The evacuation of premature babies at risk from Shifa hospital to the southern Gaza Strip. Photo by UNICEF/El Baba, 19 November 2023

Hostilities in the Gaza Strip and Israel | Flash Update #44

19 Nov 2023

KEY POINTS

On 19 November, 31 out of the 36 premature babies, along with 16 staff and family members, were evacuated from Shifa Hospital, in Gaza city, to the neonatal intensive care unit of a maternity hospital, in Rafah, southern Gaza Strip. The remaining five babies had died in previous days due to the cut off of electricity and fuel. Another 259 patients who were unable to evacuate remain in Shifa, according to the Ministry of Health (MoH) in Gaza.
Over the past 24 hours, at least six Palestinian journalists have been killed in Gaza, according to media reports. The Committee to Protect Journalists (CPJ) has preliminarily documented the death of 48 journalists since 7 October, including 43 Palestinian, 4 Israelis and 1 Lebanese, making it the deadliest month for journalists since CPJ began gathering data in 1992.
The number of fatalities in the attack that directly hit Al Fakhouri school in Jabalia on 18 November is at least 24 people, as reported by UNRWA; others were injured. At the time of the incident, the facility was sheltering about 7,000 internally displaced persons (IDPs). A previous attack hitting this school, on 4 November, killed at least 12 people and injured 54. Since the start of hostilities, at least 176 IDPs have been killed in UNRWA premises and 778 have been injured, according to the agency.
On 19 November, the UN Secretary-General expressed his shock about the attacks hitting UNRWA schools and reaffirmed that UN premises are inviolable. He reiterated his call for an immediate humanitarian ceasefire and stated that “this war is having a staggering and unacceptable number of civilian casualties, including women and children, every day. This must stop.”
In the West Bank, on 19 November, Israeli forces killed a Palestinian man with a disability during an operation that involved armed clashes in Jenin Refugee Camp. This brings the total number of Palestinians killed by Israeli forces in the West Bank, including East Jerusalem, since 7 October to 200, including 52 children. Of these fatalities, 70 were recorded in refugee camps, the majority during operations carried out by Israeli forces, most of which involved armed clashes with Palestinians.
On 19 November, 69,000 litres of fuel entered Gaza from Egypt. The Israeli authorities have confirmed that they would start allowing the entry of a daily amount of approximately 70,000 litres of fuel from Egypt, which is well below the minimum requirements for essential humanitarian operations. Fuel is set to be distributed by UNRWA to support food distribution, and the operation of generators at hospitals, water and sanitation facilities, shelters, and other critical services.
On 19 November, UNRWA and UNICEF distributed 19,500 litres of fuel to water and sanitation facilities south of Wadi Gaza (hereafter: the south), enabling them to operate generators and resume their operation. This fuel is expected to last for about 24 hours. To the north of Wadi Gaza (hereafter: the north), all water and sanitation facilities are presumed to be shut down, and no distribution of bottled water has been taking place since the start of the Israeli ground operations on 28 October, raising grave concerns about dehydration and waterborne diseases.

Hostilities and casualties (Gaza Strip)

Intense ground clashes between Israeli forces and Palestinian armed groups continued in and around Gaza city, as well as in several areas in the North Gaza governorate, as well as in Khan Younis and east of Rafah (in the south). Airstrikes and shelling by Israeli forces also continued in multiple areas across Gaza. Israeli ground troops have maintained the effective severance of the north from the south along Wadi Gaza, except for the “corridor” to the south.
In two separate attacks reported on the afternoon of 18 November in Jabalia camp, two residential buildings were hit, reportedly killing 50 and 32 people, respectively.
Since 11 November, following the collapse of services and communications at hospitals in the north, the Ministry of Health (MoH) in Gaza has not updated cumulative casualty figures. Their reported fatality toll as of 10 November at 14:00 (latest update provided) stood at 11,078, of whom 4,506 were said to be children and 3,027 women. About 2,700 others, including some 1,500 children, have been reported missing and may be trapped or dead under the rubble, awaiting rescue or recovery. Another 27,490 Palestinians have reportedly been injured.
In the 24 hours preceding 18:00 on 19 November, seven Israeli soldiers were reportedly killed in Gaza, bringing the total number of soldiers killed since the start of ground operations to 69, according to official Israeli sources.
See the latest snapshot for more breakdowns.

Displacement (Gaza Strip)

On 19 November, the Israeli military continued calling on residents in the north to evacuate and move south through a “corridor” along the main traffic artery, Salah Ad Deen Road, between 7:00 and 16:00. OCHA’s monitoring team estimates that about 20,000 people moved during the day, most of whom arrived at Wadi Gaza by donkey carts or buses, and some on foot.
Israeli forces have been arresting some of the people moving through the “corridor.” IDPs interviewed by OCHA reported that Israeli forces had established an unstaffed checkpoint where people are directed from a distance to pass through two structures, where a surveillance system is thought to be installed. IDPs are ordered to show their IDs and undergo a facial recognition scan. The movement of unaccompanied children and separated families has been increasingly observed.
Over 1.7 million people in Gaza are estimated to be internally displaced, including almost 900,000 IDPs who are staying in at least 154 UNRWA shelters. UNRWA shelters are accommodating far more people than their intended capacity and are unable to accommodate new arrivals. According to preliminary reports, thousands of IDPs are seeking security and safety by sleeping against the walls of shelters in the south, out in the open.
Overcrowding is contributing to the spread of diseases, including acute respiratory illness and diarrhea, prompting environmental and health concerns. On average, there is one shower unit for every 700 people and a single toilet for every 150 people. The congestion is affecting UNRWA's ability to provide effective and timely services.
See the live IDP dashboard for the latest figures and more breakdowns.

Humanitarian Access (Gaza Strip)

Apart from fuel trucks, 30 humanitarian truckloads entered Gaza through Egypt on 18 November (all of them after 18:00), and another 69 trucks on 19 November (all before 18:00). Overall, between 21 October and 19 November at 18:00, 1,268 trucks of humanitarian supplies have entered Gaza via Egypt (excluding fuel).
On 17 November, the Egyptian border opened for the evacuation of 689 dual and foreign nationals and 41 wounded people. Between 2 and 17 November, nearly 6,500 dual and foreign nationals exited Gaza to Egypt.
The Kerem Shalom crossing with Israel, which prior to the hostilities was the main entry point for goods, remains closed. According to media reports, the Israeli authorities have rejected requests by Member States to operate this crossing to increase the entry of humanitarian aid.

Electricity

Since 11 October, the Gaza Strip has been under an electricity blackout, after the Israeli authorities cut off the electricity supply, and fuel reserves for Gaza’s sole power plant depleted.

Health care, including attacks (Gaza Strip)

Thirty-one out of the 36 premature newborns in Shifa hospital were evacuated in temperature-controlled incubators to the Al Helal Al Emarati Hospital in Rafah, where their condition is now being stabilized and they are being cared for in the neonatal Intensive Care Unit. The newborns’ condition was rapidly deteriorating in their previous location, where the remaining five babies had died following the collapse of medical services. UNICEF and partners are supporting the identification and registration of the babies to help trace and reunify them with their parents and family members where possible. OCHA coordinated access to the hospital and back to ensure the safety of the medical evacuation operation.
On 19 November, Israeli raids reportedly continued in Shifa hospital, with at least one patient being arrested during searching and interrogation by Israeli forces.
As of 17 November, the World Health Organization (WHO) documented more than 44,000 cases of diarrhea and 70,000 acute respiratory infections in Gaza shelters, but actual numbers may be significantly higher. Furthermore, they stated that rains and floods during the approaching winter season are likely to make an already dire situation even worse.

Water and sanitation (Gaza Strip)

On 19 November, UNRWA and UNICEF distributed 19,500 litres of fuel to water and sanitation facilities across the south, enabling them to operate generators and resume operations, more than a week after they had been forced to shut down. The fuel supplied during the day is expected to last for about 24 hours. The facilities supplied include one seawater desalination plant in Khan Younis, currently producing 2,500 cubic metres of potable water per day, 50 municipal wells, producing non-potable water for domestic uses, and 17 sewage pumping stations. The latter are critical in mitigating the risk of flooding. Supply of potable water in the south via two pipelines coming from Israel has continued.
In the north, grave concerns of dehydration and waterborne diseases due to water consumption from unsafe sources continue. The water desalination plant and the Israeli pipeline are not functioning. There has been no distribution of bottled water among IDPs accommodated in shelters for over a week, raising grave concerns about dehydration and waterborne diseases due to water consumption from unsafe sources.

Food security

Since 7 November, members of the Food Security Sector have been unable to deliver assistance in the north, as access has been largely cut off. Due to the lack of cooking facilities and fuel, people are resorting to consuming the few raw vegetables or unripe fruits that remain. No bakeries are active due to the lack of fuel, water, and wheat flour, and structural damage. Wheat flour is reportedly no longer available in the market. Food Security Cluster members have raised serious concerns about the nutritional status of people, especially lactating women, and children.
Also in the north, livestock is facing starvation and the risk of death due to the shortage of fodder and water. Crops are being increasingly abandoned and damaged because of the lack of fuel which is required to pump irrigation water.
Across Gaza, farmers have begun slaughtering their animals due to the immediate need for food and the lack of fodder. This practice poses an additional threat to food security as it leads to the depletion of productive assets.

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. In total, over 1,200 Israelis and foreign nationals have been killed in Israel, according to the Israeli authorities as cited by the media, the vast majority on 7 October. As of 15 November, the names of 1,162 fatalities in Israel have been released, including 859 civilians and police officers. Of those whose ages have been provided, 33 are children.
According to the Israeli authorities, 237 people are held captive in Gaza, including Israelis and foreign nationals. Media reports have indicated that about 30 of the hostages are children. So far, four civilian hostages have been released by Hamas, one Israeli soldier was rescued by Israeli forces, and three bodies of hostages have reportedly been retrieved by Israeli forces. On 17 November, the Emergency Relief Coordinator, Martin Griffiths, reiterated his call for the immediate and unconditional release of all hostages.

Violence and casualties (West Bank)

On 19 November, Israeli forces killed two Palestinians in confrontations that occurred during search-and-arrest operations in two refugee camps, Jenin and Ad Duhaisha (Bethlehem). The Jenin operation lasted for nearly 12 hours and involved armed clashes with Palestinians and Israeli airstrikes, which also resulted in extensive residential and infrastructure damage.
Since 7 October, 200 Palestinians, including 52 children, have been killed by Israeli forces; and an additional eight, including one child, have been killed by Israeli settlers in the West Bank, including East Jerusalem. Four Israelis have been killed in attacks by Palestinians.
The number of Palestinians killed in the West Bank since 7 October accounts for 47 per cent of all Palestinian fatalities in the West Bank in 2023 (441). About 66 per cent of the fatalities since 7 October have occurred during confrontations that followed Israeli search-and-arrest operations, primarily in Jenin and Tulkarm governorates; 24 per cent have been in the context of demonstrations in solidarity with Gaza; seven per cent have been killed while attacking or allegedly attacking Israeli forces or settlers; two per cent have been killed in settler attacks against Palestinians; and one per cent during punitive demolitions.
Since 7 October, Israeli forces have injured 2,803 Palestinians, including at least 355 children, over half of them in the context of demonstrations. An additional 74 Palestinians have been injured by settlers. Some 33 per cent of those injuries have been caused by live ammunition.
In the past 24 hours, armed assailants who, while known by Palestinian residents to be settlers, were wearing Israeli military uniforms, used a private vehicle to invade Palestinian lands on the southeast outskirts of Burin village (Nablus). They attacked a Palestinians who were harvesting, vandalizing agricultural equipment, and stealing one bag of olive produce.
Since 7 October, OCHA has recorded 254 settler attacks against Palestinians, resulting in Palestinian casualties (31 incidents), damage to Palestinian-owned property (187 incidents), or both casualties and damage to property (36 incidents). This reflects a daily average of almost six 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)

No new displacements have been recorded during the past 24 hours. Since 7 October, at least 143 Palestinian households comprising 1,014 people, including 388 children, have been displaced amid settler violence and access restrictions. The displaced households are from 15 herding/Bedouin communities.
Additionally, 143 Palestinians, including 72 children, have been displaced since 7 October following demolitions in Area C and East Jerusalem, due to lack of permits; and 48 Palestinians, including 24 children, have been displaced following punitive demolitions.

Funding

As of 17 November, Member States have disbursed US$146.6 million against the updated Flash Appeal launched by the UN and its partners to implement its response plan in support of 2.2 million people in the Gaza Strip and 500,000 in the West Bank. This constitutes about 12 per cent of the $1.2 billion requested. An additional $250 million has been pledged, which if materialized, would bring the Flash Appeal funding level to 32 per cent. Private donations are collected through the Humanitarian Fund.

HUMANITARIAN NEEDS AND RESPONSES: 6-12 November

Protection

Mine action is one of the most critical life-saving activities for protection at present. Core actions include Explosive Remnants of War (ERW) risk assessments in UNRWA shelters and some Explosive Ordnance Risk Education (EORE) messaging in the south. Scale up of assessments and clearance is planned once hostilities end, and work to bolster EORE information is being planned, including printed materials, training for focal points and use of media. Current insecurity, access restrictions, and communication blackouts greatly curtail mine-removal work.

Further, a technical working group (comprising eight partners) is working to identify unaccompanied and separated children and processes to unite families. The group is developing an interagency registration system, documentation and tracing process and alternative care arrangements and reunification procedures. Critical challenges are the absence of safe spaces inside Gaza. An advocacy brief on Unaccompanied Children in Gaza and messages on risk mitigation for children are available.

During the reporting period, over 2,000 locally procured dignity kits were distributed to vulnerable women in Rafah, Khan Yunis and Al Remal, and cash transfers were done to 724 women including survivors of gender-based violence (GBV). Supply lines are grossly inadequate to meet burgeoning women’s needs, especially menstrual hygiene. Power shortages and unstable communications mean that many women cannot access remote services addressing GBV. However, nation-wide hotlines (24/7) are operating for GBV case management and Mental Health and Psychosocial Support (MHPSS).

Shelter and Non-Food Items (NFI)

During the reporting period, cluster partners distributed limited quantities of NFIs. These included 5,000 kits containing bedding sets, tarps, and dignity kits in public Palestinian Authority schools and public buildings, including hospitals, as well as 500 tents donated to UNRWA, of which the majority were installed in the Khan Younis training centre to create additional living and covered spaces to decongest the overcrowded conditions in the centre. Due to limited supplies, cluster partners only covered less than 5 per cent of the overall needs. There is still a major gap in shelter winterization materials and essential NFIs, including sealing off kits for damaged houses and creating additional living spaces; a high shortage in bedding sets, including mattresses and blankets to cover the needs of the IDPs in different settings; and lastly, winterized tents to protect homeless IDPs from upcoming harsh weather conditions.

Health

The loss of communication with key focal points in health who normally provide regular updates is making it difficult for partners to have an overview of information on the latest casualties.

The high insecurity, displacement, and lack of supplies in the north, has resulted in partner operations largely halting operations there. The majority of health response activities are now concentrated in the south, with a focus on supporting the nine hospitals, 18 primary health-care centres, and 130 mobile teams which are still partially functioning.

Partners are working to strengthen disease surveillance in the shelters to facilitate early detection of outbreak-prone diseases and ensure rapid response. Due to the high insecurity and lack of equipment, the dead bodies remain exposed or unsafely buried under the rubble.

Food Security

From the onset of the crisis, 15 Food Security Sector partners have delivered assistance to some 2 million beneficiaries, including food parcels, ready-to-eat meals, and hot meals, to various shelters (UNRWA and non–UNRWA) and host families, mobilizing approximately $7.5 million (excluding activities within the Flash Appeal).

WFP has delivered fresh bread, and tuna, among other foods. and has provided Gaza residents with cash-based transfers. On 2 November, WFP commenced distribution of date bars, reaching an estimated 550,300 IDPs situated in UN shelters.

For the last two weeks, partners in the north have been unable to distribute any assistance. Partners are also facing significant challenges in providing food assistance due to insufficient supplies, widespread destruction. Most bakeries are inactive due to destruction, lack of fuel, or lack of clean water.

Food insecurity is growing by the day. Food availability on the market is limited, prices have increased, and purchasing power has decreased. Gaza residents have no means to make use of the limited available quantities of food, due to insufficient clean water, fuel, and electricity

Logistics

The Palestine Logistics Cluster continues to monitor the overall situation and provide support to and from surrounding countries to the Egyptian and Palestinian Red Crescent societies and UNRWA to deliver life-saving assistance. On 9 November, three Logistics Cluster staff deployed to Al-Arish together with OCHA, UNRWA, UNDSS, UNICEF and WHO to work with the Egyptian Red Crescent (ERC) to set up an information cell. Moreover, the Palestine Logistics Cluster Coordinator arrived in Jerusalem on 10 November to lead the coordination efforts. To further augment the transport capacity of the ERC, 20 trucks arrived in Al-Arish on 8 November. Additionally, the second and third flights of equipment donated by the Logistics Cluster arrived from the Humanitarian Response Depot in Brindisi on 10 and 11 November. Equipment includes Mobile Storage Units, inflatable cold rooms, temperature-controlled storage, and prefabs for ERC volunteers. More information on the Logistics Cluster is available online.

Emergency Telecommunications

The Emergency Telecommunications Cluster (ETC) was activated on 31 October and is currently based in Cairo pending access to Gaza. ETC has prepared solar panels, satellite connectivity solutions, radios, and equipment to provide independent access to communications in Gaza for the humanitarian response. The ETC is focused on establishing pathways to import critical telecommunications equipment into Gaza to set up services for humanitarian workers. Efforts are underway to obtain necessary authorizations from the authorities, identify a route through either Egypt or Israel, and to consolidate this information for partners.

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.