Hostilities in the Gaza Strip and Israel | Flash Update #156

The OCHA OPT Flash Update is published three times a week, with an update on the West Bank included once a week on Wednesdays. The next update will be issued on 24 April.

Key Highlights

• There is a “palpable aura of fear” among displaced people in Rafah, states UNRWA, as airstrikes heighten concerns of a military escalation. 
• Only three hospitals are currently providing maternal care across Gaza while an estimated 180 women are giving birth every day, UNFPA reports. 
• About 12,340 tons of cooking gas, or an average of 82 tons per day, have entered Gaza since November, according to UNRWA; this is 68 per cent less than the daily average in the first nine months of 2023.  
• Four bakeries have resumed operations in northern Gaza, but this is still a “drop in the bucket,” warns WFP.

Gaza Strip Updates 

• Israeli bombardment from the air, land, and sea continues to be reported across much of the Gaza Strip, resulting in further civilian casualties, displacement, and destruction of houses and other civilian infrastructure. Airstrikes on Rafah, Deir al Balah, and Gaza city have reportedly been especially intense, with continued reports of fighting between the Israeli military and armed Palestinian groups in northern Gaza.   
• Between the afternoons of 19 April and 22 April, according to the Ministry of Health (MoH) in Gaza, 139 Palestinians were killed and 251 injured, including 54 killed and 104 injured in the last 24 hours. Between 7 October 2023 and 12:30 on 22 April 2024, at least 34,151 Palestinians were killed in Gaza and 77,084 Palestinians were injured, according to MoH in Gaza.  
• The following are among the deadliest incidents between 18 and 20 April: 
  • On 18 April at about 13:55, three Palestinians were reportedly killed and others injured when a group of people were hit in eastern Jabalya Refugee Camp in northern Gaza. 
  • On 18 April at about 18:15, at least three Palestinians were reportedly killed and others injured when a residential building was hit in Ash Sheikh Radwan area in Gaza city. Others are reported to be missing under rubble.  
  • On 18 April at about 21:00, four Palestinians were reportedly killed and three injured when a residential building was hit in Ash Shati’ (Beach) Refugee Camp in western Gaza city. 
  • On 19 April, at about 22:20 hours, nine Palestinians, including six children and two women, were reportedly killed when a residential apartment near Al Quds University building in Tal As Sultan area, west of Rafah, was hit. 
  • On 20 April at about 22:30, four Palestinians, including a girl and a pregnant woman, were reportedly killed when a house was hit near An Najma Square in Ash Shabora Refugee Camp in Rafah. 
  • On 20 April at about 23:20, at least 16 Palestinians, including 13 children and three women, were reportedly killed when a house was hit in At Tanour area in eastern Rafah. 
  • On 20 April at about 17:35, two Palestinians were reportedly killed, and ten others injured, when a location was hit in Al Mawassi area sheltering internally displaced persons (IDPs) in western Khan Younis. 
• Between the afternoons of 19 and 22 April, no Israeli soldiers were reported killed in Gaza. As of 22 April, 259 soldiers have been killed and 1,583 soldiers have been injured in Gaza since the beginning of the ground operation, according to the Israeli military. In addition, over 1,200 Israelis and foreign nationals, including 33 children, have been killed in Israel, the vast majority on 7 October. As of 22 April, Israeli authorities estimate that 133 Israelis and foreign nationals remain captive in Gaza, including fatalities whose bodies are withheld. 
• Airstrikes on Rafah have heightened concerns of an escalation in this southernmost area of Gaza, which is already hosting over half of Gaza’s population, many of whom have been displaced multiple times and are living in desperate conditions. On 21 April, the Deputy Humanitarian Coordinator and Deputy Director of UNRWA Operations in Gaza, Scott Anderson, reported that there was a “palpable aura of fear” among displaced people in Rafah about the prospect of a ground operation and stressed  the importance of allowing civilians to relocate in search of a safer place if an operation takes place. Anderson also underscored that combatting the spread of disease is as much a priority as delivering food assistance at this time, as the sanitation crisis has been exacerbated by the absence of mechanisms to collect thousands of pounds of accumulated waste, the lack of insecticides to control vectors, and rising temperatures. Moreover, on 22 April, the MoH in Gaza stressed that a ground operation into Rafah would effectively destroy what remains of the health system in Gaza, further depriving people of health services.   
• An estimated 180 women are giving birth every day in Gaza in “inhumane, unimaginable conditions,” stated the UNFPA representative in the occupied Palestinian territory, Dominic Allen, in a press briefing on 19 April, following a ten-day mission to Gaza between 8 and 17 April. Only three of the 11 hospitals that are still partially functioning across Gaza provide maternal care: As Sahaba in northern Gaza, Al Awda in Deir al Balah, and Al Emirati in Rafah. As part of an inter-agency mission to Khan Younis, Allen described seeing cables of ultrasound machines cut and screens of complex medical equipment smashed at Nasser Hospital.  Allen added that no medical equipment was functional at Al Khair hospital and there was an “eerie sense of death” in the birthing rooms. In Deir al Balah, Al Aqsa Hospital is so overwhelmed with trauma patients that it no longer provides maternity care. In Rafah, where Al Emirati Hospital represents a lifeline for pregnant women despite facing major capacity gaps, supporting 50-60 births per day including 10-12 caesarean sections, there is deep fear gripping the population that this last haven would be destroyed in the event of a military ground incursion, stressed Allen. To enhance overall capacity, UNFPA is delivering mobile maternity units and emergency obstetric care units to two of the six field hospitals operational in Gaza. UNRWA, the Palestinian Medical Relief Society (PMRS) and UNFPA have also deployed midwives to three UNRWA shelters to mitigate shortages in pre- and post-natal care, with efforts ongoing to scale-up this project. However, among wider access constraints and challenges in bringing necessary maternal health supplies and equipment into Gaza, Allen reported an instance when torches were removed from midwifery kits and another when the oxygen machine was removed from a prefabricated maternity unit during inspection at Kerem Shalom Crossing. In his briefing, the UNFPA official also underscored the heightened risk of gender-based violence (GBV), including child marriage, faced by women and girls in Gaza, and the efforts made by UNFPA and partners to re-establish support services for GBV survivors that have been largely destroyed by over six months of hostilities. Urging a massive increase in the influx of aid entering Gaza, Allen echoed the UN Secretary-General’s call for an immediate humanitarian ceasefire as the only solution to this ongoing catastrophe. 
• Food production across Gaza continues to be severely impeded by dire shortages of fuel, including cooking gas. According to UNRWA, between 24 November 2023, when Israel first permitted the entry of Egyptian-imported cooking gas into Gaza, and 21 April 2024, about 12,340 tons of cooking .gas was allowed into Gaza. This is an average of about 82 tons per day, which falls short of requirements and is 68 per cent less than the daily average between January and September 2023 (260 tons). According to the Government Media Office (GMO) in Gaza, the impact of fuel and cooking gas shortages is particularly severe in northern Gaza, where families have been forced to rely on expensive and unsafe alternatives, such as firewood, charcoal, plastic and chemicals. The resultant emission of toxic gases has led to the spread of respiratory diseases, according to GMO. Longstanding constraints on the entry of fuel have also affected food production facilities, including restaurants and bakeries, limiting people’s access to nutritious meals and exacerbating food insecurity. This month, the World Food Programme (WFP)  supplied fuel and wheat flour to bakeries in northern Gaza, enabling four bakeries to resume operations after being inactive for more than 170 days. WFP Executive Director Cindy McCain emphasized the significance of this effort, stating: "In northern Gaza, this is what humanitarian access looks like: fuel, flour and now bread for families who haven’t had it in months. An important step, but a drop in the bucket. WFP and our partners need accelerated access into and across Gaza to prevent the possibility of famine."   
• According to the Cash Working Group, the very limited entry of commercial supplies into Gaza and the complete disruption of the private sector supply chain have resulted in a near total disappearance of the formal market and high price volatility, with significant fluctuations in key commodity prices reported since 7 October. On 14 April, the Palestinian Central Bureau of Statistics (PCBS) reported that the Consumer Price Index had climbed by 165 per cent since the onset of the conflict, with an increase of over 25 per cent only between February and March 2024, and purchasing power has plummeted by 62 per cent. Informal markets have thus become a primary source for accessing essential goods, including food and water, and meeting basic household needs. In addition, displacement and loss of infrastructure has reduced the number of financial agents available for people to receive cash assistance, especially in northern Gaza.  There is also a liquidity shortage, mainly in southern Gaza, driven by the inability of banks to move cash between branches. Despite these challenges, up to 72 per cent of people who have received Multi-Purpose Cash Assistance (MPCA) have been able to draw these resources. As of 22 April, one round of emergency MPCA has been delivered to about 124,630 households and over 27,780 households have received a second round. A top-up has also been delivered to 34,000 people, including persons with disabilities and nursing mothers. According to post-distribution monitoring (PDM) data, most respondents reported a preference for cash in all assessed locations, cash assistance has helped them to meet some, or all, of the basic households needs, and most of the MPCA was reportedly spent on food, followed by medicine and drinking water.  

West Bank  

• Between 18 and 20 April, Israeli forces killed 14 Palestinians during a 50-hour operation in Nur Shams Refugee Camp and its surrounding area. During the operation, exchanges of fire between the Israeli military and armed Palestinians were reported, along with the sound of explosions. Initial reports indicate severe damage to civilian infrastructure, including residential homes, commercial stores, roads, electricity infrastructure, and water, sewage and telecommunication networks. Further technical assessments are planned. 
• On 20 April, a 50-year-old Palestinian ambulance driver was shot and killed by either Israeli settlers or Israeli forces while evacuating two Palestinians injured during an attack by Israeli settlers in As Sawiya village in Nablus governorate. About 50 settlers believed to be from Eli settlement had raided the village, shooting and throwing stones while Palestinian residents gathered and threw stones at the settlers. Israeli forces also raided the village and opened fire. In a statement on 21 April, the International Federation of Red Cross and Red Crescent Societies (IFRC) said it was appalled by the killing, noting that since the onset of hostilities, “eighteen staff members and volunteers of the PRCS [the Palestinian Red Crescent Society] have been killed in Gaza and now the West Bank and four from Magen David Adom in Israel.” 
• A full weekly update on the West Bank will be published on 24 April. 

Funding 

• On 17 April, the Humanitarian Country Team released a new Flash Appeal for the occupied Palestinian territory (OPT), which requests US$2.8 billion to meet the most critical needs of 2.3 million people in Gaza and 800,000 people in the West Bank, including East Jerusalem, between April and December 2024. The figure reflects what is deemed most likely to be implemented over the next nine months, under access constraints and security challenges that limit the rapid scale-up of the humanitarian response, and represents only a part of the requirement that the UN and partners estimate is needed to meet the scale of humanitarian needs across the OPT. This Flash Appeal replaces the previous appeal launched in October 2023 and extended until March 2024, which sought $1.23 billion; roughly half of this amount was utilized in the last quarter of 2023 and the remaining half in the first quarter of 2024. 
• The OPT HF has 118 ongoing projects, for a total of $72.5 million, addressing urgent needs in the Gaza Strip (85 per cent) and West Bank (15 per cent). In light of the updated Flash Appeal, the HF has allocated an additional $22 million to bolster prioritized HF-funded projects in Gaza to enhance the operational capacity of humanitarian partners as well as ensure the continuity and expansion of essential services amid escalating challenges. In the West Bank, the OPT HF has allocated $5 million for key partners to enhance system readiness and responsiveness to sudden-onset emergencies. Since 7 October, the OPT HF has mobilized $90 million from Member States and private donors, designated for programmes throughout Gaza. A summary of the OPT HF activities and challenges in March 2024 is available through this link and the 2023 Annual report of the OPT HF can be accessed here. Private donations are collected directly through the Humanitarian Fund. 

For the Humanitarian Needs and Cluster Response Update for the period between 16 and 22 April, please visit: Humanitarian Needs and Response Update | 16–22 April 2024. It is updated throughout the week to reflect new content. 

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