Hostilities in the Gaza Strip and Israel | Flash Update #12

KEY POINTS

• Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Mr. Martin Griffiths briefed the Security Council today, stressing the need for humanitarian actors to be able to “deliver relief to civilians in need throughout Gaza, without impediment, in places of their choice, in places where they consider themselves to be safe and where we can seek to ensure that safety.”

• On the evening of 17 October, 471 people, including children, health care staff, and Internally Displaced People (IDPs), were killed in an explosion at Al Ahli Arab/Baptist hospital in Gaza city, according to the latest figures from the Ministry of Health in Gaza. This was the deadliest incident in Gaza since hostilities escalated. In the wake of this incident, the UN Secretary-General called for “an immediate humanitarian ceasefire.”

• The cumulative fatality toll in the Gaza Strip is 3,478 as of 17:00 (18 October), including at least 853 children (as of 17 October), according to the Ministry of Health in Gaza. Hundreds of additional fatalities are believed to be trapped under the rubble.
• The number of IDPs in Gaza is estimated at about one million, including over 353,000 people staying in UNRWA schools in central and southern Gaza alone, in increasingly dire conditions.
• The complete siege of Gaza continues. The Rafah Crossing has remained closed, preventing the entry of desperately needed humanitarian aid, including food, water and medicines awaiting on the Egyptian side. The Erez and Kerem Shalom crossings with Israel also remain closed.
• The average water consumption for all needs (drinking, cooking and hygiene) is currently estimated at three litres per day per person in Gaza. People consume more and more water from unsafe sources, risking death and placing the population at risk of infectious disease outbreak.
• The Palestinian armed groups’ indiscriminate rocket firing towards Israeli population centres continued, with no new Israeli fatalities reported (as of 21:00 on 18 October). Overall, about 1,400 Israelis and foreign nationals have been killed in Israel, according to Israeli authorities, the vast majority on 7 October.
• At least 199 people are held captive in Gaza, including Israelis and foreign nationals. At the Emergency Briefing to the Security Council, the UN Special Coordinator for the Middle East Process, Mr. Tor Wennesland, stated: “We need the time and space to achieve two urgent objectives: Hamas’ immediate, unconditional release of all hostages; secondly, and fast, unrestricted access of humanitarian aid for Palestinians in Gaza.”
• In the West Bank, since the afternoon of 17 October, Israeli forces have killed three Palestinians during protests following the explosion at Al Ahli hospital in Gaza. This has brought the number of Palestinians killed by Israeli forces or settlers since 7 October to 64, including 18 children. Confrontations in the same context, between Palestinian protestors and Palestinian security forces, resulted in the killing of one child.
• At least 74 Palestinian households, comprising 545 people, over half of whom are children, have been displaced from 13 herding/Bedouin communities in Area C of the West Bank since 7 October, amid intensified settler violence and access restrictions.

GAZA HUMANITARIAN OVERVIEW

Hostilities and casualties

Israeli airstrikes and shelling continued. Between the evening of 17 October and the morning of 18 October, additional residential buildings were targeted and destroyed, including one in Al Bureij, in central Gaza, resulting in 25 fatalities, and several residential buildings in Jabalia, resulting in 37 fatalities.

Since the start of hostilities, 3,478 Palestinians have been killed and about 12,500 have been injured, according to the Ministry of Health in Gaza. The fatality toll in Gaza during the 12 days of hostilities has significantly surpassed the total number of fatalities during the 2014 escalation, which lasted for over 50 days (2,251 Palestinian fatalities). According to the Ministry of Health in Gaza, as of 16 October at 18:00, 47 entire families have been killed, amounting to about 500 people.

Additionally, it is estimated that hundreds of people are still trapped beneath the rubble awaiting rescue, or recovery. The decomposition of bodies under collapsed buildings is an increasing humanitarian and environmental concern.

Rescue teams, primarily from the Palestinian Civil Defense, are struggling to carry out their mission, amid continuous airstrikes, severe shortage of fuel to run vehicles and equipment, and with limited or no connection to mobile networks.

As of 21:00 on 18 October, no new Israeli fatalities have been reported. According to Israeli sources, at least 1,400 Israelis and foreign nationals have been killed in Israel, and at least 4,562 have been injured, the vast majority on 7 October. The fatality toll is over threefold the cumulative number of Israelis killed since OCHA began recording casualties in 2005 (nearly 400).

As of 14 October, the Gaza Ministry of Public Works reported the destruction of 8,840 housing units and the rendering of 5,434 housing units uninhabitable, resulting in the displacement of about 25,000 families. Another 83,750 housing units suffered minor to moderate damage. The total number of housing units destroyed or damaged (98,024) accounts for roughly 25 per cent of all residential housing units in the Gaza Strip. This figure is an underestimate as large areas that have been severely hit, such as Beit Hanoun and Ash Shuja’iyeh in Gaza city, remain inaccessible and buildings that were destroyed there are not included.

The World Health Organization (WHO) has documented 59 attacks on health care (including Al Ahli Hospital), resulting in 491 fatalities and 370 injuries, including 16 fatalities among health care workers and 28 injuries of health workers on duty. The attacks have affected 26 health care facilities (including 17 hospitals damaged) and 23 ambulances. Four of the hospitals, all in northern Gaza (Beit Hanoun, Hamad Rehabilitation, Al Karama, and Ad Dura) had to be evacuated and are no longer operational.

The scope of damage sustained by education facilities and other civilian infrastructure is also of increasing concern. As of 18 October, 170 educational facilities have been hit, including at least 20 UNRWA schools, two of which were used as emergency shelters for IDPs, and 140 Palestinian Authority (PA) schools, one of which was destroyed. One university building and seven churches were damaged, and at least eleven mosques were destroyed.

Water and sanitation facilities have also been severely damaged. As of 12 October, at least six water wells, three water pumping stations, one water reservoir, and one desalination plant serving over 1,100,000 people were damaged.

Displacement

On the evening of 18 October, Israeli forces repeated their call on residents of northern Gaza, including Gaza city, to evacuate, now directing them to an open area in northern Khan Younis governorate.

The cumulative number of IDPs since the start of hostilities is estimated at about one million, including over 513,907 people staying in UNRWA-designated emergency shelters (DES), of whom 353,539 are in central and southern Gaza alone. The last reported number of IDPs in UNRWA’s DES in Gaza city and North Gaza was 159,968, as of 12 October. In addition, about 66,311 IDPs are staying in 64 non-UNRWA shelters, most of which are in Gaza city and northern Gaza.

UNRWA’s 148 DES in the southern areas are overcrowded. This includes children, the elderly, those in need of medical care, people with disabilities, and pregnant women. Essential resources like water, food, and medicine are in critically short supply, leading to rising frustration and tensions among IDPs. Meanwhile, many people in northern Gaza governorates are unwilling or unable to evacuate due to a lack of alternatives, the precarious conditions of displacement and fearing they might never be allowed to return.

In Israel, an almost full evacuation of Sderot city (population about 34,000), in southern Israel, was completed on 15 October. Smaller Israeli communities around Gaza had been fully vacated in previous days, while most residents of Ashqelon (population about 155,000) have also reportedly left. The Israeli authorities are providing for the needs of these IDPs (this report focuses on the humanitarian situation in Gaza).

Basic services and livelihoods

Electricity

For the eighth consecutive day (since 11 October), Gaza has been under a full electricity blackout, following Israel’s halt of its electricity and fuel supply to Gaza, which in turn triggered the shutdown of Gaza’s sole power plant. This has forced essential service infrastructure to rely on backup generators, which are limited by the scarcity of fuel in the Strip.

According to officials at the Gaza Power Plant, the Israeli authorities have warned that the plant would be targeted if it attempted to resume operations. The Israeli Defense Minister indicated that electricity, fuel and full water supply to Gaza would not be restored until the Israeli hostages are released.

Health care

Hospitals are on the brink of collapse. Most of them have been operating at a bare minimum capacity. Measures adopted to keep emergency rooms operational include the suspension of certain surgeries, working in darkness and limiting elevator usage. Vital procedures such as sterilization and dialysis may soon be halted.

Most of those wounded in the Al Ahli hospital explosion have been evacuated to Shifa Hospital, Gaza’s largest hospital located in Gaza city. The overwhelming number of injured people that arrived forced doctors to attempt surgery on the floor and in the halls, mostly without anesthesia. Prior to the incident, Shifa was already operating well beyond its capacity, treating about a quarter of all patients in Gaza. Yesterday (17 October), WHO, together with UNRWA, managed to deliver 10,600 litres of fuel to Shifa, enabling the hospital’s generators to operate for a few more days.

The Ministry of Health in Gaza has been reallocating to hospitals limited amounts of fuel still available in other public facilities to prevent their complete shutdown, while calling on people who have fuel for domestic consumption to donate it to the hospitals.

Health Cluster partners estimate that mortality rates in Gaza, excluding casualties in the context of the hostilities, have been on the rise due to the extremely limited access to essential healthcare services.

Of particular concern is the situation of an estimated 20,000 people with mental health illnesses; their access to mental health services and drugs has been interrupted, while being exposed to violence and abuse, and going missing during evacuation. An estimated 50,000 pregnant women face extreme challenges to accessing prenatal and maternity care due to risks related to movement, the halt of health facilities, and shortage of lifesaving supplies.

Water and sanitation

Water production from municipal groundwater sources is at less than five per cent of the pre-hostilities level. The three seawater desalination plants, which, prior to the hostilities produced seven per cent of Gaza’s water supply, are currently not operational. Water trucking operations came to a halt in most areas due to the lack of fuel, insecurity and roads blocked by debris. Bottled water is largely unavailable, and its price has made it unaffordable for most families. Private vendors, who operate small water desalination and purification plants, which are mostly run by solar energy, became the main suppliers of clean drinking water.

Consequently, the average water consumption from all sources and for all needs (including cooking and hygiene) dipped to just three litres per day per person, according to estimates by partners of the Water, Sanitation and Hygiene (WASH) Cluster. People have resorted to consuming brackish water extracted from agricultural wells, increasing exposure to pesticides and other chemicals, placing the population at risk of death or infectious disease outbreak.

Eastern Khan Younis (Bani Suheila area) is currently one of the few areas where piped water is supplied to households for a few hours a day. This followed the Israeli authorities’ reactivation of one out of three water lines servicing this area. This line supplies about 14,400 cubic metres of water per day, which is less than four per cent of the water consumed in the Gaza Strip prior to the hostilities. The distribution of this water to the rest of Khan Younis city is impaired by the lack of pumping capacity.

Most of the 65 sewage pumping stations are not operational, increasing the risk of sewage flooding. In some areas, sewage and solid waste have been accumulating in the streets, posing health and environmental hazards. All five wastewater treatment plants in Gaza have been forced to shut down due to lack of power.

Food security

A spokesperson of the World Food Programme (WFP) indicated on 16 October that stocks of essential food commodities are sufficient for only two weeks, but these are stored in warehouses in Gaza city, which are difficult to access, while there are only four or five days of stocks left in shops.

Overnight on 18 October, one of the six WFP-contracted bakeries supplying bread for about 12,000 people was hit. The bakery was in Deir Al Balah in the middle area and is no longer functioning. Four other bakeries across the Strip might not be able to supply any bread by tomorrow due to the lack of fuel for the machinery. Bakeries are unable to operate due to the shortage of essential ingredients, particularly wheat flour, which is expected to be depleted in less than a week. Only one of the five mills in Gaza is functioning.

The blackout has disrupted food security by affecting refrigeration, crop irrigation, and crop incubation devices, consequently harming various livelihoods, including poultry, cattle, fish, and other commodities.

The lack of access to fodder and damage from the airstrikes have taken a toll on farmers, with many breeders, primarily small-scale ones, reporting substantial losses among their animals, particularly in the poultry sector. Farmers are losing their crops in agricultural lands east of Khan Yunis and other locations.

Movement and access

The Rafah crossing with Egypt remains closed, preventing the entry of desperately needed humanitarian aid, including food, water, and medicines; it is estimated that about 3,000 tons of goods are awaiting entry in trucks on the Egyptian side of the crossing.

The Erez and Kerem Shalom crossings with Israel also remain closed. Referrals for patients and their companions to exit the Gaza Strip to reach their medical appointments in the West Bank and Israel have ceased since 7 October.

Gazan patients who were receiving medical care in Israeli hospitals prior to 7 October have reportedly been transferred to the West Bank, with some experiencing an effective discontinuation of their treatments.

Additionally, over 4,000 workers from Gaza have been stranded in Israel since 7 October. Some were arrested by Israeli authorities and others were transferred to diverse public shelters in the West Bank. On 17 October, in two different raids, Israeli forces arrested 50 workers from Gaza in the Hebron Governorate.

Access to the sea has been prohibited by the Israeli military, and all fishing activity has ceased since the hostilities began. Access within Israel's perimeter fence remains prohibited, and it has expanded from 300 to 1,000 metres, barring entry to substantial agricultural areas. Alongside safety concerns, this extension has led to reduced crop yields, directly impacting hundreds of thousands of farmers.

Humanitarian operations

All humanitarian agencies and personnel have faced major constraints in providing humanitarian assistance, due to hostilities, movement restrictions and shortages of electricity, fuel, water, medicines and other essential items. The prevailing insecurity is preventing safe access to people in need and essential facilities, such as warehouses.

The WHO Surveillance System for Attacks on Health Care has recorded 56 health attacks since the beginning of hostilities, which included the killings of 16 health workers and the injury of 28 others while on duty. At least 15 UNRWA staff were also killed.

Despite these challenging conditions, humanitarian actors are working around the clock to support the most vulnerable. The major operation entails the hosting of IDPs in UNRWA schools, where basic food, medicine and support is provided to retain dignity and a glimmer of hope. Other interventions include the distribution of food and cash assistance to IDPs and emergency fuel to WASH facilities, psychosocial support helplines, and a mass media campaign to raise awareness about the risks of unexploded ordnance (for further detail, see Humanitarian Needs and Responses).

The reach of operations will remain limited without a humanitarian suspension of hostilities, the opening of the crossings with Israel and Egypt and significant funding for humanitarian response.

Following the outbreak of hostilities, the oPt Humanitarian Fund (HF) redirected a total of US$9 million towards the priority needs identified, while the global Central Emergency Response Fund (CERF) allocated another $9 million, supplementing a pre-existing $6 million allocation.

On 12 October, the OPT Humanitarian Country Team (HCT) launched a Flash Appeal calling for US$294 million for 77 humanitarian partners to address the most urgent needs of 1,260,000 people in Gaza and the West Bank. This Flash Appeal is set to be revised given the significant increase in humanitarian needs. So far, France has pledged $1.1 million, and Germany $631,000.

WEST BANK HUMANITARIAN OVERVIEW

Casualties

In the West Bank, including East Jerusalem, confrontations between Palestinians and Israeli forces have continued. Since the start of the hostilities and by 16:00 on 18 October, Israeli forces have killed 59 Palestinians, including 17 children. An additional five Palestinians, including one child, were killed by Israeli settlers during two consecutive settler attacks in Qusra (Nablus).

Over the past 24 hours (by 18 October at 16:00), Israeli forces shot and killed three Palestinians, including two children, and injured eleven others with live ammunition during confrontations that erupted in protests and marches in solidarity with residents of the Gaza Strip.

The tragedy at Al Ahli Arab hospital in Gaza city prompted immediate reactions, with people from around the region, including the West Bank, taking to the streets to protest. On the evening of 17 October, Palestinians protested in Ramallah, Nablus, Hebron, Jenin and other cities in the West Bank in solidarity with Gaza and in opposition to the Palestinian Authority, with some demanding that Palestinian President Mahoud Abbas leave office. In one of these protests, an exchange of fire was reported between Palestinian demonstrators and Palestinian security forces; a 9-year-old Palestinian child was killed, and 14 others were injured, including nine with live ammunition.

Additionally, since 7 October, Israeli forces have injured 1,255 Palestinians, including at least 122 children; an additional 29 Palestinians have been injured by settlers. Over 1,100 Palestinians have been injured, mostly by Israeli forces, in the context of demonstrations. Some 27 per cent of injuries have been caused by live ammunition. The number Palestinian injuries from live ammunition is almost eight times higher than the average of such injuries between 1 January to 7 October 2023.

Settler-related violence

Settler violence across the West Bank, especially in Palestinian communities near Israeli settlements, has been on the rise. Since 7 October, OCHA has recorded 86 settler attacks against Palestinians resulting in casualties or property damage, including some where Israeli forces were involved. This represents an average of almost seven incidents per day, compared with a daily average of three incidents per day since the beginning of this year.

In the past 24 hours, Israeli settlers, accompanied by Israeli forces, attacked Palestinian houses in Madama (Nablus) with Molotov cocktails and threw stones, setting fire to one car and vandalizing two others. In another incident, armed Israeli settlers physically assaulted and injured a herder and fired shots towards him and his sheep, forcing him to leave the grazing area in Hebron.

Attacks on health care

Since 7 October, WHO has documented 77 attacks on health care in the West Bank affecting 61 ambulances and including 42 attacks involving obstruction to delivery of health care; 43 involving physical violence towards health teams; 15 involving detention of health staff and ambulances; and nine involving militarized search of health assets.

HUMANITARIAN NEEDS & RESPONSES

Multi-Purpose Cash Assistance (MPCA)

Priority Needs

• Access to basic needs and services is severely halted by the lack of resources and the security situation. IDPs outside formal shelters (DES) have extremely limited access to assistance. Those are prioritized for Emergency MPCA.
• · Banks are temporarily closed, limiting access to cash. The capacities of financial service providers are severely limited and changes by the hour (partners currently using PalPay).
• · Depletion of stocked items to be purchased is worsening.

Response to Date

• · Some 5,500 households started receiving Emergency MPCA (NIS754 or US$187 per household) since the evening of 13 October.
• · An increase of Emergency MPCA to 1,650 households in the coming days is planned.

Protection

Priority Needs

• An estimated 20,000 people in need of specialized mental health services, including mental health drugs, who are in precarious situations with the disruption to mental health services.
• Documentation of violations of International Human Rights Law and Humanitarian Law.
• Opening roads, safe access to basic needs, medicines, mental health support, and ambulance services in the West Bank.

Response to Date

• Ten child protection and Mental Health Psychosocial Support (MHPSS) partners are operating in, and for, Gaza (six in the Gaza Strip and four partners in the West Bank) providing remote psychosocial support.
• The United Nations Mine Action Service (UNMAS) has initiated an emergency mass media campaign launching one-million protection messages through various platforms, including social media and radio stations, to send Explosive Ordnance Risk Education (EORE) and Conflict Preparedness and Protection (CPP) messages to as wide a population as possible.
• In the West Bank, the assigned MHPSS Focal Points are responding to settler violence triggers. The MHPSS Coordination Lead Focal Points at governorate levels are intervening as needed.

Shelter

Priority Needs

• Urgent need to provide services and basic Shelter and Non-Food Items (NFI) to IDPs.
• Provision of Non-Food Items and house maintenance for people displaced in urban centers and with host families.
• Provision of shelter cash assistance for IDPs (reintegration package and belongings loss compensation) for at least 25,000 families.

Response to Date

• About 350,000 IDPs are hosted at 102 UNRWA schools across the Gaza Strip.
• Distribution of 12,000 non-food items in Rafah and Khan Younis, including bedding sets and dignity kits.
• Distribution of 820 hygiene kits to displaced families.
• ICRC/PRCS distributed 120 non-food items for displaced families.

Health

Priority Needs

• Addressing shortages of medical supplies impacting case management.
• Fuel for hospitals and ambulances is running out.
• Urgent need to restock medical supplies given depletion of stocks in the local market.
• UNRWA has medical points in 53 out of the 108 shelters. The Health Cluster is identifying other partners to support the remaining shelters. Health Cluster partners are mobilizing and prepositioning supplies in Egypt.
• WHO was able to deliver 10,600 litres of fuel to Shifa Hospital.

Response to Date

• Partners continue to procure supplies from the local market to support hospital operations.
• Surge staff remain present in the hospitals supporting case management.
• Ambulances and emergency medical teams continue to operate despite the risk and difficult environment.

Food Security

Priority Needs

• Electricity, fuel, and water sources to maintain agriculture.
• Many shops have food supplies to last less than a week.
• Safe access to farms, livestock, fisheries, and other livelihoods.
• Urgent import of fodder.

Response to Date

• The World Food Program (WFP) reached 182,289 displaced people residing in UNRWA shelters, providing bread across 47 designated shelters.
• 243,291 IDPs received cash-based transfer (CBT) for food. Of those, 139,312 have been redeemed.
• 19,509 people redeemed their food e-vouchers in shops as of 17 October. Some 66 per cent in the northern and 34 per cent in the southern governorates.
• Five trucks carrying 100 metric tons of food parcels and 15 metric tons of fortified biscuits from Dubai are expected to arrive in Al Arish, Egypt.

Education

Priority Needs

• Safe access to schools and communities.

Planned Responses

• Provision of school-based psychosocial support and recreational activities for at least 70,000 children and school staff as soon as the situation allows.
• Emergency rehabilitation for at least 20 damaged schools, following a cluster rapid needs assessment.
• Provision of emergency supplies and learning kits to 10,000 children in DES and 50,000 children in schools once they reopen.
• Provision of catch-up classes, especially to displaced children (at least 20,000 children).

WASH (Water, Sanitation and Hygiene)

Priority Needs

• Provision of clean drinking water to the population.
• Provision of alternative power supply and 20,000 litres/day of emergency fuel to sustain the operation of WASH facilities, along with replenishing the chlorine supply for water treatment plants.
• Support to restore disrupted municipal services, including solid waste management, water, and sanitation operations, as appealed by the Gaza Strip municipalities.
• Delivery of essential WASH services and provisions to IDPs in collective centers, including drinking water and hygiene kits.

Planned Response to Date

• Providing 3 litres of bottled water per person per day in IDP shelters.
• Some 3,800 hygiene kits were distributed to the families in the UNRWA IDP centres
• Service hub planning in Rafah, Egypt with supply chain from local markets and/or agency stocks (including fuel and bottled water for quick recovery, hygiene kits, water storage bladder tanks, jerrycans, materials for treatment plans) and planning IDP kits for 300,000 people.
• Reviewing and checking feasibility of water trucking operations.

Protection against sexual abuse and exploitation (PSEA) remains a cross-cutting priority for all clusters. The SAWA helpline, reachable at 121 and through WhatsApp at +972 59-4040121 (East Jerusalem at 1-800-500-121), operates 24/7. This toll-free number is widely disseminated across all areas of intervention to report cases of SEA and to facilitate emergency counseling and referrals for affected communities to access life-saving services. The PSEA Network monitors calls daily and will increase the number of counselors if necessary.