People leaving Rafah on 7 May 2024 following an evacuation order by the Israeli authorities. Photo by WHO

Hostilities in the Gaza Strip and Israel | Flash Update #164

10 May 2024

The OCHA oPt Flash Update is published every Monday, Wednesday, and Friday, with a comprehensive update on the West Bank included every Wednesday. The next update will be issued on 13 May.

Key Highlights

Over 100,000 people already displaced from Rafah are facing dire shortages of shelter, food, water and sanitation services.
Unless fuel is immediately allowed into Gaza, five hospitals, five field hospitals, 28 ambulances, 23 medical points and 17 primary health care centres will only be able to sustain operations for less than 48 hours, warns the Health Cluster.
Eight WFP-supported bakeries in southern Gaza have already ceased operations and four will run out of fuel and supplies in three days.

Gaza Strip Updates

Israeli bombardment from the air, land, and sea continues to be reported across much of the Gaza Strip, resulting in further civilian casualties, displacement, and destruction of houses and other civilian infrastructure. Ground incursions and heavy fighting also continue to be reported south of Gaza city and in eastern Rafah, including the area of Kerem Shalom and Rafah crossings. Rafah Crossing remains closed since 7 May. On 8 May, OCHA, UNRWA, UN Mine Action Service, and the UN Department of Safety and Security carried out a security assessment at both crossings, which remain heavily militarized. “The closure of the crossings means no fuel. It means no trucks, no generators, no water, no electricity and no movement of people or goods. It means no aid…Civilians in Gaza are being starved and killed and we are prevented from helping them,” stated Under-Secretary-General for Humanitarian Affairs Martin Griffiths.
Between the afternoons of 8 and 9 May, according to the Ministry of Health (MoH) in Gaza, 60 Palestinians were killed and 110 injured. Between 7 October 2023 and 9 May 2024, at least 34,904Palestinians were killed in Gaza and 78,514 Palestinians were injured, according to MoH in Gaza. Casualty numbers covering the period until the afternoon of 10 May are not available as of the time of reporting.
The following are among the deadly incidents on 7 and 8 May:
- On 7 May, at about 15:35, two Palestinian boys were reportedly killed and 17 injured when a house was hit in southern Rafah.
- On 7 May, at about 23:00, seven Palestinians were reportedly killed and 14 injured when a house sheltering internally displaced persons (IDPs), in Az Zaytoun neighbourhood southeast of Gaza city, was hit.
- On 8 May, at about 20:25, five Palestinians were reportedly killed and 16 injured when a house was hit in Tall as Sultan area in western Rafah.
- On 8 May, at about 17:50, 13 Palestinians were reportedly killed and others injured when a dental clinic was hit in Shawa Square, east of Gaza city.
- On 8 May, at about 17:50, 11 Palestinians, including four children, were reportedly killed and others injured when the vicinity of Al Ibki Mosque in At Tuffah neighbourhood, east of Gaza city, was hit.
Between the afternoons of 8 May and 10 May, no Israeli soldiers were reported killed in Gaza. As of 10 May, 266 soldiers have been killed and 1,610 soldiers have been injured in Gaza or along the border in Israel since the beginning of the ground operation, according to the Israeli military. In addition, according to the Israeli media citing official Israeli sources, over 1,200 Israelis and foreign nationals, including 33 children, have been killed in Israel, the vast majority on 7 October. As of 10 May, it is estimated that that 132 Israelis and foreign nationals remain captive in Gaza, including fatalities whose bodies are withheld.
In a statement issued on 8 May, the Government Media Office (GMO) announced that a third mass grave had been discovered inside Al Shifa Hospital in Gaza city and that 49 bodies had already been recovered as exhumation efforts continued. The statement added that, with this latest discovery, the number of mass graves found inside Gaza’s hospitals had risen to seven - three at Al Shifa Hospital in Gaza, three at Nasser Medical Complex in Khan Younis, and one in Kamal Adwan Hospital in North Gaza - with 520 bodies recovered in total. On 7 May, responding to a media question on this subject in Geneva, OHCHR spokesperson Ravina Shamdasani indicated that “it is clear that mass graves exist” and reiterated the call for an independent investigation to establish the circumstances in which individuals were killed.
Since 6 May, UNRWA estimates that some 110,000* people have so far been displaced from Rafah and sought refuge in Khan Younis and Deir al Balah using vehicles, trucks, motorbikes and donkey carts. Reports further indicate that some IDPs have paid NIS1,500-2,000 in transportation fees. Amid a dire shortage of tents available on the market or in stocks of Shelter Cluster partners to support newly arriving IDPs, families have been carrying food items and personal belongings and setting up tents and makeshift shelters on the rubble of destroyed buildings and other places, including in southern Al Mawasi, or moving into empty UNRWA schools in Khan Younis. Multiple informal displacement sites have emerged, particularly south and west of Deir al Balah and west of An Nuseirat Refugee Camp. These areas lack infrastructure and basic services needed to support people’s access to food, water and health care. Fuel shortages continue to hinder the ability of aid actors to address priority needs of IDPs, including shelter, food, water, non-food and hygiene items, and sanitation facilities.
The closure of Rafah Crossing has abruptly halted all medical evacuations of critically ill and injured patients outside Gaza. In a statement issued on 9 May, the Government Media Office indicated that 159 critical patients, including cancer cases, were prevented from leaving Gaza to receive treatment abroad since 7 May. According to the Health Cluster, prior to the Rafah Crossing’s closure, only 58 per cent of patients for whom medical evacuations were requested had been approved by Israeli authorities (5,857 out of 10,175) and, out of all approved patients, 83 per cent could be evacuated outside Gaza (4,843). The World Health Organization (WHO) and its partners have also been forced to stop evacuations of patients from northern to southern Gaza due to dire shortages of fuel and increasingly shrinking bed capacity at health facilities in the south.
The Health Cluster warns that, unless fuel is immediately allowed into Gaza, five hospitals and five field hospitals across the Strip will only be able to sustain operations for less than 48 hours. Similarly affected are 28 ambulances, 17 primary health care centres, 23 medical facilities in Al Mawasi, and ten mobile clinics that provide immunizations, trauma care and nutrition services. Without fuel to run generators, there is a critical risk of losing patients in Intensive Care Units (ICU), including newborns in neonatal ICUs, trauma patients requiring emergency surgeries and pregnant women in need of caesarian sections (C-sections). Furthermore, patients suffering from kidney failure would be deprived of vital hemodialysis treatment. Following the evacuation of An Najjar hospital in eastern Rafah on 7 May, 1,500 patients with kidney failure who previously received treatment at the hospital’s hemodialysis department have been left with limited options that are also subject to fuel availability. At Nasser Medical Complex in Khan Younis, 25 dialysis machines have been installed and are serving 60 patients as of 9 May while additional hemodialysis capacity has been reportedly available at Al Aqsa Hospital in Deir al Balah. The lack of fuel would additionally disrupt the disinfection and sterilization of surgical equipment in hospitals and severely impact referral pathways for patients, the Health Cluster added. The immediate resumption of fuel supply into Gaza is an urgent priority to keep alive what remains of Gaza’s decimated health system, with life-saving health services hanging by a thread.
Following the evacuation of An Najjar Hospital, critical patients were transferred to the Rafah Indonesian Field Hospital and Al Kuwaiti Hospital has become the main hospital in Rafah able to provide emergency care, trauma stabilization and patient referrals, subject to fuel availability. With a 36-bed capacity and two Emergency Medical Teams (EMTs) deployed on site, Al Kuwaiti Hospital, alongside two out of four other field hospitals in Rafah, could also potentially provide maternal services to pregnant women should Al Emirati Maternity Hospital in Rafah become inaccessible or inoperable due to the Israeli ground incursion, according to the Health Cluster. In April, UNFPA stationed a 40-foot mobile maternity unit at Al Mawasi Field Hospital operated by the International Medical Corps (IMC); the unit has laboratory equipment and two tents equipped with supplies for both normal deliveries and the management of obstetric complications, including surgical capacity for C-sections and blood transfusions. Two additional mobile maternity units supplied by UNFPA remain stuck at the border, according to WHO. In Deir al Balah, both Al Awda Hospital and the new IMC field hospital are providing maternity services, while in Khan Younis, the recently restored Nasser Medical Complex includes an operational maternity and neonatal ward, added WHO. On 8 May, Médecins Sans Frontières reported that it was suspending its activities at Al-Shaboura Clinic, an important health post where over 8,200 consultations had been provided in April alone, and was handing over its activities at Al Emirati Hospital to the Ministry of Health, relocating its staff to Nasser Medical Complex to “continue to support maternity services in a safer area.”
In Khan Younis, the European Gaza Hospital remained accessible as of 9 May and, with support from two embedded EMTs, continued to provide CT scans, neurosurgery and to operate an ICU and burn unit. Overall, 19 EMTs coordinated by WHO continue to operate in five hospitals and seven field hospitals across Gaza, but EMT personnel rotations have not been possible since 7 May due to the closure of Rafah Crossing, lack of fuel and movement challenges. The entry of all medical supplies has similarly stopped since 7 May. In late April, WHO secured a new large warehouse in Deir al Balah and relocated there a sizable volume of medical supplies from its warehouses in Rafah, anticipating that they could become unreachable in the case of an Israeli ground incursion. However, unless the entry of medical supplies via crossings resumes, the Health Cluster assesses that existing stocks will last for approximately three weeks, depending on the number of casualties that the health system will have to absorb in the coming days.
The stocks of critical aid supplies, including food and fuel, continue to rapidly dwindle for the fourth consecutive day due to the closure of Rafah Crossing and the lack of safe and logistically viable access to Kerem Shalom Crossing. The World Food Programme (WFP) stressed that current supplies of food and fuel will only last a few days, as the agency’s main warehouse in eastern Rafah has become inaccessible. Without them, WFP warned, “operations will go to a standstill,” undermining recent improvements and the sustainability of humanitarian services. In addition, on 7 May 2024, a security incident occurred at the Logistics Cluster common storage facility in eastern Rafah due to active hostilities, likely resulting in damage or loss of aid commodities in common storage. The warehouse remains inaccessible and will be assessed once security conditions allow. As of 10 May, eight out of 12 bakeries supported by humanitarian partners in southern Gaza have already ceased operations and the remaining four in Deir al Balah and Rafah are currently operating at a reduced capacity and will run out of fuel and supplies in three days. In northern Gaza, the four operational bakeries have one week of supplies available for bread production.
Despite rising humanitarian needs, access constraints continue to significantly hinder the ability of humanitarian actors to reach people in need, particularly in northern Gaza. Between 1 and 9 May, nine out of 32 humanitarian aid missions (28 percent) to northern Gaza were facilitated by Israeli authorities, 5 (16 percent) were denied, 11 (34 percent) were impeded, and 7 (22 percent) were cancelled due to logistical constraints. Moreover, 25 out of 46 aid missions (54 percent) to areas in southern Gaza that require coordination were facilitated by the Israeli authorities, 9 (20 percent) were denied, 3 (6 percent) were impeded, and 9 (20 percent) were cancelled due to logistical constraints.

Funding

As of 10 May, Member States have disbursed about US$744 million out of $3.4 billion (22 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. This includes about $623 million out of $600 million (104 per cent) requested for January-March 2024 and $121 million out of $2.8 billion (4 percent) for the new Flash Appeal launched on 17 April to cover the period between April and December 2024. For funding analysis, please see the Flash Appeal Financial Tracking dashboard.
The oPt HF has 118 ongoing projects, for a total of $72.5 million, addressing urgent needs in the Gaza Strip (85 per cent) and West Bank (15 per cent). In light of the updated Flash Appeal, the HF has allocated an additional $22 million to bolster prioritized HF-funded projects in Gaza. Since 7 October, the oPt HF has mobilized $90 million from Member States and private donors, designated for programmes throughout Gaza. A summary of the oPt HF activities and challenges in April 2024 is available through this link and the 2023 Annual report of the oPt HF can be accessed here. Private donations are collected directly through the Humanitarian Fund.

For the Gaza Humanitarian Response Update for the period between 29 April and 5 May, please visit: Gaza Humanitarian Response Update | 29 April–5 May 2024. It is updated throughout the week to reflect new content.