, the majority on 7 October 2023 and its immediate aftermath. The figure includes 380 soldiers killed in Gaza or along the border in Israel since the beginning of the ground operation. In addition, 2,463 Israeli soldiers were reported injured since the beginning of the ground operation. 
• Representing the last lifeline for over two million Palestinians in Gaza, humanitarian workers continue to operate under challenging conditions that undermine their ability to meet humanitarian needs while facing risks to their personal safety. On 30 November, three World Central Kitchen (WCK) staff members were killed by an Israeli airstrike on their vehicle near an aid distribution site in Khan Younis, forcing the organization to pause its operations. On the same day, a Save the Children staff member, who is deaf, was killed in a separate Israeli airstrike in Khan Younis while returning home from a mosque. Save the Children condemned the attack in the strongest possible terms and demanded an investigation. On 27 November, UNRWA reported that two additional agency staff had been killed in Gaza, bringing the total fatality toll among UNRWA staff to 249. Overall, since 7 October 2023, at least 343 humanitarian workers have been killed in the Gaza Strip, including 253 UN staff. Calling for accountability and an immediate ceasefire to end the suffering, the Humanitarian Coordinator for the OPT, Muhannad Hadi, emphasized: “Humanitarians must be granted safe, sustained, and unimpeded access to all those in need. The continued killing of humanitarian workers is an unacceptable violation of international law and further intensifies the catastrophic humanitarian situation.” 
• On 28 November, over 75 Palestinians including children and women were reportedly killed in two strikes on two residential buildings in Beit Lahiya, in North Gaza, according to the Palestinian Civil Defense (PCD) that remains blocked by the Israeli authorities from operating in the governorate. PCD further stated that the houses near one of the targeted buildings are inhabited and their residents may have also been killed or injured but their destiny remains unknown. On 29 November, PCD spokesperson described conditions in North Gaza governorate as a “total catastrophe” whereby many people are trapped under rubble for days until they die of their injuries or due to the lack of food and water. According to PCD, more than 2,700 people are estimated to have been killed in North Gaza since 6 October, half of whom have not been retrieved, and more than 10,000 have been injured. 
• The following are some of the other deadly incidents reported between 26 November and 1 December:  
  • On 26 November, at about 14:50, 15 Palestinians were reportedly killed and others injured when Al Hurriya School, sheltering Internally Displaced Persons (IDPs), was hit in Az Zeitoun neighbourhood in southeastern Gaza city. 
  • On 27 November, at about 02:00, at least nine Palestinians including six females were reportedly killed and 20 others were injured when two floors of a building of Al Tab’aeen School, sheltering IDPs, was hit in central Gaza city. 
  • On 28 November, at about 08:40, nine Palestinians including at least one woman were reportedly killed and several others injured when a group of Palestinians sitting outside a house was hit in the New Camp, north of An Nuseirat refugee camp in Deir al Balah. 
  • On 29 November, at about 23:05, at least ten Palestinians, including two women and two children, were reportedly killed when an apartment was hit in a building in Ash Sheikh Radwan neighbourhood in northern Gaza city. 
  • On 29 November, the head of the Intensive Care Unit (ICU) at Kamal Adwan Hospital, in North Gaza, was reportedly killed in an Israeli airstrike in North Gaza. 
  • On 30 November, at about 11:35, at least eight Palestinians were reportedly killed when a five-story residential building was hit in Ash Shuja’iyeh neighbourhood, in eastern Gaza city.  
  • On 30 November, at about 13:00, at least 12 Palestinians were reportedly killed and others injured when an area near an aid distribution point was hit in Qizan an-Najjar Village in southern Khan Younis. 
  • On 30 November, at about 16:25, over 40 Palestinians were reportedly killed or injured, according to PCD, when a house sheltering tens of IDPs was hit in Tal Az-Za'atar in North Gaza. Many people are still trapped under the rubble due to very limited resources for retrieval and rescue. 
  • On 1 December, at about 19:00, 25 Palestinians, including women and children, were reportedly killed when a house was hit in Beit Lahiya Project in North Gaza. 
• On 1 December, following the denial of several requests to deploy Emergency Medical Teams (EMTs) at Kamal Adwan Hospital, an EMT made up of six staff from Medical Emergency Rescue Committee (MER-C) Indonesia was deployed to the hospital as part of a medical mission from the World Health Organization (WHO) that delivered a fuel tank and medical supplies. The hospital, which now hosts 63 patients including nine in the ICU, has been functioning with extremely limited resources and has been under attack several times. Also in North Gaza, on 26 November, the International Committee of the Red Cross (ICRC) and the Palestine Red Crescent Society (PRCS) facilitated the medical transfer of patients from Al-Awda hospital in Beit Lahiya, which also suffers from an acute shortage of supplies, to Al-Shifa hospital in Gaza city. 
• A severe shortage of medical supplies and the lack of food and water for patients continue to hinder the provision of much needed healthcare across the Gaza Strip. Coupled with soaring medical needs due to the onset of winter and hunger, these conditions have forced health workers to turn people away at some facilities and could “push people over the edge,” warned Médecins Sans Frontières (MSF) on 29 November. At Nasser Hospital in Khan Younis, basic supplies like gauze and bandages are running out, forcing MSF teams to extend dressing change intervals and heightening infection risks. Also at Nasser, MSF teams have not been able to set up a clinical bacteriology laboratory because the cold chain to operate it has been constantly “opened and damaged by Israeli officers at the crossing point," according to MSF. In Deir al Balah, the MSF field hospital is struggling due to a lack of painkillers and antibiotics, hindering pain management and the treatment of low respiratory infections among children. Medications for hypertension, or high blood pressure, are similarly in short supply, leaving many people untreated and at risk of acute complications. According to WHO, of the estimated 350,000 people who live with chronic diseases in the Gaza Strip, about 225,000 have hypertension. Likewise, UNRWA recently reported that its health facilities, including seven health centres and 54 medical points that remain operational, have limited stocks of medicine and shortages of laboratory supplies have rendered only three tests available for patients compared with 35 tests prior to 7 October 2023. According to UNRWA, under current conditions, at least 60 medications, including inter alia 19 mental health and non-communicable disease medications, 17 antimicrobials and antiparasitic medicines, eight anti-inflammatory and gastrointestinal drugs, will run out at its health facilities by the end of December 2024. In addition, MSF teams have been relying on expensive water trucking due to the lack of authorization from the Israeli authorities to import desalination units or generators. However, last week they were forced to reduce water trucking activities by half due to the high cost and limited availability of fuel. 
• Attacks on health facilities across the Gaza Strip continue to take place, further hindering the provision of services and placing additional strain on an already overwhelmed healthcare system. On 28 November, Al Awda Health and Community Association reported that one of its ambulances had been hit while evacuating injured people in An Nuseirat refugee camp, in Deir al Balah, resulting in the injury of one paramedic. On the same day, quadcopters reportedly dropped small diameter bombs outside the reception and emergency ward of Al Awda Hospital in An Nuseirat, injuring four people, including two staff.  In addition, on two occasions on 30 November, Israeli forces reportedly opened fire and fired shells towards the Indonesian Hospital, in North Gaza governorate, resulting in the injury of one doctor, the destruction of three electricity generators, and damage to the hospital's third floor and water tanks. Moreover, Oxfam’s partner, Juzoor, which continues to operate in North Gaza, reported that it had its homeless shelter, food and medical storage facility and one of its 15 health points hit by recent Israeli bombardments, “destroying equipment and burning medicines” at the health point. 
• On 27 November, six cancer patients and 11 trauma patients, along with 17 companions, were evacuated by WHO from Gaza to receive specialized medical treatment in the United States and Jordan. As of 27 November, 352 patients have been exceptionally evacuated from Gaza abroad since early May, following the Israeli ground operation in Rafah and subsequent closure of Rafah crossing. With the decimation of Gaza’s health care system and a severe shortage of supplies and specialized care, thousands of patients remain on the waiting list. According to the UN Children’s Fund (UNICEF), “at the current rate of medical evacuations, it would take seven years to rescue 2,500 children in urgent need of medical evacuation,” and some children have died while waiting for approvals. One such case took place recently when an 11-year-old boy died of Leukaemia, after six requests for his medical evacuation from Gaza were denied, UNICEF reported.   
• Water supply in the Gaza Strip continues to be limited and dependent on fuel supplies since the shut-off of the main electricity supply lines by Israel and the forced shut-down of the Gaza power plant in October 2023. Overall, gross water production reported by the Palestinian Water Authority (PWA) and the Coastal Municipalities Water Utility (CMWU) has dropped by nine per cent in November, from an average of 96,394 to 87,358 cubic metres per day, and there is a high percentage of losses through the network due to damaged networks. On 14 November, the Southern Gaza Desalination Plant was reconnected by the Israeli authorities to an electric feeder line from Israel -- which marked the first time the Israeli authorities have allowed any electricity connection to Gaza since October 2023 – allowing it to operate at a maximum capacity. At present, the plant is producing an average of 15,000 cubic metres of water per day, three-fold the production level when it was connected to a back-up diesel generator, according to the Water, Sanitation and Hygiene (WASH) cluster. Concurrently, drinking water supplied to southern Gaza from Israel through the two Mekorot pipelines has dropped from an average of 21,000 cubic metres per day to 14,000 cubic metres per day for unclear reasons whereas the third pipeline to northern Gaza continued to operate at near full capacity, supplying an average of 20,000 cubic metres per day. Finally, over the course of November, critical fuel shortages have resulted in a 43-per-cent decrease in water production by groundwater wells, from 61,000 to about 35,000 cubic metres per day, while fuel deliveries to operate water and sanitation facilities in North Gaza governorate have remained blocked since 1 October 2024.  
• On 3 December, PWA stated that damage to Gaza's water sector has exceeded 80 per cent, affecting wells, pumping stations, desalination plants, distribution networks, and sewage treatment plants. Only 19 per cent of water wells are considered functional at present while two-thirds (208 out of 306) have become fully non-operational and 39 only partially operational. Small desalination plants, which are at present a primary source of potable water, have incurred similar damage; 80 out of 103 plants have been destroyed and 15 plants have been partially damaged. Meanwhile, only two of the three major desalination plants are operational and the third one (the North Desalination Plant) has been damaged and out of service since the escalation of hostilities in October 2023. In addition, nearly all the sewage pumping stations except two (76 out of 78) have been either destroyed (58) or partially damaged (18).  
• On 29 November, two young girls and one woman suffocated to death while queuing among large crowds to get bread at a bakery supported by the World Food Programme (WFP) in Deir al Balah, amid severe flour shortages and reduced food distributions due to access constraints and insecurity.  Mourning this tragic loss, WFP stressed that “the lack of food aid and the absence of the commercial sector are driving people into hunger,” urging authorities to provide the secure conditions necessary to ensure that humanitarian aid can reach people in need. As of 3 December, five out of 19 WFP-supported bakeries are operational across the Gaza Strip, including four in Gaza city and one in Khan Younis. The four bakeries in Gaza city have been functioning since 30 November at half capacity due to fuel shortages. In Khan Younis, one WFP-supported bakery re-opened on 3 December after two days of closure due to overcrowding. Seven WFP-supported bakeries in Deir al Balah have remained closed since the 29 November incident due to flour shortages and overcrowding, of which six were operating at full capacity on 27 and 28 November, while seven remained closed in North Gaza and Rafah due to ongoing hostilities 
• Between 1 and 30 November, out of 578 planned aid movements across the Gaza Strip requiring coordination with Israeli authorities, 41 per cent (237) were facilitated, 35 per cent (204) were denied, 16 per cent (93) were impeded, and eight per cent (44) were cancelled due to logistical and security challenges. These included 132 aid movements needed to pass through the Israeli military-controlled checkpoints on Al Rashid or Salah ad Din roads to reach areas north of Wadi Gaza (including both North Gaza and Gaza governorates), of which only 26 per cent (34) were facilitated by the Israeli authorities, 24 per cent (32) were impeded, 42 per cent (56) were denied, and eight percent (10) were cancelled. Aid missions to the North Gaza governorate were particularly disrupted, especially those seeking to reach Jabalya, Beit Lahiya and Beit Hanoun. Between 1 and 30 November, the UN attempted to reach these besieged areas 53 times, of which 48 attempts (90 per cent) were denied, five were initially approved but then severely impeded on the ground, and none were facilitated. Coordinated aid missions to areas in Rafah governorate, where there has been an ongoing Israeli military operation since early May, have faced similar challenges. Thirty out of 36 coordinated requests submitted to the Israeli authorities to access Rafah governorate were outright denied, one was cancelled, one was impeded and four were facilitated. This excludes 81 coordinated movements to Kerem Shalom crossing, of which 65 per cent (53) were facilitated, 17 per cent (14) were impeded, three per cent (two) were denied and 15 per cent (12) were cancelled.    
• On 1 December, UNRWA announced that it has paused aid delivery through Kerem Shalom, the main crossing point for the passage of humanitarian aid into Gaza due to a breakdown in public order and safety that has rendered humanitarian operations unnecessarily impossible. UNRWA attributes these conditions to the “ongoing siege, hurdles from Israeli authorities, political decisions to restrict the amounts of aid, lack of safety on aid routes and [the] targeting of local police.”  According to UNRWA, the road out of Kerem Shalom crossing has not been safe for months and aid supplies have been stolen by armed gangs on multiple occasions, including most recently on 30 November. UNRWA chief, Philippe Lazzarini, stressed that this difficult decision comes at a time when hunger is rapidly deepening, calling on the State of Israel as the occupying power to ensure that aid flows into Gaza safely and to refrain from attacks on humanitarian workers. 
• On 2 December, the Israeli military issued an evacuation order affecting about three square kilometres in northern Khan Younis governorate and parts of Deir al Balah, which were previously placed under evacuation on four occasions between December 2023 and August 2024. The area includes about two square kilometres for which an evacuation order had been rescinded in October 2024. The next morning, according to humanitarian partners, about 400 families or 2,000 people are estimated to have moved from largely destroyed buildings in this area to Al Mawasi, noting that the majority previously had tents in Al Mawasi and regularly moved between the two areas. The area to which they moved includes Al Qarara seaport, where high tides had displaced many families in recent days. Since October 2023, about 80 per cent of the Gaza Strip’s territory has been placed under evacuation orders that remain active, excluding orders that were subsequently rescinded. 
• The Cairo Ministerial Conference, titled "A Year Since the Humanitarian Catastrophe in Gaza: Urgent Needs, Lasting Solutions," was held on 2 December 2024 under the auspices of President Abdel Fattah El-Sisi of Egypt and UN Secretary-General António Guterres. Co-convened by Egypt's Ministry of Foreign Affairs, UNRWA and OCHA, the conference brought together foreign ministers and high-ranking representatives to discuss urgent humanitarian needs, early recovery, and long-term reconstruction efforts for Gaza. Deputy Secretary-General, Amina J. Mohammed presented the SG’s remarks at the conference, calling for compliance with international law, strong defense of the humanitarian aid system, especially UNRWA, and intensified efforts for a political solution to end the crisis.

Funding 

• As of 3 December, Member States have disbursed about US$2.37 billion out of the $3.42 billion (69 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, water, sanitation and hygiene (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.