Water distribution in Deir al Balah. Photo by UNRWA

Hostilities in the Gaza Strip and Israel | Flash Update #33

08 Nov 2023

KEY POINTS

About 50,000 more people evacuated the north of Gaza to the south through a “corridor” opened by the Israeli military on 8 November.
Hundreds of thousands of people remaining north of Wadi Gaza, including IDPs, are facing a dire humanitarian situation and are struggling to secure the minimum amounts of water and food to survive.
Due to the lack of fuel to run generators, Al Quds hospital in Gaza city shut down key services on 8 November, and Al Awda hospital, the only provider of maternity services in northern Gaza, warned about an imminent closure.
On 7 November, UNRWA and the World Health Organization (WHO) delivered medical supplies and medicines to Shifa hospital in Gaza city.
On 8 November, an UNRWA school in Gaza city sheltering thousands of displaced people was hit by an airstrike, resulting in dozens of Palestinians fatalities, according to initial reports.
Shelters are unable to accommodate for the overwhelming number of IDPs. In UNRWA shelters, every toilet is shared by 160 people on average.
The daily volume of humanitarian assistance entering from Egypt meets a fraction of people’s needs. Drinking water brought in serves just 4 per cent of Gaza’s residents, while desperately needed fuel remains banned.

Hostilities and casualties (Gaza Strip)

On 8 November, clashes between Israeli forces and Palestinian armed groups continued in and outside of Gaza city, as well as in the North Gaza governorate. Meanwhile, intense Israeli bombardments from the air, sea, and land continued across the Gaza Strip, while Palestinian armed groups continued launching projectiles toward Israel. The north and the south of Gaza have reportedly been disconnected by Israeli ground troops.
Between 7 November (14:00) and 8 November (14:00), 241 Palestinians were killed in Gaza, according to the Ministry of Health (MoH) in Gaza. Among the deadliest incidents was an airstrike in Gaza city that reportedly killed 43 members of one extended family. On 7 November, around 15:00, airstrikes reportedly hit two residential buildings in Deir al Balah, killing 23 Palestinians and injuring dozens of others.
The fatality toll reported by MoH in Gaza since the start of the hostilities stands at 10,569, of whom 67 per cent are said to be children and women. About 2,450 others, including 1,350 children, have been reported missing and may be trapped or dead under the rubble, awaiting rescue or recovery.
The reported fatalities since 7 October include at least 192 medical staff, according to the MoH Gaza. Of them, at least 16 were on duty when killed, according to WHO. The fatalities further include 92 UNRWA staff, and 18 Palestinian Civil Defense personnel.
As of 8 November, 32 out of the 37 journalists killed since the escalation of hostilities, were Palestinians from Gaza, according to the Committee to Protect Journalists (CPJ). Additionally, they stated that this is the deadliest month for journalists globally since their records began in 1992.
On 8 November, three Israeli soldiers were reportedly killed in Gaza, bringing the total number of soldiers killed since the start of ground operations to 33, according to official Israeli sources.
See the latest snapshot for more breakdowns.
On 8 November, the UN High Commissioner for Human Rights, Volker Türk, stated that “parties to the conflict have the obligation to take constant care to spare the civilian population and civilian objects, which remains applicable throughout the attacks. The actions of one party do not absolve the other party of its obligations under international humanitarian law. Attacks against medical facilities, medical personnel and the wounded and sick are prohibited.”

Access and movement (Gaza Strip)

On 8 November, the Israeli military continued calling on residents of the north to move southwards. For the fifth consecutive day, it opened a “corridor” along the main traffic artery, Salah Ad Deen Road, for residents to leave the north between 10:00 and 14:00, which was then extended by one hour, as people were still moving southwards. It is estimated that about 50,000 people evacuated during the day, the largest number since the corridor opened, bringing the estimated figure since 5 November to 72,000.
Clashes and shelling on and around the road reportedly continued, endangering evacuees with reports of corpses alongside the road. Most evacuees are moving on foot and Israeli military reportedly forced those evacuees who use vehicles to leave them at the southern edge of Gaza city, at Al Kuwaiti roundabout. The evacuees then walk 4-5 kilometres down the corridor, with an estimated distance of up to 20 kilometres for those traveling farthest.
One of the evacuees told OCHA observers: “I’ve come from Gaza city. I’ve come with tens of my family members, sisters, brothers, children, aunts, and cousins. My aunt is old and in a wheelchair. We managed to find transportation to drop us at the Kuwaiti roundabout and had to walk for about two hours. I saw a lot of damage on my way, I saw Israeli tanks and soldiers positioned at the eastern side of the road, near Netzarim, and they did not approach us. I saw a few dead bodies and body parts on the road. We had already been displaced inside one of the schools [in the north] and had to evacuate again due to the intensity of the bombardments. We couldn’t stay any longer.”
For unconfirmed reasons, the Rafah Crossing with Egypt did not open for the movement of people on 8 November.
A total of 106 trucks, primarily carrying food, medicines, health supplies, bottled water and hygiene products, crossed from Egypt into Gaza on 8 November, bringing the number of trucks that have entered Gaza since 21 October to 756. Prior to the start of hostilities, an average of 500 truckloads entered Gaza every working day.
The Kerem Shalom crossing with Israel, which prior to the hostilities was the main entry point for goods, remains closed, as does the Israeli pedestrian crossing of Erez.

Displacement (Gaza Strip)

About 1.5 million people in Gaza are internally displaced. Of them, nearly 725,000 are sheltering in 149 UNRWA facilities, 122,000 in hospitals, churches, and public buildings, 131,134 in 94 non-UNRWA schools, and the remainder with host families.
Overcrowding remains a major concern. More than 557,000 people are sheltering in 92 UNRWA facilities in the south, where shelters are unable to accommodate new arrivals. The number of toilets differs from one shelter to another; however, on average, 160 people sheltering in UNRWA schools facilities share a single toilet and there is one shower unit for every 700 people.
The worsening sanitary conditions, along with the lack of privacy and space, generate health and safety hazards. Thousands of cases of acute respiratory infections, diarrhea and chicken pox have been reported among people taking refuge at UNRWA shelters.
An estimated 160,000 IDPs are housed in 57 UNRWA facilities in the north. UNRWA, however, is no longer able to provide services in those areas and does not have accurate information on people’s needs and conditions since the Israeli evacuation order on 12 October.
See the live IDP dashboard for the latest figures and more breakdowns.

Electricity

Gaza remains under a full electricity blackout since 11 October, following Israel’s halt of its power and fuel supply, which triggered the shutdown of Gaza’s sole power plant.
The entry of fuel, which is desperately needed to operate electricity generators to run life-saving equipment, remains banned by the Israeli authorities.

Health care, including attacks (Gaza Strip)

On 8 November, Al Quds Hospital in Gaza city announced that its main generator had been shut down, and a smaller generator is being used instead to reduce fuel consumption. As a result, the surgical ward, oxygen generation plant and MRI ward, have had to shut down. The hospital will provide two hours of electricity a day for IDPs taking shelter in its facilities. The hospital has been isolated from neighbouring areas and is facing a severe shortage of food, baby formula, medicine and disposables.
On 8 November, areas in close proximity to the Al Quds hospital were struck, injuring patients and IDPs, and damaging buildings, according to the Palestine Red Crescent Society (PRCS). Medical teams were unable to reach the hospital or leave to retrieve injured people.
On 8 November, Al Awda Hospital indicated that its fuel stock will be exhausted within 30 hours. This hospital provides emergency services and specialized surgeries, and it is the only provider of maternity services in the northern Gaza Strip.
According to the Director of Surgery at Shifa Hospital in Gaza city, patients who have undergone surgery are at a high risk of infection due to the unhygienic conditions and lack of equipment. In some cases, wounds have been covered by white flies and their larva, risking tissue damage, bacterial infection, and septicemia.
On 7 November, UNRWA facilitated the delivery of the WHO’s much needed emergency medical supplies and medicines to Shifa hospital in Gaza city, north of the Gaza Strip. This is only the second delivery of lifesaving supplies to the hospital since the escalation of hostilities and the total siege of Gaza began.
WHO warned on 8 November of the risk of the rapid spread of infectious diseases and bacterial infections due to the water shortage and related consumption of contaminated water. Since mid-October, over 33,500 cases of diarrhea have been reported, of whom more than half were among children under five; by contrast, the monthly average of diarrhea cases in the latter group in 2021 and 2022 stood at 2,000.

Water and sanitation (Gaza Strip)

About half of the 120 municipal water wells across the Gaza Strip, which resumed operations on 6 November after receiving fuel from UNRWA and UNICEF, shut down on 8 November, and the rest are expected to do so on 9 November as fuel is exhausted. The water extracted from these wells is brackish and meant only for non-drinking domestic uses.
In the north, neither the water desalination plant nor the Israeli pipeline is operational. Municipal staff are struggling to access some of the water wells producing brackish water. For the past week, partners specializing in water, sanitation and hygiene (WASH) have been unable to distribute bottled water among IDPs accommodated in shelters in the north. While the situation remains largely unclear due to the hostilities and lack of access, there are serious concerns about dehydration and waterborne diseases following water consumption from unsafe sources.
In the south, the two desalination plants are currently operating at about 15 per cent of their capacity and supplying drinking water to IDP shelters through trucking. Two pipelines from Israel connected to the Deir al Balah and Khan Younis are also providing households connected to the network with driking water for a few hours per day.
UNRWA has been providing about 1.5 litres of potable water and 3-4 litres of non-potable water per person per day in all shelters in the south. In the largest shelter located in Khan Younis (over 21,700 IDPs), UNRWA in partnership with UNICEF, installed a desalination plant, which turns brackish water extracted from wells, into potable water.
Water entering from Egypt in bottles and jerry cans is only addressing 4 per cent of residents’ water needs per day, based on an allocation of three litres per person per day for all purposes, including cooking and hygiene; well below the minimum emergency standards. Water assistance is being primarily distributed in the south, where over 700,000 people have sought refuge in shelters.
Anecdotal reports indicate that people hosted or living near the sea, are reaching the beaches to bath and wash clothes in the sea, as well as carrying seawater to their homes and shelters for domestic consumption. This practice may carry various negative health ramifications. Even before the hostilities, seawater in most Gaza beaches was highly polluted, a situation that was exacerbated by the shutdown of all wastewater treatment and dumping of raw sewage to the sea.

Food security

As of 8 November, no bakeries were active in the north, due to the lack of fuel, water, and wheat flour, as well as the damage sustained by many. On 7 November, many people desperately looking for food reportedly broke into the last three bakeries with remaining stocks of wheat flour and took about 38 metric tons. Currently, wheat flour is reportedly no longer available in the market throughout the north.
Food security partners have been unable to deliver assistance in the north during the past eight days. Reports by IDPs indicate that no food is provided in the shelters and people are merely surviving with limited assistance by local NGOs and community-based organizations. There are indications of negative coping mechanisms due to food scarcity, including skipping or reducing meals and using unsafe and unhealthy methods for making fire. People are reportedly resorting to unconventional eating, such as combinations of raw onion and uncooked eggplant.
Access to bread in the south is also challenging. The only operative mill in Gaza remains unable to grind wheat due to a lack of electricity and fuel. Eleven bakeries have been hit and destroyed since 7 October. Only one of the bakeries contracted by the World Food Programme (WFP), along with eight other bakeries in the south, intermittently provides bread to shelters, depending on the availability of flour and fuel. People queue for long hours in front of bakeries, where they are exposed to airstrikes.
WFP and its partners report that some essential food items such as rice, pulses, and vegetable oil are nearly depleted in the market. Other items, including wheat flour, dairy products, eggs, and mineral water, have disappeared from the shelves in shops across Gaza over the past two days. Despite limited stock at the wholesale level, these items cannot reach retailers due to extensive damage, security issues, and the lack of fuel.
While about 9,000 tons of wheat grain are stored in mills in Gaza, a significant portion of it cannot be used, due to massive destruction, security concerns, and shortages of fuel and electricity.
Food supplies entering from Egypt include mainly ready-to-eat food (canned tuna and date bars) and are primarily distributed to IDPs and host families in the south.

Hostilities and casualties (Israel)

The indiscriminate firing of rockets by Palestinian armed groups towards Israeli population centres has continued over the past 24 hours, with no reported fatalities. As of 3 November, the names of 1,159 of fatalities in Israel have been released, including 828 civilians. Of those whose ages have been provided, 31 are children.
According to the Israeli authorities, 239 people are held captive in Gaza, including Israelis and foreign nationals. Media reports indicate that about 30 of the hostages are children. So far, four civilian hostages have been released by Hamas, and one female Israeli soldier was rescued by Israeli forces. Hamas has claimed that 57 of the hostages were killed by Israeli airstrikes.

Violence and casualties (West Bank)

No Palestinian fatalities were reported between the afternoon of 7 November and noontime on 8 November. Since 7 October, 150 Palestinians, including 44 children, have been killed by Israeli forces; and an additional eight, including one child, have been killed by Israeli settlers. Three Israelis have been killed in attacks by Palestinians.
The number of Palestinians killed in the West Bank since 7 October accounts for more than one-third of all Palestinian fatalities in the West Bank in 2023 (397). About 55 per cent of the fatalities since 7 October occurred during confrontations that followed Israeli search-and-arrest operations, primarily in Jenin and Tulkarm governorates. Some 30 per cent were in the context of demonstrations in solidarity with Gaza; eight per cent were killed in settler attacks against Palestinians, and the remaining seven occurred while attacking or allegedly attacking Israeli forces or settlers.
Since 7 October, Israeli forces have injured 2,397 Palestinians, including at least 253 children, over half of them in the context of demonstrations. Sixty-four Palestinians have been injured by settlers. Some 27 per cent of those injuries have been caused by live ammunition.
Since 7 October, OCHA has recorded 222 settler attacks against Palestinians, resulting in Palestinian casualties (28 incidents), damage to Palestinian-owned property (160 incidents), or both casualties and damage to property (34 incidents). This reflects a daily average of seven incidents, compared with three since the beginning of the year. Over one-third of these incidents included threats with firearms, including shootings. In nearly half of all incidents, Israeli forces were either accompanying or actively supporting the attackers.

Displacement (West Bank)

Since 7 October, at least 111 Palestinian households comprising 905 people, including 356 children, have been displaced amid settler violence and access restrictions. The displaced households are from 15 herding/Bedouin communities.
An additional 135 Palestinians, including 66 children, have been displaced since 7 October following demolitions in Area C and East Jerusalem, due to lack of permits, and another 27, including 15 children, following punitive demolitions.

Funding

On 7 November, the UN and its partners issued a plan that outlines the minimum necessary to scale up humanitarian operations in support of 2.2 million people in the Gaza Strip and 500,000 of the most vulnerable in the West Bank. An estimated US$1.2 billion is required to deliver existing humanitarian services amid ongoing hostilities. The UN has shared its response plan with potential donors and partners as part of an updated Flash Appeal.
Private donations are collected through the Humanitarian Fund.

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 27,634 households started receiving Emergency MPCA (NIS754 or $187 per household) as of 26 October. Redemption rates were 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 Tulkarm, 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 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 the registration of unaccompanied and separated children, to facilitate identification, reunification, and alternative care options at national level (both Gaza and the West Bank).

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 centres 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

Some 716,881 IDPs are hosted at 149 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 and 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 health-care services in the shelters, through 95 mobile medical units and medical teams.
PMRS has eight mobile health teams also providing primary health-care 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

On 2 November, WFP continued to assist UN shelters by distributing bread, tuna, date bars and food parcels for host communities.
Oxfam covered 189 households in the Gaza governorate.
Dan Church Aid (DCA) covered 18,000 households sheltering in UNRWA designated emergency shelters in the Gaza governorate.
Islamic Relief Palestine provided food assistance to 10,000 IDPs in non-UNRWA shelters or with host families.
Anera provides hot meals to a total of 120,000 people. Food parcels, 80 per cent to UNRWA DES shelters, 20 per cent to hosting communities and other smaller scale shelters. 2,000 households in North Gaza and 12,000 households in Khan Yunis have already been covered. Ten thousand households in the Middle Area are ongoing. Vegetable baskets to host families and small-scale shelters for 2,000 IDPs (UN shelter) in Khan Younis and 2,000 IDPs (UN shelter) in the Middle Area. Planning food parcels distributed covering 1,000 IDPs in collective shelters and host families.
Save the Children is providing food in-kind to 75,000 IDPs outside UNRWA shelters.
UPA in partnership with PARC is providing 617 food parcels in five different shelter schools.

Education

Priority needs

Safe access to schools and communities.

Response to date

Provision of emergency education supplies and learning, recreational kits/stationery to 11,250 children.
Provision of psychosocial support to 28,300 school-aged children
Provision of recreational activities for school-aged 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 centres, including drinking water and hygiene kits.

Response to date

Since 7 October WASH partners have provided:
Some 9,500 hygiene kits to families in the UNRWA IDP centres.
1,950 cubic metres of drinking water trucked to IDP centres and host families.
175 cubic metres of bottled water among IDPs in UNRWA shelters.
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 by communities and shelters.
8,000 units of ten litres of water capacity.
4,000 water purification tools for the hosted families in vulnerable communities and IDP centres.
211 cubic metres of fuel to WASH facilities.
5 cubic metres of anti-scaling to desalination plants.

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.