Humanitarian Situation Update #249 | 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 26 December.

Key Highlights

• North Gaza remains under a near-total siege. Since 1 December, Israeli authorities have denied 48 of 52 UN attempts to coordinate humanitarian access, while four approved movements all faced impediments.
• Attacks near or on Al Awda and Kamal Adwan hospitals in North Gaza have continued to be reported, amid an urgent need for food and water provision.
• Some 1.7 million people in central and southern Gaza face shortages of flour and other supplies, exorbitant costs, and scant opportunities to resume even small-scale farming.
• Only three ventilators for infants who need intensive care remain available in Gaza city, warns UNICEF, while doctors tell UNRWA that premature babies and patients with treatable illnesses are dying amid depleted medical supplies and lack of life-saving equipment.

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 more than 11 weeks (see data below). Rocket fire by Palestinian armed groups towards Israel was reported.
• On his first visit to the Middle East as Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Tom Fletcher highlighted the humanitarian needs throughout the Gaza Strip and the challenges facing humanitarian workers who are committed to stay and deliver against mounting odds: “[I]t has become almost impossible to deliver even a fraction of the aid that is so urgently required,” he said in a statement. “The Israeli authorities continue to deny us meaningful access – over 100 requests to access North Gaza denied since 6 October. We are also now seeing the breakdown of law and order and the systematic armed looting of our supplies by local gangs.”
• Between the afternoons of 17 and 24 December, according to the Ministry of Health (MoH) in Gaza, 279 Palestinians were killed and 723 were injured. Between 7 October 2023 and 24 December 2024, at least 45,338 Palestinians were killed and 107,764 were injured, according to MoH in Gaza.
• Between the afternoons of 17 and 24 December, three Israeli soldiers were killed in Gaza, according to the Israeli military. Between 7 October 2023 and 24 December 2024, according to the Israeli military and official Israeli sources cited in the media, more than 1,589 Israelis and foreign nationals were killed, the majority on 7 October 2023 and its immediate aftermath. The figure includes 389 soldiers killed in Gaza or along the border in Israel since the beginning of the ground operation. In addition, 2,494 Israeli soldiers were reported injured since the beginning of the ground operation. As of 24 December, it is estimated that 100 Israelis and foreign nationals remain captive in Gaza, including hostages who have been declared dead and whose bodies are withheld in Gaza.
• Following are accounts of some of the deadliest incidents reported between 17 and 23 December:
  • On 17 December, at approximately 0:15, ten Palestinians, including children and women, were reportedly killed and others injured when a house sheltering internally displaced persons (IDPs), was hit in Ad Daraj neighbourhood in central Gaza city.
  • On 17 December, at about 19:00, eight Palestinians were reportedly killed and others injured when a house sheltering IDPs was hit in front of the western gate of Kamal Adwan Hospital in Beit Lahiya, in North Gaza.
  • On 18 December, at approximately 20:00, eight Palestinians including three children were reportedly killed and others injured when a house was hit in Jabalya Al Balad, in North Gaza.
  • On 19 December, at about 15:00, 13 Palestinians, including women and children, were reportedly killed and at least 30 others were injured when a school, designated as an IDP shelter, was hit in At Tuffah neighbourhood, in Gaza city.
  • On 19 December, at approximately 12:30, ten Palestinians were reportedly killed and others, including children, injured when a group of people was hit in Ash Shati’ (Beach) Refugee Camp in Gaza city.
  • On 20 December, at about 16:00, eight Palestinians from a single family, including four children and one woman, were reportedly killed and others injured when two floors of a building were hit in An Nuseirat refugee camp, in Deir al Balah.
  • On 20 December, at approximately 18:00, ten Palestinians, including seven children and one woman, were reportedly killed and others injured when a house was hit in Jabalya An Nazlah in North Gaza.
  • On 21 December, at about 22:10, 12 Palestinians, were reportedly killed and others injured when a house was hit in eastern Deir al Balah.
  • On 23 December, over 50 people were reportedly killed and others injured, and 20 housing units were reportedly destroyed, when Israeli forces raided the new camp in An Nuseirat refugee camp in Deir al Balah, in an operation that involved the use of an aircraft, according to the Government Media Office (GMO).
• Between 18 and 23 December, the Israeli military issued two evacuation orders for areas of Deir al Balah and Gaza city. In both cases, several evacuation orders had already been issued for the designated areas. The first order covered approximately 1.2 square kilometres in Al Bureij and Al Bureij refugee camp in Deir al Balah, where approximately 23,100 people were staying, including some 10,300 people sheltering at three IDP sites. While limited displacement was subsequently observed, the order has led to the suspension of services at five medical points and two water trucking points. The second order covered approximately 1 square kilometre in Ash Shuja'iyyeh and Al Turkman neighbourhoods of Gaza city, affecting locations where at least 5,000 households were staying. About 250-500 families from these areas subsequently moved westwards, particularly toward At Tuffah, Ad Daraj, and central Gaza city. Some 80.5 per cent of the Gaza Strip’s territory is under active evacuation orders, excluding orders that were rescinded. On 22 December, approximately 350 people were reportedly displaced after the Israeli military dropped leaflets ordering people in Beit Hanoun to move southward. Most of the displaced were reportedly women and children, as men were said to be separated from their families at an Israeli checkpoint.
• The situation at Kamal Adwan, Indonesian and Al Awda hospitals in North Gaza has drastically deteriorated since 21 December, reports the Health Cluster. On 24 December, the Israeli military reportedly entered the Indonesian Hospital, ordering patients, caregivers and staff to evacuate to Gaza city. As of the morning hours, all patients and their companions have fled, with only a doctor and an engineer remaining, according to the Health Cluster. Also on 24 December, military tanks reportedly attacked the third floor of the eastern wing of the Al Awda Hospital, causing panic among the 31 patients, their companions and the 65 medical and administrative personnel inside. In previous days, Al Awda had already sustained significant damage due to multiple airstrikes on its vicinity. Attacks near or on Kamal Adwan have also continued, as reported by the Health Cluster and the hospital’s Director, with bullets penetrating the Intensive Care Unit, where they ignited a fire, as well as the maternity ward, and the specialized surgery department, forcing staff to relocate patients to the corridors. On the evening of 22 December, the hospital’s Director reported that Kamal Adwan had been ordered to evacuate, just hours after a mission led by the World Health Organization (WHO) had managed to reach the hospital, amid explosions around the facility, delivering 5,000 litres of fuel and 100 blood units and transferring eight critical patients and their 13 companions to Al Shifa Hospital in Gaza city. “Reports of bombardment near Kamal Adwan Hospital and an order to evacuate the hospital are deeply worrisome,” stressed the WHO Director-General, Tedros Adhanom Ghebreyesus, appealing for an immediate ceasefire near the facility and the protection of patients and health workers. According to information available to the Health Cluster as of the morning of 24 December, about 400 IDPs and 91 patients, including children and the elderly, remain at Kamal Adwan, amid an urgent need to supply food and water. Reporting further attacks in close proximity to the hospital on 23 and 24 December, which injured 20 people in the facility, including five medical staff, the Director reiterated his appeal for the urgent establishment of a safe corridor to allow necessary supplies and aid to enter. Overall, since mid-October, WHO has attempted to conduct 18 missions to the Kamal Adwan Hospital, eight of which were denied and 10 proceeded with impediments.
• Food security continues to deteriorate in central and southern Gaza. A new assessment conducted by the Food Security Cluster (FSS) in the first half of December shows that, for the third consecutive month, bread and pulses continue to dominate households’ diets, while fruits, vegetables, meat and dairy products remain nearly absent, with 90 per cent of families experiencing a further reduction in access to food compared with November. Persistent looting targeting trucks with supplies collected from Kerem Shalom crossing continue to severely jeopardize the ability of FSS partners to deliver sufficient aid, forcing them to reduce monthly food rations - now barely sufficing for ten days - and adjust the content of cooked meals to reach more people. As of mid-December, 420,000 cooked meals were distributed by FSS partners daily across central and southern Gaza, but with an estimated 1.7 million people currently staying in these areas, the coverage remains insufficient. All eight bakeries supported by the World Food Programme (WFP) in Deir al Balah and Khan Younis remain closed due to flour shortages and concerns related to overcrowding, and the five in Rafah have been closed since May due to ongoing hostilities. While partners continue to prioritize household-level flour distribution in the three southernmost governorates, only 600,000 people (35 per cent of the total) could be assisted thus far in December due to limited supplies, while hundreds of tons of food supplies are now stranded outside Gaza facing spoilage and approaching expiration dates. To help safeguard surviving livestock and support the production of fresh, nutritious food, such as meat and dairy, FSS partners distributed about 120 metric tonnes of animal feed to 2,500 households in southern and central Gaza so far in December. Resuming agricultural production, even on a small scale, remains extremely difficult since large swaths of farmland have been damaged or potentially contaminated by unexploded ordnance and recent attempts by partners to bring in seed kits, tubers, fertilizers and nylon panels for greenhouses have been reportedly denied by the Israeli authorities.
• Most people cannot afford the prohibitive costs of the few food commodities available on the local market. For example, the price of a 25-kilogramme bag of wheat flour ranges between US$160 to $190, while Christian Aid reports that a kilogramme of sugar costs up to $135 and a single frozen chicken, which has to be cooked on the same day it is bought due to lack of refrigeration, is sold for up to $41, 10 times its price before October 2023. A post-distribution monitoring survey conducted by the UN Children’s Fund (UNICEF) between 20 and 26 November among recipients of humanitarian cash assistance reveals that about 80 per cent of the households surveyed across the Gaza Strip had at least one child going without food in the three days prior to the survey. Overall, more than 96 per cent of all children aged six to 23 months and pregnant and breastfeeding women are not meeting their basic nutrient requirements, with a sharp deterioration in dietary diversity observed over the past four months, particularly in Deir al Balah and Khan Younis. The worsening energy crisis continues to further exacerbate the situation; cooking gas remains completely unavailable in northern Gaza and is sold in limited quantities and at exorbitant prices in central and southern Gaza. The scarcity and high prices of firewood are also threatening the continued operation of kitchens and forcing more families to rely on burning waste to cook. On 20 December, UNICEF warned that many of Gaza’s children, “cold, sick and traumatized” amid utter deprivation and suffering, “are searching through rubble for scraps of plastic to burn.”
• Amid hostilities and displacement, UNFPA estimates that 42,000 pregnant women will be exposed to acute cold and hunger during this winter season. More than half of all pregnant women are already suffering from anaemia, with miscarriages on the rise, and pre-term births and low birthweights now accounting for approximately 10 per cent of all deliveries across the Strip, up from five per cent before October 2023. UNRWA reported that doctors have informed them that premature babies are dying daily in hospitals, due to the lack of ventilators, special milk formula and other essential equipment and supplies. In Gaza city, where newly displaced people have been arriving from the North Gaza governorate since early October, only three ventilators remain available in the Paediatric Intensive Care Unit of the Patients Friends Association Hospital – shared between paediatric and neonatal patients, according to UNICEF. As of 16 December, one of these ventilators was occupied by a ten-year-old child immobilized by quadriplegia, after a shrapnel fragment shattered his spine during bombardment. UNICEF has reported newborns gasping for air, toddlers with sepsis, and children ripped apart by shrapnel or crushed by debris arriving daily at the facility. Those in respiratory distress face death at any moment because there are no ventilators available.
• On 19 December, Médecins Sans Frontières (MSF) reported that ensuring the entry of critical medications and equipment into Gaza remains difficult, with Israel imposing strict restrictions on items deemed as having “dual use” – goods considered usable for either civilian or military purposes – ranging from generators, scalpels and scissors, to autoclaves and oxygen concentrators. For each of these items, “humanitarian organizations must navigate painstaking formalities, … providing a photo, technical sheet, intended use, and the GPS location where the item will be used,” MSF said. Even when authorization is granted, items can still be blocked, explains the NGO, noting that five of its autoclaves essential to sterilize medical instruments remain stalled in Egypt. Moreover, if pallets are too damaged due to prior searches when they reach Kerem Shalom, or if a single item is rejected at the crossing, the Israeli authorities may reject the entire shipment, sending it back to Al Arish in Egypt for instance, which requires humanitarian actors to re-start the process and severely delays the delivery of critical supplies. MSF had to wait five months to receive approval for refrigerators and freezers necessary to store medical items and is yet to receive authorization to import materials for desalination units and generators. Even when supplies finally enter Gaza they risk being looted, and transporting them through heavily congested areas is difficult, “especially in Khan Younis and Rafah, where trucks can take up to four hours to travel one kilometre,” added MSF.
• The International Medical Corps (IMC) highlighted that, on 22 December, 22 trucks carrying medical and hygiene supplies as part of a 70-truck convoy were looted while en route from the Kerem Shalom crossing to a UN warehouse in Khan Younis, with IMC loosing 111 out of 150 pallets of supplies meant for its two Field Hospitals in central Gaza. Commenting on the impact of the lack of medical supplies, machineries and Infection Prevention and Control equipment, UNRWA noted that, beyond dealing with a constant influx of severely injured patients, overwhelmed doctors at still partially functioning hospitals as the Nasser Medical Complex are now seeing “people dying from treatable illnesses.” UNRWA’s health facilities are contending with a complete lack of cancer treatment, dire shortages of insulin supplies, with insulin syringes already exhausted and new stocks presently awaiting in Egypt, and severe gaps in laboratory reagents and equipment; overall, if not replenished, at least 60 items are likely to run out within a month, stressed the Agency.
• The risk of death, injury and contracting a disease in Gaza remains high. Doctors at the Nasser Medical Complex in Khan Younis report that they have seen an increase in the ratio of people killed to injured when strikes happen, as most people are now sheltering in makeshift tents without buildings or structures to protect them and children are being injured by shrapnel over a kilometre away from the strikes, “because they have nothing but pieces of fabric around them.” At the same time, infectious diseases continue to spread due to overcrowding and dire hygiene conditions, with over 500 cases of chickenpox reported at a single site hosting 8,000 IDPs in Deir al Balah in recent weeks. While chickenpox is usually not dangerous for children, it can be life-threatening for adults, stresses UNICEF.
• The mental health conditions in Gaza have deteriorated significantly due to continuous bombardment, forced evacuations, overcrowded shelters, malnutrition, limited health services and widespread disease. A recent survey conducted by Gaza Community Mental Health Programme (GCMHP) found that displaced families in Gaza are in severe psychological distress. In 2024, the NGO’s psychological first aid (PFA) teams reached 24,034 people in Deir Al Balah and Khan Younis and referred 1,922 people with severe symptoms to specialized mental health services. According to the NGO, the data suggests that, on average, eight per cent of the people in central and southern Gaza require advanced mental health care, while this percentage is likely higher in the Gaza and North Gaza governorates due to worse living conditions. The NGO stresses that this is likely an under-representation as trauma symptoms typically become more apparent after a crisis is over. Severe psychological symptoms were found to be more common among women and girls, possibly due to their heightened vulnerability during displacement, having to shoulder more responsibility in evacuating children and the elderly, lack of privacy, and the type of trauma they experience, such as sexual and gender-based violence.
• Between 1 and 23 December, out of 461 planned aid movements across the Gaza Strip requiring coordination with Israeli authorities, 34 per cent (159) were facilitated, 40 per cent (183) were denied, 16 per cent (75) were initially approved but then faced impediments, and ten per cent (44) were cancelled by the organizers due to logistical and security challenges. Depending on the case, movements facing impediments were accomplished partially or not at all. Of the coordinated movements, 117 needed to cross from southern Gaza through the Israeli military-controlled checkpoints on Al Rashid or Salah Ad Din roads to areas north of Wadi Gaza (including both North Gaza and Gaza governorates); of these, only 26 per cent (31) were facilitated, 36 per cent (42) were denied, 24 per cent (28) were initially approved but faced impediments, and 14 per cent (16) 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 23 December, the UN attempted to reach besieged areas 52 times, with 48 of these attempts denied and only four missions allowed to proceed but facing impediments, as follows:
  • A mission to the Kamal Adwan Hospital on 1 December, which deployed an international Emergency Medical Team (that has since been forced to evacuate) and evacuated patients to Gaza city, faced long delays by the Israeli authorities. A second mission to Kamal Adwan on 22 December delivered fuel and blood units to the facility but Israeli forces detained one of the patients set to be taken to Gaza city and closed the checkpoint leading to the south, forcing the convoy to stay overnight north of Wadi Gaza.
  • On 11 December, the Israeli authorities allowed a UN team led by the Deputy Humanitarian Coordinator to visit two health facilities in North Gaza, but prevented it from reaching areas of Jabaliya and Beit Lahiya where communities remain.
  • On 20 December, an aid convoy comprising seven trucks of wheat flour and food parcels and two trucks of bottled water reached the besieged area of Beit Hanoun, distributing supplies to an estimated 800 people, but access to one planned location was denied by the Israeli authorities.
• Coordinated aid missions to areas in Rafah governorate, where there has been an ongoing Israeli military operation since early May, have faced similar challenges. Twenty-seven coordinated requests submitted to the Israeli authorities to access Rafah governorate between 1 and 23 December were denied, and one request was approved but faced impediments. This excludes 56 coordinated movements to Kerem Shalom crossing, of which 70 per cent (39) were facilitated, 18 per cent (10) were approved but faced impediments, four per cent (2) were denied, and nine per cent (5) were cancelled.

Funding

• As of 24 December, Member States have disbursed approximately $2.53 billion out of the $3.42 billion (74 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 approximately 2.1 million people remain in the Gaza Strip, and this updated number is now used for programmatic purposes.)on 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.)
• On 11 December 2024, the UN and humanitarian partners launched a Flash Appeal for nearly $4.07 billion to address the humanitarian needs of three million out of 3.3 million people identified as requiring assistance in Gaza and the West Bank, including East Jerusalem, in 2025. Nearly 90 per cent of those funds are for the humanitarian response in Gaza, with just over 10 per cent for the West Bank. The $4.07 billion ask is much less than what is actually needed to mount a full-scale humanitarian response, which would require $6.6 billion. However, the Flash Appeal reflects the expectation that aid organizations will continue to face unacceptable constraints on their operations in 2025. This will severely limit the amount of assistance that humanitarians are able to provide, which in turn will only increase the suffering that Palestinians are enduring. The appeal stresses that, to be able to implement the full scale of what is urgently needed, Israel must take immediate and effective measures to ensure the essential needs of civilians are met. This includes lifting all impediments to aid and fully facilitating humanitarian operations, including the distribution of essential goods to Palestinians in need.
• During November, the oPt Humanitarian Fund (oPt HF) managed 124 ongoing projects, totalling $91.7 million. These projects aimed to address urgent needs in the Gaza Strip (89 per cent) and the West Bank (11 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, 70 are being implemented by international non-governmental organizations (INGOs), 40 by national NGOs and 14 by UN agencies. Notably, 50 out of the 84 projects conducted by INGOs or the UN are being implemented in collaboration with national NGOs. 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.