Hostilities in the Gaza Strip and Israel | Flash Update #23

KEY POINTS

• On 28 and 29 October, the vicinities of Shifa and Al Quds hospitals in Gaza city and of the Indonesian hospital in northern Gaza have been reportedly bombarded, causing damage. This followed renewed calls by the Israeli military to evacuate these facilities immediately. All 13 hospitals* still operational in Gaza city and northern Gaza have received repeated evacuation orders in recent days. Thousands of patients and medical staff, as well as about 117,000 internally displaced persons (IDPs), are staying in these facilities. 
• On 28 October, the World Health Organization (WHO) called upon “all parties to the conflict to take all precautions to protect civilians and civilian infrastructure [including] health workers, patients, health facilities and ambulances, and civilians who are sheltering in these facilities.” WHO reiterated “that it is impossible to evacuate patients without endangering their lives.” On 26 October, the Humanitarian Coordinator for the Occupied Palestinian Territory, Lynn Hastings, stated  that “for people who can’t evacuate – because they have nowhere to go or are unable to move – advance warnings make no difference.” 

• On 28 October, thousands of people broke into several UNRWA warehouses and distribution centres in the middle and southern areas of Gaza, taking wheat flour, hygiene supplies and other items. On 29 October, UNRWA’s Operations Director, Tom White, indicated that “this is a worrying sign that civil order is starting to break down after three weeks of war and a tight siege on Gaza.” 
• On 29 October, at least 33 trucks carrying water, food, and medical supplies entered Gaza through the Rafah crossing with Egypt. This is the largest delivery of humanitarian aid since 21 October, when limited deliveries resumed. While this increase is welcome, a much larger volume of aid is needed on a regular basis to prevent further deterioration in the dire humanitarian situation, including civil unrest. In particular, entry of fuel to operate medical equipment and water and sanitation facilities is urgently required. 
• Telecommunication in Gaza, including cellular lines and internet services were largely restored by the morning of 29 October, after being shut down on the evening of 27 October. 
• 302 Palestinians were killed in Gaza between 18:00 on 28 October and noon on 29 October, according to the Ministry of Health (MoH) in Gaza. This brings the cumulative reported fatality toll in Gaza since the start of hostilities to 8,005, of whom 67 per cent are reportedly children and women.  
• As of 29 October, more than 1.4 million people in Gaza were internally displaced, with some 671,000 sheltering in 150 UNRWA facilities. The average number of IDPs per shelter is over three times their intended capacity.  
• Palestinian armed groups’ indiscriminate rocket firing towards Israeli population continued over the past 24 hours, with no fatalities reported. Overall, about 1,400 Israelis and foreign nationals have been killed in Israel, according to the Israeli authorities, the vast majority on 7 October. 
• According to the Israeli authorities, 239 people are held captive in Gaza, including Israelis and foreign nationals. Forty people are still reported missing. Media reports indicated that about 30 of the hostages are children. Four adult hostages were released on 20 and 23 October. On 26 October, Hamas claimed that 50 of the hostages had been killed by Israeli airstrikes. 
• In the West Bank, Israeli forces killed four Palestinians between the afternoon of 28 October and 21:00 on 29 October. During this time, another Palestinian died of wounds sustained previously. This brings the total number of Palestinian fatalities by Israeli forces or settlers since 7 October to 115, including 33 children, alongside one Israeli soldier killed by Palestinians. 
• Nearly 1,000 Palestinians have been forcibly displaced from their homes in the West Bank since 7 October. This includes at least 98 Palestinian households, comprising over 800 people, driven out from 15 herding/Bedouin communities in Area C, amid intensified settler violence and access restrictions. Another 121 Palestinians were displaced following the demolition of their homes by the Israeli authorities on grounds of lack of Israeli-issued building permits or on punitive grounds.  

Gaza Humanitarian Overview

Hostilities and Casualties

Israeli bombardment and airstrikes continued during the past 24 hours. According to the Israeli military spokesperson, Israeli forces expanded their ground operations within the Gaza Strip.  

While communication lines were largely restored by the morning of 29 October, it is difficult to assess the real extent of damages and fatalities on 27-29 October, with Civil Defense and medical personnel struggling to reach casualties. According to anecdotal evidence, in the north of Gaza, airstrikes appear to be systematically destroying sections of entire residential areas. 

Among the deadliest attacks reported in the past 24 hours were airstrikes targeting residential structures. In the early hours of 29 October, airstrikes reportedly struck a house in Jabalia, northern Gaza, killing 26 Palestinians, while 14 others are still under the rubble. About the same time, another house was hit in Khan Younis Camp, southern Gaza, killing 16 Palestinians and injuring 25 others. 

Since 7 October, 8,005 Palestinians have been killed, including at least 3,324 children and 2,062 women, and about 20,242 have been injured, according to the MoH in Gaza. Over two thirds of fatalities are said to have been killed in their homes alongside their family members. 

Among these fatalities, 995 have not been identified yet, including at least 248 children. As of 27 October, over 60 per cent of the fatalities were reported in the northern region of Gaza. 

As of 29 October, about 1,800 people, including at least 940 children, have been reported missing and may 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 missions, amid continuous airstrikes, severe shortage of fuel to run vehicles and equipment The Palestinian Red Crescent Society (PRCS) announced that, due to the lack of fuel, it was forced to reduce the number of ambulances it operates.  

Palestinian Civil Defense has stated that the decomposition of bodies under collapsed buildings, amid the limited rescue missions, raises humanitarian and environmental concern.  

According to the MoH in Gaza, as of 27 October, 192 Palestinian families had lost ten or more of their members, 136 Palestinian families had lost 6 to 9 members, and 444 families had lost two to five of their members.  

 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. Israeli media reported that, as of 25 October, the names of 1,117 of these fatalities have been released, including 808 civilians, 309 soldiers. Of those whose ages have been provided, 30 are children. 

Displacement

The cumulative number of IDPs since the start of hostilities in Gaza is estimated at over 1.4 million. This figure includes nearly 671,397 people staying in 150 UNRWA facilities, 121,750 sheltering in hospitals, churches, and other public buildings, and nearly 83,000 in 72 non-UNRWA schools. In addition, the Ministry of Social Development estimates that some 700,000 IDPs are residing with host families.  

Reports suggest that IDPs are moving from one area to another based on the availability of means to survive, food and water, and security concerns.  

As of 29 October, MoH in Gaza agreed to provide services to at least 117,000 IDPs sheltering in 13 hospitals and other health care facilities, mainly in Gaza city and north Gaza. These services will be administered through the Ministry of Social Development similar to the services provided in other public shelter centres. 

Over 15 percent 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.  

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). 

Basic services and livelihoods 

Electricity 

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.  

Health care 

Hospitals are facing an unprecedented level of devastation, primarily driven by the overwhelming number of injuries, critical shortages of vital resources and concerns of being targeted by airstrikes. Over the past 24 hours, on two separate occasions, the vicinity of the Al Quds hospital in the North of Gaza was bombarded; affecting staff, patients and 14,000 IDPs. In the same time period, residential buildings near the Indonesian Hospital, in Beit Lahia and Shifa Hospital in Gaza city, were hit, reportedly by airstrikes. 

Since the start of hostilities, over one-third of hospitals in Gaza (12 of 35) and nearly two-thirds of primary health care clinics (46 of 72) have shut down due to damage or lack of fuel, increasing the pressure on the remaining health facilities that are still operational. All ten hospitals* in the north have received evacuation orders. 

On 29 October, at least 33 trucks entered Gaza through the Rafah Crossing, including 12 trucks carrying medical supplies and 3 trucks carrying medical supplies and other items. 

Overall, at least 70 out of the 117 trucks that have entered Gaza through the Rafah crossing since 21 October, carried medical supplies. While limited in volume, these supplies play a crucial role in bolstering trauma response and sustaining essential healthcare services.  

The distribution plan for these supplies is based on the needs confirmed on the ground by technical officers, by WHO, and by PRCS in Gaza. After delivery into Gaza and reception, the technical officers accompany the supplies to each hospital. Post-delivery monitoring is carried out regularly to assess consumption.  

The ongoing hostilities have displaced most of the medical professionals in Gaza, forcing the hospitals to operate with less than one-third of their normal staffing levels, according to MoH in Gaza. The hospitals continue to suffer from a severe fuel shortage, leading to stringent rationing and limited use of generators for only the most essential functions. Moreover, maintaining and repairing backup generators, originally not intended for continuous operation, is growing increasingly challenging due to the scarcity of spare parts. 

Water, sanitation, and hygiene (WASH) 

Two out of the 33 trucks that entered Gaza on 29 October through the Rafah crossing carried WASH supplies and other items. Overall, out of the 117 trucks that have entered Gaza through the Rafah crossing since 21 October, at least 13 carried WASH supplies. 

On 29 October, the Israeli authorities informed the Palestinian Water Authority (PWA) that they would resume water supply from Israel to the Middle Area and that PWA personnel is authorized to repair the damage sustained by the relevant pipeline. Once repaired, this connection is expected to supply about 500 cubic metres of drinking water per hour. This would be the second pipeline from Israel (out of three) to resume operations, after the connection supplying southern Gaza was reactivated on 15 October. 

Additionally, water supply to the areas south of Wadi Gaza have witnessed significant improvement since 22 October, following daily deliveries of small amounts of fuel by UNRWA and UNICEF from their reserves within Gaza to key water facilities.  

These deliveries have enabled two seawater desalination plants in the Middle Area and Khan Younis to resume operations at 30 per cent of their full capacity (the third seawater desalination plant in northern Gaza remains closed). Furthermore, the supply of piped water to other areas in the south, primarily brackish water, was made possible by the operation of 120 water wells and 20 pumping stations. On the other hand, about 70 per cent of leakage was identified in one of the main pipelines between Rafah and Khan Younis, due to the damage it sustained, compelling water providers to resort to less efficient water trucking. 

Food security 

As of 29 October, only one of the bakeries contracted by the World Food Programme (WFP), and eight additional bakeries (one in Rafah, four in Khan Younis, and three in the Middle area) are operational and supplying bread to shelters. The shortage of fuel is the primary obstacle preventing these bakeries from meeting local demand. Unless fuel is allocated to them, most bakeries will shut over the next few days.  

During the same nine-day period, ten bakeries were struck and destroyed; six in Gaza city, two in northern Jabalia, and two in the Middle Area (Maghazi Camp and Nusseirat). As a result, people are struggling to obtain bread. Long queues between 4-6 waiting hours are reported in front of bakeries, where people are exposed to airstrikes.  

WFP estimates that current stocks of essential food commodities in Gaza are sufficient for about eight days. However, at the shop level, the available stock is expected to last for five days. Retailers are facing significant challenges when restocking from wholesalers due to widespread destruction and lack of security. 

Out of the 117 trucks that have entered Gaza through the Rafah crossing since 21 October, at least 57 carried food and three carried nutrition items, including ready-to-eat food such as canned tuna, canned meat, and other non-perishables. All food items are being distributed in UNRWA shelters. With delivery, WFP began the distribution of corned beef and canned tuna at a DES in the Khan Younis Training Center. 

Movement and access 

Thirty-tree trucks with humanitarian supplies entered on 29 October through the Rafah crossing with Egypt after passing through Nitzana crossing between Israel and Egypt (about 40 kilometres south of Rafah) for security checks by the Israeli authorities. The trucks contained beds, food, medical and WASH items. 

Prior to the hostilities, patients, including some 2,000 cancer patients from Gaza, had been referred for regular treatment in hospitals in East Jerusalem and Israel. However, this practice has been halted since 7 October.  

Access to the sea along Gaza’s shore has been prohibited by the Israeli military, and all fishing activity ceased when 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.  

Humanitarian operations 

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. 

On 28 October, thousands of people entered several UNRWA warehouses and took food supplies and hygiene kits. One of the warehouses, in Deir al Balah, is where UNRWA stores supplies from the humanitarian convoys coming from Egypt. 

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). 

As of 27 October, about US$107.93 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 37 per cent of the estimate required when the Appeal was first launched. Of the total amount pledged, 88 per cent are for UN agencies and 12 per cent for national and international NGOs. About $81.85 million were earmarked for UNRWA; $7.1 million for WHO, and $4 million for WFP.  

Private donations to the Occupied Palestinian Territory Humanitarian Fund are collected online through this link: crisisrelief.un.org/opt-crisis. 

West Bank Humanitarian Overview 

Casualties 

In the West Bank, between the afternoon of 28 October and 21:00 on 29 October, Israeli forces killed four Palestinians, and another one died from wounds sustained previously. Three Palestinians were killed during search-and-arrest operations in Beit Rima (Ramallah), Ad Duheisha Refugee Camp (Bethlehem), and Tammun (Tubas). In two separate incidents, one Palestinian was killed, and another died from wounds sustained after being shot by Israeli forces during confrontations that occurred during punitive demolitions in Askar and Balata Refugee Camps (both in Nablus). 

Since 7 October, Israeli forces and settlers have killed 115 Palestinians, including 33 children. Almost 50 per cent of the total were killed during confrontations that followed Israeli search-and-arrest operations; about 40 per cent in the context of demonstrations in solidarity with Gaza; and most of the remaining 10 per cent during attacks and alleged attacks by Palestinians against Israeli forces or settlers, and in settler attacks against Palestinians.  

Since 7 October, Israeli forces and settlers have injured 2,150 Palestinians, including at least 193 children. Some 27 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 average of such injuries between 1 January and 6 October 2023. 

Settler-related Violence 

The already high level of Israeli settler violence recorded during the first nine months of 2023 has sharply increased since the escalation of hostilities. Since 7 October, OCHA has recorded 167 settler attacks against Palestinians, resulting in Palestinian casualties (26 incidents), damage to Palestinian property (113 incidents), or both casualties and damage to property (28 incidents). This reflects a daily average of seven incidents, compared with three since the beginning of the year.  

More than one-third of the incidents involved threats with firearms, including shooting, by settlers. Almost half of all incidents involved Israeli forces accompanying or actively supporting Israeli settlers while carrying out the attacks. Many of the latter incidents were followed by confrontations between Israeli forces and Palestinians, where three Palestinians were killed, and dozens injured. Affected properties included 24 residential structures, 41 agricultural/animal-related structures, 73 vehicles and more than 650 trees and saplings. 

Displacement 

Since 7 October, 65 Palestinians have been displaced following demolitions in Area C and East Jerusalem, due to lack of permits, and another 20 following punitive demolitions, targeting the family homes of perpetrators and alleged perpetrators of fatal attacks against Israelis.  

In addition, there has been an increase in the displacement of Palestinians amid settler violence and access restrictions. Since 7 October, at least 98 households comprising 828 people, including 313 children, have been displaced in this context. The displaced households are from more than 15 herding/Bedouin communities.  

On 28 October, 24 Palestinians households, comprising 141 people, half of them children, were displaced from Khirbet Zanuta herding community in Hebron, after settlers pointed guns at them, threatening to kill them if they do not leave. The following day, the families dismantled about 50 residential and animal structures and left the area along with their 5,000 livestock. One of the family members, 43-year-old Abu Khaled, stated: 

“On 26 October, settlers attacked us, destroying our homes, water tanks, solar panels, and cars. That day, I felt the presence of death so tangibly as if I saw it with my own eyes. I was torn between staying in or leaving the place I love, where I belong, where I may die. On 28 October, I made the hardest decision in my life: to leave Zanuta and leave everything behind, as memories. I did this to protect my children." 

HUMANITARIAN NEEDS AND 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 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 change by the hour (partners currently using PalPay). 
• Depletion of stocked items to be purchased is worsening. 

Response to Date 

• Some 13,241 households started receiving Emergency MPCA (NIS754 or $187 per household) as of 26 October. Redemption rates reported as up to 86 per cent. 

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 

• Some 3,000 IDPs have received psychosocial support and social work intervention services from UNRWA social workers and counsellors since the crisis began. 
• In the West Bank, UNRWA provided psychosocial support services to 155 Palestinian workers from Gaza, in Hebron, Ramallah, and Tularm, and to 240 students at Nur Shams Boys’ schools. 
• One partner reached at least 4,000 IDPs in shelters in Gaza and provided psychological first aid (PFA) and needs assessment for non-food items (NFIs) and assistive devices. 
• Partners provided about 700 psychological, social, and legal consultations for gender-based violence (GBV) incidents. Furthermore, 1,144 first psychiatric medical services were provided for GBV cases. 
• UNICEF is leading the mapping of orphanages and shelters which host children with a view to support Unaccompanied and Separated Children (UASC) registration, to facilitate identification, reunification, and alternative care options at national level (both Gaza and WB). 

Shelter 

Priority Needs 

• Urgent need to provide services and basic shelter and NFI to IDPs.  
• Provision of NFIs 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 671,000 IDPs are hosted at 150 UNRWA schools across the Gaza Strip. 
• Distribution of 20,000 NFIs in Rafah and Khan Younis, including bedding sets and dignity kits. 
• Distribution of 820 hygiene kits to displaced families.  
• ICRC/PRCS distributed 15,500 NFIs for displaced families, mainly mattresses and blankets.  

Health 

Priority Needs 

• Improve the nutritional status, particularly of about 283,000 children under five and pregnant or lactating women, in response to the concerning food security and water situation in Gaza. 
• Ensuring the provision of Infant and Young Child Feeding in Emergencies, including preventive nutrition interventions, cash voucher assistance, curative nutrition interventions, intact nutrition supplies pipeline, and a functional nutrition coordination mechanism. 
• Addressing shortages of medical supplies impacting case management. 
• Fuel supply for hospitals and ambulances. 
• Urgent need to restock medical supplies given depletion of stocks in the local market. 
• Need for short and long-term mental health and psychosocial support services for large numbers of psychologically traumatized people. 
• Access to mobile clinics for 29 communities in Area C locations in Hebron, Jenin and Qalqiliya who have not had access since escalations began. 

Response to Date 

• UNRWA continues to provide primary healthcare services in the shelters, through 95 mobile medical units and medical teams.  
• PMRS has eight mobile health teams also providing primary healthcare services to IDPs and expects to increase the number to twelve. 
• Partners are continuing to mobilize resources in Cairo; with support from WHO, the Health Cluster has deployed a logistics team based in Cairo to assist partners with health coordination. 

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 

• Due to the complete internet and cellular blackout in the Gaza Strip, WFP was not able to contact contracted shops and bakeries, operations were at a halt for 36 hours. 
• UNRWA started distributing corned beef, together with the canned tuna distributed by WFP in the DES operating in the Khan Younis Training Center. 
• WFP reached some 550,000 people with emergency food and cash assistance since the crisis began, most of them IDPs in UNRWA DES. On 27 October, 22,493 displaced persons in UN shelters received fresh bread; As of 27 October, 12,821 people redeemed WFP’s cash-based transfer assistance in active shops. 

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. 
• Provision of alternative power supply and 20,000 litres per 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. 

Response to Date 

• Some 9,000 hygiene kits were distributed to the families in the UNRWA IDP centres since 7 October. 
• 1,950 cubic metres of drinking water have been trucked to IDP centres and host families since 7 October. 
• 175 cubic metres of bottled water distributed among IDPs in UNRWA shelters since 7 October. 
• Four water storage tanks with a capacity of 10 cubic metres and twenty others with a capacity of 1.5 cubic metres each to be used at community and IDP centre levels were received through Rafah crossing. 
• 8,000 unit of ten litres of water capacity were delivered through Rafah crossing 
• 4,000 purification water tools for the hosted families at the vulnerable communities and IDP centers were delivered through Rafah crossing. 

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.

* This figure has been rectified following the publication of this update.