Israeli airstrikes and shelling across the Gaza Strip have persisted in the past 24 hours (as of 17:00). In Al Zaytoun area of Gaza city, one of the oldest churches (Saint Porphyries), where some 400 IDPs had sought refuge, was directly hit by an airstrike, reportedly killing at least 18 people and trapping dozens under the rubble.
Other airstrikes with high fatality numbers hit residential structures, including a house in Deir Al Balah (reportedly ten were killed); a house in east of Khan Yunis city (reportedly 21 were killed); six houses in another part of Khan Yunis (reportedly at least 17 were killed); a tower east of Deir Al Balah (reportedly five were killed). Hundreds were injured in these attacks.
Israeli air strikes continued targeting residential towers in Gaza city, reportedly destroying 24 multi-story residential towers in the Az Zahra' compound, in the early hours of 20 October. No casualties were reported from these strikes as residents were reportedly given warning and managed to evacuate. However, between 6,000 and 8,000 people were displaced to nearby schools and university buildings.
Since the start of hostilities, 4,137 Palestinians have been killed, including at least 1,661 children and 908 women, and about 13,162 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 84 per cent higher than the total number of fatalities during the 50-days escalation of hostilities in 2014 (2,251 Palestinian fatalities).
The Palestinian Civil Defense estimated that about 1,000 people, including children, are trapped beneath the rubble, some of whom are believed to still be alive. 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, the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) issued a warning that the Gaza Strip is facing a shortage of body bags due to the rising number of fatalities. Furthermore, about 100 unidentified bodies were buried on 15 October 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, as of 18 October. Another 121,000 housing units are said to have 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. Entire neighborhoods have been largely destroyed, including Beit Hanoun, Beit Lahia, Shuja’iyeh, and Abbassan Kabeera.
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 62 attacks on health care affecting 29 health care facilities (including 19 hospitals damaged) and 23 ambulances. Seven hospitals, including four in northern Gaza (Beit Hanoun, Hamad Rehabilitation, Al Karama, and Ad Dura) either sustained damage or had to be evacuated and are no longer operational.
The extent of damage sustained by educational facilities and other civilian infrastructure is also a growing concern. As of 20 October, 193 educational facilities have been affected, including at least 29 UNRWA schools. Eight of these schools were used as emergency shelters for IDPs, with one of them being directly hit, resulting in at least eight IDPs killed, and 40 others injured. Additionally, one university building suffered severe damage, and minor damage was reported in one Directorate of Education and one rehabilitation centre for the visually impaired.
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 20 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 20 October, the Israeli authorities have released the names of 767 fatalities, whose identity had been confirmed, including 427 civilians, 282 soldiers, and 58 police officers. Among those civilians whose age is provided, 22 are children.
The cumulative number of IDPs since the start of hostilities in Gaza is estimated at over 1.4 million, including over 544,000 people staying in 147 UNRWA-DES, of whom 367,500 are in central and southern Gaza alone and 70,000 in 67 non-UNRWA schools, and about 101,000 took shelter in the Orthodox center, churches in Gaza city, hospitals, and other public buildings. In addition, the Ministry of Social Development estimates that there are about 700,000 IDPs with hosting families.
Overcrowding of UNRWA-DES in the central and southern areas has been increasing. 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 ’emergency standard’ is 15 litres. Overcrowding and shortages of basic supplies have triggered tensions among IDPs, alongside reports about cases of gender-based violence.
To cope with this situation, on 19 October, UNRWA established the first IDP tent camp in Khan Younis, consisting of 60 tents, hosting hundreds of IDPs.
Meanwhile, due to the security conditions, UNRWA is no longer able to assist or protect IDPs that remained in its DES in the northern Gaza governorates, who are unwilling or unable to evacuate, and does not have information on their needs and conditions.
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 most vulnerable people, including children, the elderly, those in need of medical care, people with disabilities, and pregnant women. It is feared that they are exposed to 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).
For the tenth 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.
On October 20, the 17 hospitals that are still operational in Gaza City, North Gaza, and one hospital in Rafah received evacuation orders from the Israeli military. These hospitals have not been evacuated yet because doing so would immediately endanger the lives of vulnerable patients. There is extremely limited capacity and space to transfer them to other hospitals.
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. Only eight (out of 22) of UNRWA health centres in Middle, Khan Younis and Rafah governorates are providing primary health care services to critical outpatients and patients in need of treatment for non-communicable diseases.
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 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.
Three out of the five WFP-surveyed bakeries ceased operations on 20 October, due to fuel shortages and a lack of essential ingredients, while another bakery, which was providing bread for about 12,000 people, was forced to shut down after sustaining damage from an Israeli airstrike on 18 October.
Wheat flour across Gaza is expected to be depleted in about five days. Moreover, only one out of the five mills in Gaza are currently operational.
On 20 October, 12 WFP-contracted shops in the Gaza Strip (six in the northern governorates and six in the southern governorates) reported that the available stock for most food items is projected to last for only five days. Many retailers are encountering substantial challenges when restocking from wholesalers, predominantly located in Gaza City, due to widespread destruction and security concerns.
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.
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.
Hundreds of aid-laden trucks are being prepared to enter Gaza from Egypt, with more than 3,000 tons of aid set to be delivered, under the supervision of the United Nations through the Rafah crossing, which remains closed for the tenth consecutive day.
Speaking at the Rafah side of the crossing, on 20 October, the UN Secretary-General indicated that there are agreements in principle between Egypt and Israel regarding the opening of the crossing for humanitarian aid, but there is a “need to overcome the conditionalities and the obstacles that still exist.”
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 and 19 October, in three different raids, Israeli forces arrested more than 100 Palestinian workers from Gaza in the Bethlehem and Hebron Governorate.
Access to the sea has been prohibited by the Israeli military, and all fishing activity has ceased since the hostilities began. Access to areas near Israel’s perimeter fence remains prohibited, and it has expanded from 300 to 1,000 metres from the border, barring entry to substantial agricultural areas. Alongside safety concerns, this stretch has led to reduced crop yields, directly affecting hundreds of thousands of farmers.
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 16 UNRWA staff have been killed, with over ten other staff members injured. According to UNRWA, the actual number is likely to be significantly higher, as these figures encompass only those cases that the Agency has been able to confirm.
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 ceasefire, 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.
In the West Bank, three additional Palestinian fatalities, all children, were recorded in the past 24 hours (as of 21:00).
Israeli forces killed two of these children (15- and 16-year-old) during confrontations between Palestinians and Israeli forces that have been ongoing in the Nur Shams refugee camp (Tulkarm) since yesterday morning and involved exchange of fire. During this 27-hour-long incident, 13 Palestinians, including six children, as well as one member of Israeli forces were killed. Additionally, 62 Palestinians and nine members of Israeli forces were injured. Extensive damage to roads and other infrastructure was reported. Humanitarian partners are set to conduct a needs assessment as soon as the conditions allow so.
Israeli forces shot and injured another Palestinian child (15-years-old) on 20 October during confrontations that erupted in Beitunia (Ramallah) following a search-and-arrest operation and subsequently died of his wounds.
Since the start of the escalation, and by 21:00 on 20 October, Israeli forces in the West Bank had killed 82 Palestinians, including 25 children. An additional six Palestinians, including one child, were killed by Israeli settlers in Qusra (Nablus) and Dura al Qar'a (Ramallah). As reported above, one member of Israeli forces was reportedly killed by Palestinians.
Additionally, since 7 October, Israeli forces have injured 1,391 Palestinians, including at least 134 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 biweekly average of such injuries between 1 January to 7 October 2023.
Settler violence across the West Bank, especially in Palestinian communities near Israeli settlements, has been on the rise. Since 7 October, OCHA has recorded 102 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.
Since 7 October, WHO has documented 81 attacks on health care in the West Bank affecting 64 ambulances and including 45 attacks involving obstruction to delivery of health care; 44 involving physical violence towards health teams; 16 involving detention of health staff and ambulances; and nine involving militarized search of health assets.
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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.