Massive Israeli bombardments from the air and land intensified overnight across the Gaza Strip. The Israeli military indicated that they have attacked 320 targets, a three-fold increase compared to previous days. Among the deadliest attacks recorded in the past 24 hours were several airstrikes on residential buildings in Jabalia Refugee Camp, northern Gaza (at least 63 fatalities); Rafah city (at least 43 fatalities); in Deir Al-Balah (14 fatalities) and in Khan Younis (11 fatalities).
Furthermore, in the last 24 hours, two UNRWA installations, one in Al Bureij camp and the other in Nuseirat in the Middle area, sustained collateral damage due to airstrikes in the surrounding areas of these facilities.
Since 7 October, 5,087 Palestinians have been killed, including at least 2,055 children and 1,119 women, and about 15,273 have been injured, according to the MoH in Gaza. Some 67 per cent of the total Palestinian fatalities were reported in Gaza city and North Gaza governorates. The reported fatality toll in Gaza during the 17 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).
Additionally, about 1,500 people, including at least 800 children, have been reported missing and are presumed to be trapped or dead under 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 21 October, Israeli airstrikes hit a Civil Defense rescue team while on duty east of Rafah, killing one civil defense staff and injuring four others, bringing the fatality toll among Civil Defense members to 34.
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 rock ets 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 other units uninhabitable, as of 21 October. Another 142,500 housing units sustained minor to moderate damage. The total number of housing units reported as destroyed or damaged accounts for at least 43 per cent of all housing units in the Gaza Strip. Entire neighborhoods 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 23 October, the World Health Organization (WHO) has documented 72 attacks on health care in the Gaza Strip that have resulted in 16 fatalities and 30 injuries of health care workers on duty. The attacks have affected 34 health care facilities (including 19 hospitals damaged) and 24 ambulances. Twelve hospitals and 46 primary care clinics are no longer functioning, while all hospitals are implementing emergency contingency plans that affect functioning and access to health care. 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.
According to Israeli sources, at least 1,400 Israelis and foreign nationals have been killed in Israel, and at least 5,431 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 23 October, the Israeli authorities have released the names of 855 fatalities, whose identity had been confirmed, including 516 civilians, including 28 children, 281 soldiers, and 58 police officers.
The cumulative number of IDPs since the start of hostilities in Gaza is estimated at over 1.4 million. This figure includes nearly 590,000 people staying in 150 UNRWA 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 DES in the central and southern areas has been a major concern. The number of IDPs has reached in many shelters 4,400, while they were designed to host 1,500-2,000 IDPs per shelter. 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 fourteenth 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 entering Gaza since 21 October through the Rafah crossing have not included 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.
Four out of the 20 trucks that entered Gaza through the Rafah crossing on 23 October carried vital medical supplies. These supplies will play a crucial role in bolstering trauma response and sustaining essential healthcare services. WHO is coordinating with the Palestine Red Crescent Society (PRCS) to facilitate the swift delivery of these supplies to major hospitals. Since 21 October, 13 trucks with medical supplies have successfully made their way into Gaza.
As of 23 October, five of Gaza's main hospitals have erected tents within their compounds to accommodate patients due to a lack of available space. Shifa hospital in Gaza city, the largest in the Gaza Strip, is 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 the Middle Area, Khan Younis and Rafah governorates, provide primary health care services. The UNRWA stocks of medicines are critically decreasing with different medicines available for another 5-15 days.
In addition to the shortage of fuel, hospitals operations are undermined by the recurrent breakdown and malfunctioning of backup generators, which are not designed to operate uninterruptedly. Their maintenance and repair are increasingly challenging due to the lack of necessary spare parts.
The Ministry of Health has requested the deployment of international medical teams, particularly those with expertise in trauma and surgical care, to enhance the hospitals’ capacities and relieve the health workers who have been tirelessly working for the past 17 days. Although 14 teams worldwide are on standby, they cannot be deployed due to the ongoing siege.
Kidney failure patients are facing life-threatening risks. Prior to 7 October, the Ministry of Health in Gaza was running kidney dialysis services at six centres, conducting about 13,000 dialysis sessions every month. However, the severe shortage of fuel and essential medical supplies has compelled these centres to shorten dialysis sessions from 4 to 2.5 hours for more than 1,000 patients, including at least 30 children. Kidney failure patients now fear that they may soon be unable to access these vital dialysis services due to the unavailability of essential medical supplies. The Ministry of Health's supplies of kidney dialysis filters, cannulas, and blood transfer tubes are entirely depleted, with only a limited quantity remaining in the kidney dialysis departments.
The Water, Sanitation and Hygiene (WASH) Cluster reported that, since 22 October, the volume of water supplied from Israel to the western Khan Younis area declined by some 20 per cent (from about 600 to 480 cubic metres per hour); the reasons are unclear. Meanwhile, water supply through two other pipelines from Israel is suspended since 8 October, including one line reaching Deir Al Balah town, located south of Wadi Gaza.
On 21 October, one of the three seawater desalination plants located in Khan Younis resumed operations at less than seven per cent of its capacity. This was made possible after UNRWA managed to coordinate the retrieval and distribution of fuel from one of its storage facilities in Gaza. The newly available water (some 450 cubic metres per day) is being trucked to UNRWA DES. The other two plants remain non-operational.
Water trucking operations by private suppliers 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 WASH Cluster.
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.
Eleven out of the 20 trucks that entered Gaza through the Rafah crossing on 23 October carried food items, including food parcels, canned tuna, and wheat flour.
Currently, only five out of the 24 bakeries contracted with the World Food Programme (WFP) are operational and supplying bread to shelters. The shortage of fuel is the primary obstacle preventing these bakeries from meeting local demand for fresh bread, putting them at risk of shutting down. Bakeries are struggling, with long queues forming before dawn. The average waiting time is reportedly six hours, and people endure this wait to receive half the normal portion.
Furthermore, as of 23 October, 17 out of the 202 WFP contracted shops have been forced to close. This closure is a result of destruction caused by hostilities, particularly within Gaza city and North Gaza governorates, or due to security concerns and blocked roads caused by debris.
On 21 October, WFP indicated that stocks of essential food commodities within Gaza were sufficient for about 13 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 third 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 (about 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 35 UNRWA staff, six of whom were killed in the past 24 hours.
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, secured, regular and sustainable access for humanitarian supplies and commodities across the Gaza Strip and significant funding for the humanitarian response.
As of 23 October, about $99.6 million worth of pledges have been confirmed in support of the inter-agency Flash Appeal launched on 12 October by the oPt Humanitarian Country Team. This represents about 34 per cent of the $294 million estimated as required when the Appeal was first launched. About $70.6 millions of these pledges were earmarked for UNRWA.
In the West Bank, Israeli forces killed four Palestinians, including one child since the afternoon of 22 October (by 21:00 on 23 October). These fatalities were recorded during confrontations that erupted over the course of two search-and-arrest operations carried out in Al Jalazun refugee camp (Ramallah) and Zawata village (Nablus).
This has brought the total number of Palestinians killed by Israeli forces or settlers since the start of the escalation to 95, including 28 children. During that period, one member of Israeli forces was killed by Palestinians in the West Bank.
Additionally, since 7 October, Israeli forces have injured 1,700 Palestinians, including at least 157 children, in the West Bank. 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 120 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.
Settler violence continued unabated, targeting herding and farming communities. On 22 and 23 October, Israeli settlers reportedly vandalized more than 200 Palestinian-owned olive trees in As Sawiya (Nablus), Immatin (Qalqiliya) and Kafr ad Dik (Salfit). On 22 October, assailants believed to be from Asfar settlement set fire to several structures and tons of animal fodder in Jurat Al Kheil community (Hebron).
Since 7 October, WHO has documented 96 attacks on health care in the West Bank affecting 77 ambulances and including 49 attacks involving obstruction to delivery of health care; 53 involving physical violence towards health teams; 17 involving detention of health staff and ambulances; and ten 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.