Hostilities in the Gaza Strip and Israel | Flash Update #123

Key points

• Intense Israeli bombardment from air, land and sea continues to be reported across much of the Gaza Strip, resulting in further civilian casualties, displacement, and destruction of civilian infrastructure. Ground operations and heavy fighting between Israeli forces and Palestinian armed groups also continue to be reported, particularly south of Gaza city and Al Mawasi area northwest of Khan Younis, where tens of thousands of internally displaced persons (IDPs) are currently located.
• Between the afternoons of 20 and 21 February, according to the Ministry of Health (MoH) in Gaza, 118 Palestinians were killed, and 163 Palestinians were injured. Between 7 October 2023 and noon on 21 February 2024, at least 29,313 Palestinians were killed in Gaza and 69,333 Palestinians were injured, according to MoH in Gaza. There are no figures available for the number of detainees from the Gaza Strip held by the Israeli military.
• Between the afternoons of 20 and 21 February, one Israeli soldier was reported killed in Gaza. As of 21 February, 235 soldiers have been killed and 1,395 soldiers injured in Gaza since the beginning of the ground operation, according to the Israeli military. In addition, over 1,200 Israelis and foreign nationals have been killed in Israel, according to the Israeli authorities, the vast majority on 7 October. As of 21 February, the Israeli authorities estimate that some 134 Israelis and foreign nationals remain captive in Gaza and include fatalities whose bodies are being withheld.
• Catastrophic levels of acute food insecurity are reportedly intensifying across Gaza, with growing reports of families struggling to feed their children and a rising risk of hunger-induced deaths in northern Gaza. The Global Nutrition Cluster is reporting a steep rise in malnutrition among children and pregnant and breastfeeding women in the Gaza Strip. The situation is especially serious in northern Gaza where 1 in 6 children under the age of two (15.6 per cent) who were screened at IDP shelters and health centres in January were found to be  acutely malnourished, a decline in a population’s nutritional status that is unprecedented globally in three months. In comparison, 5 per cent of children under the age of two in Rafah  were found to be acutely malnourished, evidence that access to humanitarian aid can help prevent the worst outcomes. In addition, 70 per cent of screened children had diarrhea in the preceding two weeks, a 23-fold increase compared with the 2022 baseline. “Hunger and disease are a deadly combination,” warned Dr Mike Ryan, Executive Director of the World  Health Organization’s (WHO) Health Emergencies Programme. “Hungry, weakened and deeply traumatised children are more likely to get sick, and children who are sick, especially with diarrhea, cannot absorb nutrients well. It’s dangerous, and tragic, and happening before our eyes.” Earlier this month, Anera highlighted the “silent crisis” of hunger-induced deaths: “In the tragic circumstances of starvation in Gaza, there’s a compounding issue: many who perish from starvation-related symptoms aren’t accurately documented. Their deaths often get attributed to other physical causes, masking the true toll of starvation.”
• A public health catastrophe is unfolding in the Gaza Strip despite repeated warnings, and this requires urgent action, warned the water, sanitation and hygiene (WASH) and health clusters in the occupied Palestinian territory on 20 February. According to the same sources, the only currently operating water pipeline from Israel is operational at 47 per cent of its full capacity, the water desalination plant in northern Gaza ceased operations in October 2023, all wastewater treatment plants are no longer functional, and 83 per cent of groundwater wells are not operating. The dire water and sanitation conditions are also aggravating the state of health in Gaza, with more than 300,000 reported cases of acute respiratory infections and more than 200,000 reported cases of acute watery diarrhoea, of whom more than half are children under five, among other outbreaks. Accordingly, the WASH and health clusters emphasize that effective early detection of infectious diseases and prevention of avoidable deaths require inter alia a major scale-up in capacities, the removal of impediments to the entry and distribution of aid including fuel, as well as the free and safe movement of medical and humanitarian personnel into and within the Gaza Strip.
• Humanitarian operations continue to face immense challenges, with aid workers themselves killed. On 21 February, Medecins sans Frontieres (MSF) reported that a shelter hosting MSF staff and their families in Al Mawasi area west of Khan Younis was shelled. As a result, at least two family members of MSF staff were killed* and six others were injured, including two children with burns, all evacuated by Palestine Red Crescent Society (PRCS) medical teams to the International Medical Corps field hospital in Rafah, in coordination with OCHA. Since 7 October, 160 UN staff have been killed in Gaza.
• Intense hostilities, limitations on the entry and delivery of aid, and growing insecurity continue to gravely hamper the provision of lifesaving services across Gaza. On 20 February, PRCS reported that Al Amal hospital in Khan Younis continues to be directly impacted by artillery shelling that led to major damage to its facilities and to casualties. The hospital already faces a lack of fuel reserves to generate electricity for high-risk patients and a near exhaustion of food supplies. On 20 February, PRCS ambulances evacuated 21 injured people from Nasser Hospital, also in Khan Younis, to two field Hospitals in Rafah, in collaboration with WHO and OCHA. The previous two days, the same partners had evacuated 32 patients in critical condition from Nasser Hospital to three other hospitals in Gaza following the siege and raid on the hospital complex by the Israeli military. According to MoH in Gaza, some 110 sick and injured patients, and an estimated 15 doctors and nurses, still remain in the hospital, which has no electricity or running water, has sewage water flooding some departments, medical waste accumulating, and the decomposing bodies of eight ICU patients who died for lack of oxygen. As of 21 February, there are 12 partially functional hospitals in the Gaza Strip, including six in northern Gaza and six in the south, in addition to three partly functional field hospitals, according to WHO. As of 18 February, according to UNRWA, only seven out of its 23 health centres are now operational.
• On 20 February, the UN World Food Programme (WFP) announced that it is pausing deliveries of food aid to northern Gaza, largely due to a breakdown in civil order combined with the absence of a functioning humanitarian notification system. On 21 February, WFP Chief Cindy McCain stated: “We’ve had to make the impossible choice to pause aid distributions in Northern Gaza. There’s an incredible level of desperation against the backdrop of immense humanitarian need. A famine doesn’t have to happen. But if things don’t change, it will.” Between 1 January and 15 February, less than 20 per cent of missions (15 out of 77) planned by humanitarian partners to deliver aid and undertake assessments in areas to the north of Wadi Gaza were facilitated by the Israeli authorities fully or partially and 51 per cent were denied (39 out of 77). Facilitated missions primarily involved food distribution, while the access of missions to support hospitals and facilities providing water, hygiene and sanitation (WASH) services was among those overwhelmingly denied.
• The following are among the deadliest incidents reported on 19 February:
  • On 19 February, at about 13:00, five Palestinians were reportedly killed and others injured when a group of people was struck in western Khan Younis.
  • On 19 February, at about 20:00, six Palestinians were killed and others injured when a house in Az Zaytoun neighborhood, in eastern Gaza city, was struck.
  • On 19 February, at about 20:30, four Palestinians were killed and others injured when a residential square in western An Nuseirat, in Deir al Balah, was hit. Other bodies reportedly remain under the rubble.

West Bank Updates

• On 20 February, an Israeli forces undercover unit shot and killed a Palestinian man after besieging a house in Jenin Refugee Camp; another Palestinian was injured. The unit was followed by Israeli forces and bulldozers. Clashes erupted between Palestinian armed groups and Israeli forces, with reports on an exchange of fire when the unit was discovered by Palestinians. Initial information indicates that multiple sections of roads in the camp were bulldozed, causing severe damage to infrastructure, and at least two houses sustained severe damage when they were hit by Israeli drones. The operation ended in the early morning hours of the next day.
• Since 7 October 2023 and as of 20 February, 394 Palestinians have been killed, including 100 children, and 4,528 Palestinians, including 702 children, have been injured in conflict-related incidents across the West Bank, including East Jerusalem, and Israel. During the same period, 12 Israelis, including four members of Israeli forces, were killed and 80 injured in conflict-related incidents in the West Bank, including East Jerusalem, and Israel.
• Since 7 October 2023 and as of 20 February, OCHA has recorded 573 Israeli settler attacks against Palestinians that resulted in Palestinian casualties (51 incidents), damage to Palestinian-owned property (459 incidents), or both casualties and damage to property (63 incidents).
• Demolition of five homes due to the lack of Israeli-issued permits on 19 and 20 February, resulted in displacement to 25 Palestinians, including eight children, in Al Walaja village (Bethlehem) and Ras al Amud area in East Jerusalem. Two of the houses were demolished by their owners to avoid paying fines imposed by the Israeli authorities. Since 7 October 2023 and as of 20 February, 551 people, including 264 children, have been displaced in Area C, and East Jerusalem, after their homes were demolished due to the lack of Israeli-issued building permits, which are almost impossible to obtain.
• Since 7 October 2023, 830 Palestinians, including 337 children, have been displaced, following the destruction of 131 homes during operations carried out by Israeli forces across the West Bank. About 95 per cent of the displacement was reported in the refugee camps of Jenin, Nur Shams and Tulkarm.

Funding

• The Flash Appeal for the occupied Palestinian territory (oPt), which requests US$1.2 billion to meet critical needs of 2.7 million people across the oPt (2.2 million in the Gaza Strip and 500,000 in the West Bank, including East Jerusalem), was extended through the end of March 2024. As of 19 February, member states disbursed nearly $901 million against the updated Flash Appeal (73 per cent); this includes $612 million out of $629 million (97 per cent) requested for October-December 2023 and $289 million out of $600 million (48 per cent) requested for January-March 2024. For funding analysis, please see the Flash Appeal Financial Tracking dashboard.
• The occupied Palestinian territory Humanitarian Fund (oPt HF) and the Central Emergency Relief Fund (CERF) are currently funding more than 94 ongoing projects in the Gaza Strip to meet urgent humanitarian needs, notwithstanding constraints on the entry and delivery of aid into and within the Gaza Strip. These interventions, totalling about $88 million, address needs in the areas of food security, shelter, water, sanitation and hygiene (WASH), health and protection. Since October 7, the oPt HF has received a total of $88 million in contributions from member states and private donors. Private donations are collected directly through the Humanitarian Fund.

HUMANITARIAN NEEDS AND RESPONSE UPDATES | 13–19 February

Health

Needs

• There is a growing need for: primary health services in informal shelters; increasing routine immunization coverage and conducting catch-up campaigns; reducing overcrowding in maternity hospitals; anaesthetic and analgesic medications which are in short supply;
• There is an urgent need for medication for non-communicable diseases and psychotropics; laboratory equipment and reagents to support diagnostics; and blood and blood products to ensure patients receive timely and necessary transfusions.
• The continued siege on some hospitals is greatly affecting case management capacity of hospitals leading to overcrowding of the ones that are still accessible.
• There is a need to strengthen referral mechanisms between hospitals.

Response

• On average, partners are reaching about 450,000 people in need of various health services per week.
• Ongoing disease surveillance at all health facilities to ensure early diagnosis and treatment of cases as well as early detection of any potential outbreak.
• Plans to open stabilization centres for acute malnutrition cases with medical complications are underway.
• On average, partners provided nearly 300,000 primary health care consultations per week.

Challenges and Gaps

• Increased insecurity in Rafah is greatly affecting response activities. The influx of IDPs migrating to Rafah has overwhelmed available bed capacities at hospitals.
• High insecurity and limited access to health facilities in the northern and middle governorates continue to present major challenges to partners’ response activities.
• Persistent siege of hospitals impedes access and the implementation of response activities.
• The waiting list for patient referrals outside of Gaza continues to grow.
• Partner operations continue to be negatively affected by the displacement of staff, social stresses and telecommunication challenges.
• Limited access to proper WASH facilities is hindering prevention.

Nutrition

Needs

• Ongoing collaboration with partners is still needed to enhance capacity in Mid-Upper Arm Circumference (MUAC) screening, identify cases of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM), and the delivery of effective treatment.
• The Gaza nutrition vulnerability situation analysis results have been published on the Global Nutrition Cluster (GNC) website and shared across GNC's social media platforms. This assessment was carried out by the NIS-E Task Force under the leadership of GNC and co-chaired by WFP and UNICEF. The findings show:
  • Over 90 per cent of children aged 6-23 months and pregnant and breastfeeding women (PBWs) face severe food poverty (consuming two or fewer food groups each day).
  • Some 90 per cent of children under 5 are affected by one or more infectious diseases.
  • Some 81 per cent of households lack safe and clean water with average household access estimated at less than one litre per person per day.
  • One in six (15 per cent) children aged 6-23 in north Gaza are acutely malnourished.
  • In Rafah, five per cent of children aged 6-23 are acutely malnourished; this lower rate is mainly due to the limited humanitarian assistance provided, demonstrating that humanitarian assistance can mitigate the worst outcomes.

Response

• Thirty-six staff members (17 Female, 19 male) received training on MUAC screening to enhance early case identification and treatment. The training is crucial for enhancing the capacity of our partners and expanding MUAC screening across affected areas.
• Five implementing partners continue conducting screenings for malnutrition among children aged 6 to 59 months, using MUAC measurements in shelters and health facilities. Children who are detected with MAM and SAM are referred for treatment using simplified treatment protocol. Cumulative MUAC assessment data are as follows:
  • Total Children Screened (Cumulative): 7,479
  • Average number of children Screened per week: 1,247
  • Total SAM children identified: 83
  • Total MAM Children Identified: 378

Challenges and Gaps

• Ongoing hostilities in Gaza have caused significant food shortages, poor access to clean water and sanitation facilities, and disruptions to healthcare services. This situation is putting children under five and pregnant or lactating women (PLW) at a relatively higher risk of malnutrition.
• Without private areas for breastfeeding women, it is challenging to encourage and sustain breastfeeding practices. This lack of privacy could have lasting negative effects, particularly on children under two years of age and new-born babies.

Food Security

Needs

• The humanitarian situation in North Gaza and Gaza governorates is extremely critical. The food security situation in Deir al Balah and the southern governorates is particularly acute, with the majority of the population in extreme hunger. In Rafah, the situation is becoming increasingly concerning. People in Rafah are reported to be stopping aid trucks to take food, highlighting the severity of their desperation and hunger.
• There is an urgent need to augment the fleet of delivery trucks to ensure the entire population's nutritional requirements are met and to improve healthcare services, including primary health services, routine immunization coverage, and the provision of medication for non-communicable diseases.
• Gaza's food production sector is severely impacted, eliminating the local production of essential fresh foods like eggs, vegetables, and milk. There is a critical need to restart the import of these vital inputs to revive local production and ensure the availability of balanced nutrition, especially for children and the broader population. Without this, achieving dietary balance remains an unattainable goal.
• Vulnerable segments of the population, including children, the elderly, and individuals with underlying health conditions, are particularly susceptible to the risk of malnutrition. Partners are working to ensure that aid reaches these vulnerable groups.
• Establishing secure and uninterrupted humanitarian corridors in Gaza, with the support of the private sector and a focus on critical resources like fuel and cooking gas, is essential to address the immediate needs of the affected population and support the overall humanitarian response.

Response

• Between 12 and 18 February, a total of 15 partners engaged in providing food assistance across the Gaza Strip. Around 1.7 million people were reached, with Rafah Governorate receiving about 32 per cent of the total food assistance, followed by Deir al Balah (28 per cent), Khan Younis (26 per cent), and northern Gaza Strip (14 per cent).

Challenges and Gaps

• Ongoing airstrikes and heavy fighting in Gaza continue to affect the flow of food supply, posing challenges for the conduct of safe and efficient humanitarian operations. Frequent border closures, restrictions, and security concerns hinder the ability to ensure a consistent and dependable food supply.
• The escalation of hostilities has substantially damaged critical infrastructure, including roads, electricity, and water supply systems, exacerbating severe impediments to the efficient distribution of food.

Shelter and Non-Food Items (NFI)

Needs

• Some 1.7 million people need shelter and NFI assistance across the Gaza Strip.
• Urgent needs are tents, sealing-off kits (SOKs) and NFIs, including bedding, kitchen sets, and winter clothing. SOKs can be used to consolidate makeshift shelters or to protect damaged housing to facilitate return where possible.
• Partners estimate that the amount of debris generated by the destruction of residential housing residential housing units will exceed 12,000 metric tons and will take over four years to remove, given Gaza’s current capabilities.

Response

• Since the start of hostilities, cluster partners reached about 900,000 people with partial shelter and NFI assistance. Partial assistance means that although a household has received some shelter and NFI items, not all their needs have been met.
• During the reporting period, cluster partners distributed 7,900 bedding items, 1,600 SOKs and 340 clothing kits to IDPs sheltering outside of UN shelters in Rafah.
• Some 28,000 tents, 7,600 SOKs, and 35,000 NFI kits are currently in the pipeline.
• At present, there are 26 cluster partners operating in Gaza. Most of the assistance is currently provided in-kind; cash will be pursued further when market conditions allow.
• Further details in the Cluster response strategy and website dashboard.

Challenges and Gaps

• Slow entry of items into Gaza due to limited aid trucks and complicated bureaucratic and procurement processes.
• Rising prices of shelter materials in neighbouring markets, including high freight rates and shipping costs.
• Need to restore commercial imports and re-establish local markets to relieve pressure on in-kind provision.
• Restrictions on or denial of the entry of key shelter items including timber, hand tools, and cooking stoves.
• Lack of security and access to IDP locations, lack of fuel, and rising social tensions because of the limited quantity of aid available in comparison to outstanding needs.
• Unplanned sites and lack of adequate equipment is leading to water damage to makeshift shelters and tents, and recurrent displacement resulting in the need for re-distribution of assistance.
• Urgent funding is needed to address the key gaps in the supply of shelter and NFIs. As of 19 February, only 28 per cent of the Shelter Cluster funding requirement ($209.2M) has been funded.

Protection

Needs

• Main needs include identification, tracing and reunification, and interim and alternative care arrangements of unaccompanied, previously detained and separated children.
• There is an urgent need to provide Mental Health and Psychological Support (MHPSS), including psychological first aid (PFA); winterization materials, including warm clothing and blanket, for children and new-born babies.
• There is urgent need to provide essential supplies, including menstrual management (MHM) kits and hygiene kits for women and girls.

Response

• In January, Child Protection Area of Responsibility (AoR) partners reached 111,202 boys and girls, and 2,633 women and men through awareness raising interventions; MHPSS for children and caregivers; identification and registration of Unaccompanied and Separated Children (USAC); and distribution of clothing kits.
• Partners distributed essential supplies, including Menstrual Hygiene Management (MHM) kits and hygiene kits for women and girls. A total of 3,500 Dignity Kits and 8,926 MHM kits have been distributed by Gender-Based Violence (GBV) Sub-Cluster partners.
• GBV responders are conducting procurement and distribution of Clinical Management of Rape (CMR) kits, and identification of health service points to provide CMR. Partners are also trying to establish emergency safe spaces, to provide PFA and recreational activities for vulnerable women and girls. Partners continue to expand PFA services for vulnerable groups, including GBV survivors, through frontline responders.

Challenges and Gaps

• The increased hostilities in Rafah governorate pose a significant threat for partners providing lifesaving protection services in the governorate. There is a lack of available space to provide group-based psychosocial support activities, due to the population density.
• Limited access to other governorates prevents thousands of affected people from being reached with critical protection services.

Education

Needs

• More than 625,000 students and nearly 23,000 teachers in the Gaza Strip have been affected by school closures and attacks on education, leaving them with no access to education or safe places.
• According to the Ministry of Education, as of 13 February, more than 5,055 students and 246 educational staff have been killed and more than 8,497 students and 836 teachers have been injured in Gaza since 7 October.
• Some 92 per cent of all school buildings in Gaza are being used as shelters for IDPs and/or have sustained varying levels of damage. Some 394 schools (79.5 per cent of the total school buildings in Gaza) have sustained damage, including 142 schools that sustained major damage or were destroyed. Combined, these schools previously served some 459,231 children and more than 17,110 teachers. The North, Gaza, and Khan Younis governorates have been especially impacted, accounting for 76 per cent of all damaged schools (source: Education Cluster Damaged School Dashboard.)
• The Education Cluster conducted a Satellite-derived Damage Assessment of all Gaza schools to verify damage to schools based on proximity to damaged sites. Key findings include:
  • Satellite-derived Damage verification exercise confirmed the large level of damage to schools previously reported by the cluster in Gaza.
  • Actual damages to school infrastructure might be 15 to 20 per cent higher than what has been previously reported by the Education Cluster.
  • At least 55 per cent of schools in Gaza will either need full reconstruction or major rehabilitation work to be functional again.
  • One quarter of directly hit and damaged schools are UNRWA-run schools.
  • Forty-five per cent of school buildings that have been used by IDPs as shelters, have been either directly hit or damaged.
  • The satellite-derived images provide evidence for the military use of schools.
• Education partners are concerned about reports, videos and pictures depicting schools being used for military operations by Israeli forces, including their use as detention and interrogation centres, or as military bases.
• Key priorities include the provision of Education in Emergencies (EiE) recreational activities and psychological support, including Social Emotional Learning (SEL) activities to children in shelters and designated emergency shelters (DESs); establishing Temporary Learning Spaces (TLS) in shelters/DESs to start non-formal learning for children; and provision of emergency supplies and learning kits. In addition, a key need is to identify and support of children with disabilities and other needs, with assistive devices for learning.

Response

• Since October 2023, eleven partners have reached more than 160,975 students and teachers with psychosocial support, emergency learning, recreational supplies and activities, and awareness sessions in the Deir al Balah, Khan Younis, and Rafah governorates. Most of the cluster responses are delivered by local partners (source: Education Cluster 5W dashboard).

Challenges and Gaps

• No activities have been undertaken in the North Gaza and Gaza governorates due to ongoing hostilities and access challenges.
• As of 18 February, the education response remains significantly underfunded, receiving less than 10 per cent of its requirements. Urgent funding is required to meet immediate response requirements.

Logistics

Response

• As of 18 February 2024, the Logistics Cluster has stored 7,256 cubic metres of cargo on behalf of 17 organisations, and supported 21 organisations with cargo notification service in Rafah.
• Of relief items transported through the Jordanian corridor, the Logistics Cluster facilitated partners` access to the inter-agency convoy, transporting a total of 6,159 metric tons of relief items on 463 WFP trucks on behalf of six partners.
• The Logistics Cluster has circulated the Compiled Logistics Supplier List through the mailing list. The aggregated list comes from partners to partners and is intended to ease access to and exchange of information; it is the list is based on partners' vendors’/suppliers’ contributions. The list will be circulated on a regular basis.

Challenges and Gaps

• The storage and transport capacity inside Gaza remains limited. The Logistics Cluster continues to facilitate access to temporary storage, transport from handover points to common warehouses, and cargo notification trans-shipment services.
• The Logistics Cluster is coordinating the pipeline for incoming cargo through the Egyptian and Jordanian corridors for the coming three months. This is a vital exercise for operational planning, in terms of understanding the resources available and making allocations based on the prioritization list. Partners have received a dedicated form and are requested to update it weekly. Partners who have not received the form can reach out to [email protected].

Emergency Telecommunications

Needs

• There is an urgent need for independent communications platforms for responders in Gaza to coordinate the delivery of relief items amid the ongoing telecoms blackouts and unreliable/intermittent access to telecommunication services.

Response

• On 12 February, the UN Humanitarian Coordinator received approval from the Israeli authorities to import 30 digital Very High Frequency (VHF) handheld radios for the use of UN agencies in Gaza, and solar solutions to power radio repeaters. Since its establishment on 3 November 2023, the ETC has been engaging with the Israeli authorities to obtain authorizations to import all essential telecommunications equipment into Gaza and provide independent access to communications for humanitarian responders.
• Since 9 January, the ETC has supported humanitarian agencies with Information and Communication Technology (ICT) assessments, technical advice and information, repairs, and guidance on the use of ICT equipment in Gaza. To date, the ETC has conducted eight ICT assessments across four locations in Rafah and supported 14 humanitarian agencies with ICT repairs, technical advice, and guidance on the use of ICT equipment, in order to maximize the available telecommunications resources on the ground.

Challenges and Gaps

• Limited access to electricity, fuel, and telecommunications services continues to hamper the humanitarian response in Gaza.
• The import of telecommunications equipment into Gaza is fraught, lengthy, and extremely challenging.

Multi-Purpose Cash Assistance (MPCA)

Response

• Since the start of hostilities, one round of emergency MPCA was delivered to some 130,000 households, a top-up was delivered to 35,000 people (including people with disabilities and nursing mothers), and over 21,000 households have received a second round.
• Around 93,000 households have cashed out their assistance since 7 October. Around 5,400 payments have been cancelled after not being cashed out for months, despite multiple follow ups. Cash out operations are currently almost exclusively in the southern governorates.
• The assistance provided falls well short of need under the recurrent in-extremis circumstances, particularly given market collapse and price volatility. The last post-distribution monitoring data (PDMD) showed a significant decrease in the number of people who reported being able to meet all their needs, with the received assistance, combined with a major decrease in the number of people who reported not being able to cover any need. Overall, some 70 per cent of respondents reported that the assistance helped them access needed basic goods and services.
• Based on the last PDMD collected between mid-January and mid-February, food remains the most purchased item with humanitarian cash (80 per cent), followed by medicines (39 per cent), water (23 per cent), hygiene bedding (10 per cent), and transportation.

Challenges and Gaps

• Poor electricity supply and connectivity is affecting the ability of financial service providers to make cash accessible, compromising the encashment of the MPCA package.
• Since late December, commercial trucks have sporadically entered Gaza, with 770 trucks recorded up to date. Truck vendors sell goods on the streets and in informal markets, complicating efforts to track distributions and gather market data. Informal markets are the primary source of accessible goods. Currently, there is limited market data available on informal markets/street vendors due to challenges with collecting data about informal market transactions.

IASC Protection from Sexual and Exploitation Abuse (PSEA) Network

Needs

• There is a need to mainstream PSEA messages & safeguarding practices across the Gaza Strip and West Bank, including East Jerusalem.
• There is a pressing need to prioritize protection interventions at large. Safeguarding and SEA risk have become prominent in a context of severe aid dependency. The lack of safe aid delivery increases vulnerability and leads to exploitation and abuse.
• Provide safe and accessible reporting channels, that lead to assistance and investigations of PSEA allegations.
• Ensure that services are available for people at risk of sexual exploitation and abuse (SEA).

Response

• Since October 2023, more than 1,500 cases have been referred by the SAWA Foundation specialized counsellors, including eight per cent from the West Bank.
• Due to the communication cuts in Gaza, a range of public communication materials were produced and distributed.
• The PSEA Network has made available MHPSS support and remote counselling sessions for PSEA focal points on the ground in Gaza, who are documenting the impact and the emerging needs by collecting complaints and feedback.

Challenges

• Identifying cases and reaching vulnerable individuals pose significant challenges, particularly due to internet and telecommunication blackouts. Electricity and communication cuts make it challenging to establish contact with on-the-ground PSEA focal points.

Protection against sexual abuse and exploitation (PSEA) remains a cross-cutting priority for all clusters. Aid distribution must be delivered with dignity and respect. Any wrongdoing can be reported through SAWA toll-free number 164. SAWA will assist and provide services free of charge and with the utmost confidentiality.

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