Hostilities in the Gaza Strip and Israel | Flash Update #13

KEY POINTS

• As hostilities entered the thirteenth day, relentless bombardments on Gaza continued, resulting in an additional 307 Palestinians killed in the past 24 hours (as of 17:00). This brings the cumulative fatality toll in the Gaza Strip to 3,785, including at least 1,524 children, according to the Ministry of Health in Gaza. Hundreds of additional fatalities are believed to be trapped under the rubble.
• At least 30 per cent of all housing units in the Gaza Strip have been either destroyed (12,845), rendered uninhabitable (9,055) or moderately/lightly damaged (121,000), since the start of the hostilities, according to the Ministry of Housing in Gaza.

• The number of internally displaced persons (IDPs) in Gaza is estimated at about one million, including over 527,500 people staying in 147 UNRWA-designated emergency shelters in increasingly dire conditions.
• The complete siege of Gaza continues. The Rafah, Kerem Shalom and Erez crossings remained closed, preventing the entry of desperately needed humanitarian aid, including food, water, medicines and fuel.
• Speaking in Cairo on 19 October, the UN Secretary-General reiterated his call for “an immediate humanitarian ceasefire,” highlighting the need for “unrestricted access of humanitarian aid.” 
• 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.
• Palestinian armed groups’ indiscriminate rocket firing towards Israeli population centres continued, with no new Israeli fatalities reported (as of 21:00) in that context. Overall, about 1,400 Israelis and foreign nationals have been killed in Israel, according to the Israeli authorities, the vast majority on 7 October. Israeli media reported that, as of 19 October, the names of 705 of these fatalities have been released; of those for whom age was provided, 20 are children.
• At least 203 people are held captive in Gaza, including Israelis and foreign nationals, as per Israeli estimations. The Secretary-General has called upon Hamas to release the hostages immediately and unconditionally.
• In the West Bank, Israeli forces have killed 14 Palestinians in the past 24 hours (as of 21:00), including eleven in Nur Shams refugee camp, while another Palestinian was killed by an Israeli settler. This brings the total fatality toll by Israeli forces and settlers since 7 October to 79, including 20 children. One Israeli soldier was also killed by Palestinians, according to Israeli media. 
• 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. Among the deadliest incidents recorded in the past 24 hours (as of 17:00) were airstrikes targeting residential structures in Khan Yunis (26 fatalities in two separate airstrikes); Jabalia (at least five fatalities); and Rafah (25 fatalities in two separate airstrikes). 

On 19 October, Israeli airstrikes targeted the vicinities of two bakeries, where many people, including women and children, were queuing, reportedly killing 20 people in Gaza city and five more in An Nussairat camp. In Gaza city, three residential towers were targeted and destroyed in the morning of 19 October, resulting in no fatalities.

Since the start of hostilities, 3,785 Palestinians have been killed, including at least 1,524 children, and about 12,500 have been injured, according to the Ministry of Health in Gaza. The reported fatality toll in Gaza during the 13 days of hostilities is about 60 per cent higher than the total number of fatalities during the 2014 escalation, which lasted for over 50 days (2,251 Palestinian fatalities). 

Additionally, it is estimated that hundreds of people including women and children are still trapped beneath the rubble awaiting rescue, or recovery. 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.

On 15 October, about 100 unidentified bodies were buried in a mass grave in Rafah due to the lack of refrigerated space to store them until recognition procedures are conducted. This measure followed environmental and human indignity concerns related to the decomposition of the bodies.

According to the Ministry of Health in Gaza, as of 18 October, 79 families had lost ten or more of their members; 85 families had lost 6 to 9 members, and 320 families had lost two to five of their members.

The Gaza Ministry of Public Works reported the destruction of 12,845 housing units and the rendering of 9,055 housing units uninhabitable. Another 121,000 housing units suffered minor to moderate damage. The total number of housing units destroyed or damaged  accounts for at least 30 per cent of all housing units in the Gaza Strip. 

An assessment of the North Gaza Governorate area, by the United Nations Satellite Centre, identified 927 destroyed structures and 4,337 moderately to severely damaged structures, corresponding to about 15 per cent of all structures in that area. The assessment was based on a comparison of images collected on 15 October 2023 with those from 1 May 2023. 

The World Health Organization (WHO) has documented 59 attacks on health care affecting 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, 178 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. 

As of 21:00 on 19 October, no new Israeli fatalities have been reported in the context of hostilities in Gaza and Israel. According to Israeli sources, at least 1,400 Israelis and foreign nationals have been killed in Israel, and at least 4,629 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).

According to Israeli media, as of 19 October the Israeli authorities have released the names of 705 fatalities, whose identity had been confirmed, including 317 civilians, 285 soldiers, and 57 police officers. Among those civilians whose age is provided, 20 are children.

Displacement

The cumulative number of IDPs since the start of hostilities in Gaza is estimated at about one million, including over 527,500 people staying in 147 UNRWA-designated emergency shelters (DES), of whom 367,500 are in central and southern Gaza alone. The last reported number of IDPs in UNRWA’s DES in Gaza city and North Gaza was nearly 160,000, as of 12 October. In addition, about 66,300 IDPs are staying in 64 non-UNRWA shelters, most of which are in Gaza city and northern Gaza.

UNRWA’s DES in the central and southern areas are overcrowded. Essential resources like water, food, and medicine are in critically short supply. In some DES, UNRWA has been forced to ration down potable water, providing only one litre of water per person per day. The minimum international standard is 15 litres. 

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. Moreover, anecdotal evidence indicates that some IDPs are returning to the north, following the continuous bombardments in the south, as well as due to the inability to find reasonable accommodation.   

The displacement of civilians and the related poor access to basic services has raised concerns regarding the protection of the most vulnerable, including children, the elderly, those in need of medical care, people with disabilities, and pregnant women. Issues of concern include psychosocial distress, conflict and tension amongst the IDPs, denial of access to information and potential abuse or exploitation.

In Israel, hundreds of thousands residing in the vicinity of the Gaza Strip, as well as along the border with Lebanon, have fled or been evacuated, with the Israeli authorities providing for the needs of these IDPs (this report focuses on the humanitarian situation in Gaza).

Basic services and livelihoods

Electricity

For the ninth 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 due to the shortage of power, medicine, equipment and specialized personnel. Yet, the number of patients treated or awaiting treatment is at 150 per cent of their capacity; many lay on the floors and corridors. To keep emergency rooms operational, vital procedures such as sterilization and dialysis may soon be halted. This has been exacerbated by the shutdown of over 60 per cent of primary health care facilities.

The Ministry of Health in Gaza has been reallocating to hospitals limited amounts of fuel still available in other public facilities to prevent their shutdown, while calling on people who have fuel for domestic consumption to donate it to the hospitals. On 17 October, WHO, together with UNRWA, managed to deliver 10,600 litres of fuel to Shifa hospital, enabling the hospital’s generators to operate for a few more days; additional fuel allocations by these UN agencies from their existing reserves within Gaza are expected in the coming days. 

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 are over 9,000 cancer patients, who depend on chemotherapy treatment for their survival. The Turkish-Palestinian Friendship Hospital, the only facility in Gaza providing chemotherapy, is struggling to remain operational, relying on a single electricity generator. Additionally, some patients are missing their appointments, facing the expansion of tumors, as it has become risky and difficult to get to the hospital. Prior to the hostilities, some 2,000 cancer patients from Gaza had been referred for regular treatment to hospitals in East Jerusalem and Israel. However, this practice has been halted since 7 October.

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. All five wastewater treatment plants in Gaza have been forced to shut down due to lack of power, resulting in large amounts of raw sewage being continuously dumped into the sea. 

Due to the access restrictions to Gaza’s main landfills, near the perimeter fence with Israel, solid waste has been accumulating in temporary locations and in the streets, posing health and environmental hazards.

Food security

Damage sustained by two bakeries during airstrikes on 19 October (see Hostilities section), further compounds the access of people to fresh bread. This follows damage on 18 October to one of the six WFP-contracted bakeries supplying bread for about 12,000 people, which is no longer functioning. Most other 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.

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.

Telecommunications

Telecommunications enable information gathering on humanitarian needs and is therefore paramount to assistance delivery. Damage to related infrastructure during the hostilities, compounded by the fuel shortages, have severely impaired connectivity, undermining lifesaving operations. 

Network monitoring systems of the Paltel Group show that across the Gaza Strip, 83 per cent of fixed line users are disconnected; 54 per cent of fixed line sites are disconnected; and 50 per cent of their main Fiberoptic internet lines are not operational. This is a result of infrastructure damage and fuel shortage. Bombardments have resulted in cuts in two out of three fiber cables going out of Gaza, one of which was repaired after the Israeli authorities granted the company a two-hour window for staff to fix one fiber cable.

Movement and access

The Rafah crossing with Egypt remains closed, preventing the entry of an estimated 200 trucks, with some 3,000 tons of aid, that are positioned at or near 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. 

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. Since the start of the hostilities 16 health workers and at least 15 UNRWA staff have been 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 in Rapid Response funding, supplementing a pre-existing $6 million allocation from the Underfunded Emergencies Window. 

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.

WEST BANK HUMANITARIAN OVERVIEW

Casualties

In the West Bank, in the past 24 hours (as of 21:00), Israeli forces have killed 14 Palestinians and injured 13 by live ammunition, while another Palestinian was killed by an Israeli settler. The deadliest incident, which is still ongoing, took place in Nur Shams refugee camp (Tulkarm), where 11 Palestinians, including two boys (aged 16 and 13), were killed by Israeli forces. One Israeli soldier was also killed by Palestinians, according to Israeli media. The clashes followed an Israeli search and arrest operation in the Camp, during which Palestinians threw explosive devices at Israeli forces and there was an exchange of fire. Israeli forces launched several ground and air strikes, utilizing drones, and bulldozed sections of a road, reportedly, to neutralize explosives planted in the ground. A blackout in the electricity and water network has also been reported during the operation. The damage to infrastructure and homes is yet to be assessed. According to medical sources, Israeli forces impeded the work of paramedics during the operation.

Additionally, three Palestinians were killed during confrontations that erupted during a protest in solidarity with Gaza in Jamma'in (Nablus) and during search-and-arrest operations in Budrus (Ramallah), and Ad Duheisha Refugee Camp (Bethlehem). 

Since the start of the hostilities and by 21:00 on 19 October, Israeli forces had killed 73 Palestinians, including 19 children. An additional six Palestinians, including one child, were killed by Israeli settlers during settler attacks in Qusra (Nablus) and Dura al Qar'a (Ramallah). One member of Israeli forces was reportedly killed by Palestinians.

Additionally, since 7 October, Israeli forces have injured 1,399 Palestinians, including at least 129 children; an additional 35 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 of 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 100 settler attacks against Palestinians resulting in casualties or property damage, including some where Israeli forces were involved. This represents an average of almost eight 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 shot and killed a Palestinian man and injured another one near the water spring area in Dura al Qara’ village in Ramallah. In another three incidents in Madama and Burqa (both in Nablus), Israeli settlers, accompanied by Israeli forces, opened live fire and threw stones at Palestinian houses and cars, setting fire to Palestinian property. During these incidents, Israeli forces shot and injured 54 Palestinians, including three with live ammunition. In another two incidents, Israeli settlers opened fire at Palestinians while they were picking their olives in Kobar village (Ramallah) and against a Palestinian herder while he was filling water near Mughayyir ad Deir (Ramallah). As a result, two Palestinian men were injured, including one with live ammunition fired by settlers.

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 6,570 households started receiving Emergency MPCA (NIS754 or US$187 per household) since the evening of 13 October.

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

• Child protection and Mental Health Psychosocial Support (MHPSS) partners are operating for, Gaza (four partners in the West Bank) providing remote psychosocial support.
• One partner working on inclusion and persons with disabilities has been able to reach 38 out of the 87 shelters in the south with following activities: distribution of 93 assistive devices, 156 wound dressings, 36 kitchen sets, 45 dignity kits, 435 diapers, and 57 baby blankets.
• 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.