Intense Israeli airstrikes and shelling across the Gaza Strip continued in the past 24 hours (as of 17:00 on 22 October). Nearly two-thirds of the fatalities during this period, 170 Palestinians, were recorded in the Middle Area, particularly in Al Bureij and Nuseirat camps and Deir Al Balah town, according to reports by medical and other sources. Airstrikes hitting three residential buildings in Khan Younis and Rafah reportedly resulted in the killing of 38 people. These localities are south of Wadi Gaza, the area into which Israeli authorities have ordered residents of northern Gaza to move. The targeting of multi-story residential buildings in Gaza city has continued, leading to at least 19 fatalities.
Since 7 October, 4,651 Palestinians have been killed, including at least 1,873 children and 1,023 women, and about 14,245 have been injured, according to the MoH in Gaza. The reported fatality toll in Gaza during the 15 days of hostilities is more than double the total number of fatalities during the 50-day escalation of hostilities in 2014 (2,251 Palestinian fatalities).
According to the MoH in Gaza, as of 22 October, 108 Palestinian families had lost ten or more of their members,99 Palestinian families had lost 6 to 9 members, and 367 families had lost two to five of their members.
In a press conference held on 21 October, the Israeli military’s spokesperson said that, since the start of hostilities, there had been 550 failed shootings of rockets fired by Palestinian armed groups towards Israel, which fell short in Gaza, killing a number of Palestinians.
The Gaza Ministry of Public Works reported the destruction of 15,749 housing units and the rendering of 10,935 housing units uninhabitable, as of 21 October. Another 142,500 housing units sustained minor to moderate damage. The total number of housing units destroyed or damaged accounts for at least 43 per cent of all housing units in the Gaza Strip. Entire neighbourhoods have been destroyed, particularly in Beit Hanoun, Beit Lahia, and Ash Shuja’iyeh, the area between Gaza and Ash Shati’ Refugee Camp, and Abbassan Kabeera. As of 19 October, New satellite imagery produced by UNOSAT shows the large scope of destruction .
As of 19 October, the World Health Organization (WHO) had documented 62 attacks on health care affecting 29 health care facilities (including 19 hospitals damaged) and 23 ambulances. Seven hospitals, all in Gaza city and northern Gaza, were forced to shut down due to the damage they sustained, lack of power and supplies and/or evacuation orders.
The extent of damage sustained by educational facilities and other civilian infrastructure is a growing concern. As of 21 October, 206 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. One university building sustained severe damage, and minor damage was reported in one Directorate of Education building and one Rehabilitation Centre for the Visually Impaired.
According to Israeli sources, at least 1,400 Israelis and foreign nationals have been killed in Israel, and at least 4,932 have been injured, the vast majority on 7 October. The reported 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 22 October, the Israeli authorities have released the names of 792 fatalities, whose identity had been confirmed, including 451 civilians, 283 soldiers, and 58 police officers. Among those whose age has been provided, 27 are children.
The cumulative number of IDPs since the start of hostilities in Gaza is estimated at over 1.4 million. This figure includes nearly 580,000 people staying in 150 UNRWA Designated Emergency Shelters (DES), 101,500 sheltering in hospitals, churches and other public buildings, and nearly 71,000 in 67 non-UNRWA schools. In addition, the Ministry of Social Development estimates that some 700,000 IDPs are residing with host families.
Overcrowding of UNRWA’s DES in the central and southern areas has been a major concern. The number of IDPs per shelter has reached in many shelters 4,400, while they were designed to host 1,500-2,000 IDPs per shelter. The most crowded shelter (Khan Younis Training Center) is currently hosting about 21,000 IDPs.
In many shelters, up to 70 people are accommodated in one classroom. To ensure a safer environment, at night, women and children remain in the classrooms, while men and adolescent boys stay outdoors in the schoolyard. Overcrowding and shortages of basic supplies have triggered tensions among IDPs, alongside reported gender-based violence.
Essential resources such as water, food, and medicine are in critical short supply. Despite the limited availability of fuel, desalination equipment in the UNRWA shelters have so far continued to operate and provide potable water, supplemented by water trucking.
Anecdotal evidence indicates that hundreds, and possibly, thousands, of IDPs are returning to the north, due to continuous bombardments in the south, and the inability to find adequate shelter. Since the beginning of hostilities (as of 21:00 on 22 October), 12 IDPs sheltering at UNRWA schools have been killed and about 180 have been injured.
Over 15 per cent of the IDPs are estimated to have disabilities, yet most shelters are not adequately equipped for their needs. Shelters lack the required medical mattresses and beds, causing ulcers and other medical issues that cannot be treated in unsterilized conditions. Similarly, the food distributed does not meet the needs of those with swallowing difficulties.
In Israel, hundreds of thousands of people residing near 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 thirteenth 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.
Goods that entered Gaza on 21-22 October via the Rafah crossing did not include fuel. On 22 October, UNRWA coordinated with the Israeli and local authorities the transport of fuel stored in a facility within Gaza adjacent to the Rafah crossing, and its distribution to DES and hospitals.
Thirteen of the 20 trucks that entered Gaza through the Rafah crossing on the 21 October carried medical supplies. Four of the trucks were from WHO and which stated, “the supplies include trauma medicines and supplies for 1,200 people and portable trauma bags for on-the-spot stabilization of up to 235 injured people. They also include chronic diseases medicines and treatments for 1,500 people and basic essential medicines and health supplies for 300,000 people for three months.” The other nine trucks were with medical supplies from Egyptian Red Crescent and Qatar. Additional supplies entered today (22 October). Some of the trucks entering on 22 October also carried medicines.
All 17 operational hospitals in Gaza city and north Gaza have remained so despite calls by the Israeli military to evacuate them. According to Health partners, this would endanger the lives of vulnerable patients and there is also extremely limited capacity and space to transfer them to other hospitals.
Shifa hospital in Gaza city, the largest in the Strip, is currently treating some 5,000 patients, significantly over its capacity of 700 patients, in addition to approximately 45,000 IDPs taking refuge within and around the hospital. The Al Quds Hospital, also in Gaza city, is accommodating more than 400 patients and about 12,000 IDPs.
These and other hospitals are on the brink of collapse due to the shortage of electricity, medicine, equipment and specialized personnel. Large numbers of patients are being treated on the ground given there are not enough hospital beds. Only eight of UNRWA’s 22 health centres in Middle Area, Khan Younis and Rafah governorates, are providing primary health care services.
About 130 premature babies across the Gaza Strip, being treated in incubators for their survival, are at heightened risk, according to the MoH Gaza. In Shifa Hospital, an eight-day-old premature baby was transferred from another hospital after his home was hit on 15 October, with his entire family killed. His mother was 32-weeks-pregnant when she was injured. Medical teams managed to get her to the hospital, where she gave birth to her child just before dying. This eight-day-old premature baby is facing multiple health issues, with the added risk stemming from the shortage of fuel to power his incubator. The severe shortage of available fuel and medical supplies has forced the shutdown of seven incubators typically used for critical cases in Shifa Hospital. On 22 October, only incubators for moderate cases were operational in the premature baby department.
Two out of the 20 trucks that entered Gaza on 21 October via the Rafah crossing carried 44,000 units of bottled water supplied by UNICEF, which is enough for only 22,000 people for one day. A limited number of additional units of bottled water entered on 22 October.
The three seawater desalination plants, which, prior to the hostilities, produced seven per cent of Gaza’s water supply, are currently not operational, while only a few municipal groundwater sources operate at reduced levels. Water trucking operations came to a halt in most areas due to the lack of fuel, insecurity and roads being 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.
People are consuming saline water with over 3,000 milligrams per litre of salt content from agricultural wells. This poses an immediate health risk, raising hypertension levels, especially in babies under six months, pregnant women and people with kidney disease. The use of saline groundwater also increases the risk of diarrhea and cholera. Health partners have detected cases of chicken pox, scabies and diarrhea, attributable to the poor sanitation conditions and consumption of water from unsafe sources. The incidence of such diseases is expected to rise unless water and sanitation facilities are provided with electricity or fuel to resume operations.
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.
Eastern Khan Younis (Bani Suheila area) is currently one of the few areas where piped water is supplied to households for a few hours per day. This follows the Israeli authorities’ reactivation of one out of three water lines servicing this area on 15 October. 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 substantial 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.
On 22 October, UNRWA distributed wheat flour to 16 bakeries (seven in Rafah, seven in Khan Younis, and two in the central area) to boost bread production and reduce the price of bread.
Five of the 20 trucks that entered Gaza through the Rafah crossing on 21 October carried food items, including three with food parcels and two with canned tuna, and additional food supplied entered on 22 October.
On 21 October, the World Food Program (WFP) indicated that stocks of essential food commodities within Gaza were sufficient for about 13 days. However, at the shop level, the available stock is expected to last only for four more days. Despite the availability of essential food items, retailers are facing significant challenges when restocking from local wholesalers due to widespread destruction and insecurity.
Wholesalers are mainly in Gaza city and face difficulties distributing available food stocks to the southern region. Due to the shortage of flour and fuel, bakeries are unable to meet local demand for fresh bread and are at risk of shutting down. The only operative mill cannot transform wheat due to electrical power outages.
The electricity 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 inability to access fodder and damage from the airstrikes has had a significant impact on farmers, particularly small-scale breeders, leading to substantial losses among their animals, especially in the poultry sector. Currently, more than 500,000 layers are without fodder, which is anticipated to result in a disruption of egg production after just two weeks of limited access to feed. Additionally, a considerable loss of cattle is expected. Farmers are also experiencing crop losses 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 due to infrastructure damage and fuel shortage. Hostilities have resulted in cuts in two out of three fiber cables leaving Gaza, one of which was repaired after Israeli authorities granted the company a two-hour window for staff to fix one fiber cable.
For the second consecutive day, the Rafah crossing with Egypt opened for the passage of a limited number of trucks (as detailed above). As per the agreement reached between all stakeholders, trucks are directed first to the Nitzana crossing between Israel and Egypt (around 40 kilometres south of Rafah) for security checks by the Israeli authorities, before they are allowed through the Rafah crossing.
The Erez and Kerem Shalom crossings with Israel remain closed. Since 7 October, patients have not been referred to medical appointments in the West Bank or Israel. 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 public shelters in the West Bank. On 17 and 19 October, Israeli forces, in three separate raids, arrested more than 100 Palestinian workers from Gaza in the Bethlehem and Hebron Governorates.
Access to the sea along Gaza 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 key agricultural areas. The extension has led to reduced crop yields affecting hundreds of thousands of people harvesting crops.
All humanitarian agencies and personnel have faced significant constraints in providing humanitarian assistance, due to ongoing hostilities, movement restrictions and shortages of electricity, fuel, water, medicines, and other essential items. Humanitarian partners cannot safely access people in need and warehouses where aid supplies are stored. Since the start of hostilities, at least 16 health workers have been killed while on duty, along with 29 UNRWA staff.
Despite these challenges, 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, a secured, regular and sustainable access for humanitarian supplies and commodities across the Gaza Strip and significant funding for the 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, Israeli forces killed seven Palestinians since 21 October afternoon (by 21:00 on 22 October). This has brought the total number of Palestinians killed by Israeli forces or settlers since the start of the escalation to 91, including 27 children. One member of Israeli forces was killed by Palestinians in the West Bank.
Two of the Palestinian fatalities in the past 24 hours occurred during an Israeli airstrike targeting a mosque in Jenin Refugee Camp, where, according to the Israeli army, a cell was about to launch a large attack. In another incident, Israeli forces killed a Palestinian man and injured four others during a search’and’arrest operation in Askar Refugee Camp (Nablus). Additionally, in Al 'Arrub Refugee Camp (Hebron), Israeli forces opened fire at a Palestinian driver, who, according to Israeli sources, attempted to carry out a ramming attack, and killed him; Israeli forces reportedly prevented an ambulance from reaching him while he was bleeding on the ground.
In two search and arrest operations in Qabatiya (Jenin) and Tubas, Israeli forces shot and killed two Palestinians during clashes, one of which involved exchange of fire. Another Palestinian died of wounds sustained by Israeli forces on 13 October during a demonstration in Nablus.
Additionally, since 7 October, Israeli forces have injured 1,696 Palestinians, including at least 157 children. Another 38 Palestinians have been injured by settlers. Over 1,200 Palestinians have been injured, mostly by Israeli forces, in the context of demonstrations. Some 28 per cent of the injuries have been caused by live ammunition. The number of Palestinian injuries from live ammunition is almost eight times higher than the biweekly average number 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 113 settler attacks against Palestinians resulting in casualties or property damage, including some where Israeli forces were involved. This represents an average of seven incidents per day, compared with a daily average of three incidents per day since the beginning of this year.
On 21 October, armed settlers, reportedly from Meitarim settlement outpost, attacked Palestinian families in Khirbet Ar Ratheem herding community (Hebron), where they vandalized a residential structure, an animal shelter and a solar panel. A Palestinian family comprised of 16 membes, including 8 children, fled the area after settlers threatened them at gunpoint.
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.