Hostilities in the Gaza Strip and Israel | Flash Update #54

Key points

• On 29 November, the humanitarian pause entered its sixth consecutive day. It has enabled a major increase in the delivery of basic supplies into and across Gaza, primarily by the Egyptian and Palestinian Red Crescent Societies and UN agencies. However, as the UN Secretary-General stressed in a briefing to the Security Council, the level of aid “remains completely inadequate to meet the huge needs of more than two million people.”
• Aid convoys to areas to the north of Wadi Gaza (hereafter: the north), which prior to the pause had been almost completely absent, continued on 29 November. The Palestine Red Crescent Society (PRCS) and UNRWA delivered food and non-food items, medical supplies, and fuel to shelters hosting internally displaced persons (IDPs), as well as to warehouses and hospitals. The latter included two hospitals in Gaza city, Al Ahli and As Sahaba, which received a total 10,500 litres of fuel, enough to operate generators for about seven days.
• Despite the pause, there has been almost no improvement in the access of residents in the north to water, as most of the main water production facilities remain shut down, due to the lack of fuel and some also due to damages. Concerns about dehydration and waterborne diseases due to water consumption from unsafe sources persist.
• Enhanced aid distribution, including fuel to hospitals, water and sanitation facilities, and IDP shelters, also continued in areas south of Wadi Gaza (hereafter: the south), where the vast majority of IDPs are staying. Cooking gas, which has been entering daily from Egypt since the start of the pause, has been available in the market at one distribution centre in Khan Younis, albeit in quantities well below the demand.
• One of the partially operational hospitals in the north, Kamal Adwan in Jabalia, urgently requires supplies and medical staff in the fields of obstetrics, paediatrics, neonatology, surgery, and orthopaedics. Eighty of its patients require immediate transfer to a better-equipped facility in the south for their survival. On 28 and 29 November, no evacuations of patients and wounded people from hospitals in the north to those in the south took place.
• The UN Secretary-General reiterated his call for “the opening of additional crossings and streamlined inspection mechanisms to facilitate the delivery of life-saving aid.”
• On 29 November, the Director-General of the World Health Organization (WHO) reiterated his concern about the high risk of infectious diseases in IDP shelters, attributing this to severe overcrowding and the disruption of health, water, and sanitation systems. He noted that more than 111,000 cases of acute respiratory infection, 36,000 cases of diarrhoea in children below five, and 24,000 cases of skin rash had been recorded since the start of the crisis.
• On 29 November, twelve Israelis and four foreign nationals, held as hostages in Gaza, and 30 Palestinian detainees, held in Israeli prisons, were released. The freed hostages included seven women and five children. Among the Palestinian detainees were 15 women and 15 children. Since the start of the pause, 210 Palestinians, 68 Israelis, and 20 foreign nationals have reportedly been released. 

Hostilities and casualties (Gaza Strip)

• Since the humanitarian pause entered into force at 7:00 on 24 November, airstrikes, shelling, and ground clashes have largely ceased. However, in the early morning of 29 November, shelling by the Israeli navy towards the Gaza shore in the south was reported, resulting in no casualties.
• On 27 and 28 November, 160 bodies were recovered from the rubble, according to the Government Media Office (GMO) in Gaza. The office also stated that, since the start of hostilities, more than 15,000 Palestinians have been killed in Gaza, including about 6,150 children and 4,000 women. The GMO, which is under the de facto authorities in Gaza, has been reporting casualties since the Ministry of Health (MoH) in Gaza stopped doing so on 11 November, following the collapse of services and communications at hospitals in the north.
• The fatality toll since 7 October includes at least 198 Palestinian medics, according to the Gaza Ministry of Health; 112 UN staff; 70 journalists and media workers, according to the Palestinian Journalist Syndicate; and at least 15 Civil Defense staff, according to the Palestinian Civil Defense.
• Overall, 75 Israeli soldiers have been killed in Gaza since the start of the Israeli ground operations, according to official Israeli sources.

Displacement (Gaza Strip)

• Some IDPs in the south have been trying to go back to their homes in the north, despite the Israeli forces’ announcement that such movement is forbidden. On 24, 25 and 26 November, there were reports of shooting by Israeli forces towards IDPs attempting to move north, resulting in several casualties.
• In recent weeks, the Israeli military has been calling and exerting pressure on residents of the north to leave southwards through a “corridor” along the main traffic artery, Salah Ad Deen Road, every day between 9:00 and 16:00. No available estimate for the number of people who managed to cross on 29 November.
• The movement of unaccompanied children and separated families continues to be observed in the "corridor" in recent days. Humanitarian actors are assisting these children, including through registration of cases. However, urgent measures are required to augment the presence of child protection teams in shelters; enhancing registration efficiency and addressing the specific needs of these children.
• Up to 1.8 million people in Gaza, or nearly 80 per cent of the population, are estimated to be internally displaced. However, obtaining an accurate count is challenging; including because of difficulties in tracking IDPs staying with host families and accounting for those who returned to their homes during the pause but remain registered in UNRWA and other shelters.
• Nearly 1.1 million IDPs are registered in 156 UNRWA facilities across Gaza, of whom about 86 per cent (946,000) are registered in 99 UNRWA shelters in the south. Another 191,000 IDPs are estimated to be staying in 124 public schools and hospitals, as well as in other venues such as wedding halls, offices, and community centres. The rest are hosted by families.
• Due to the overcrowding and poor sanitary conditions at UNRWA shelters, there have been significant increases in some communicable diseases and conditions such as diarrhoea, acute respiratory infections, skin infections and hygiene-related conditions like lice. There are also initial reports of disease outbreaks, including hepatitis.
• Concerns have been raised about vulnerable groups of people who are struggling with difficult shelter conditions. This includes people with disabilities; women who are pregnant, have recently given birth, or are breastfeeding; people who are recovering from injuries or surgeries; and those with compromised immune systems.
• Across the Gaza Strip, more than 46,000 homes have been destroyed and over 234,000 housing units have been otherwise damaged. These constitute over 60 per cent of the housing stock, as reported by the Shelter Cluster on 24 November.

Humanitarian Access (Gaza Strip)

• On 29 November, as in previous days, significantly larger convoys than prior to the pause, carrying a variety of humanitarian supplies, fuel and cooking gas entered Gaza from Egypt.
• On 29 November, the Rafah Egyptian border opened in both directions for the evacuation of ten wounded and sick people and nine of the people who were accompanying them, alongside the entry of 74 Gaza residents who had been stranded outside.

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)

• The health system across the Gaza Strip continues to be overstretched amid severe shortage of medical supplies.
• On 29 November, UN agencies delivered to two hospitals in Gaza city, Al Ahli and Al Sahaba, lifesaving medicines and surgical supplies (in addition to fuel) estimated to be sufficient to meet the urgent health needs of 100 patients at each facility. Along with another three hospitals, these are the only five hospitals in the north (out of 24 prior to the hostilities), which are now functional, albeit partially, and admit some patients.
• In addition, on 29 November, the MoH in Gaza announced that the Indonesian Hospital in Beit Lahiya, also in the north, will reactivate parts of its dialysis department. Over the weeks prior to the pause, the hospital sustained extensive damage during bombardments and Israeli operations inside the compound. This follows a similar announcement regarding the dialysis department of Shifa hospital in Gaza city on 27 November.

• On 28 November, the International Committee of the Red Cross (ICRC) delivered medical supplies, including, pain relief medication and blood bags to the European Gaza hospital in Rafah, in the south.

Water and sanitation (Gaza Strip)

• The Gaza Municipality has reportedly warned about the potential flooding of large areas in the Sheikh Radwan quarter due to the overflow of a wastewater and rainwater lagoon in the city, following the accumulation of rain in recent days. Pumping from the lagoon has stopped for several weeks due to lack of fuel needed to operate the pumps, as well as damage to several conveyor lines.
• On 28 November, UNRWA and UNICEF continued delivering fuel to Gaza’s main water utility, which in turn distributed it to water and sanitation facilities in the south: two seawater desalination plants, 79 water wells, 15 water pumping stations, 18 sewage pumping stations, and one wastewater treatment plant. Supply of potable water in the south via two pipelines coming from Israel has continued.
• In the south, UNRWA continues to operate eight water wells that provide potable and domestic water to IDP shelters, alongside water trucking operations. Solid waste collection from the camps, and emergency shelters and transfer to landfills also continues in the south.

Food security

• On 28 November, the Palestinian Central Bureau of Statistics (PCBS) stated that Gaza suffers a US$1.6 million daily loss in farm production. The institution assesses the losses are likely higher considering the destruction of farm equipment and farmland, and damage caused to thousands of trees, especially olive trees. The economic impact is also significant, considering that 55 per cent of Gaza’s agricultural products used to be sold outside the coastal enclave, PCBS stated.
• The amount of cooking gas that has reportedly entered Gaza from Egypt since the start of the pause (about 85 tons per day) is a third of the equivalent daily average that entered between January and August 2023. Queues at a filling station in Khan Younis have reportedly extended for about 2 kilometres, with people waiting at them overnight. Meanwhile, reports indicate that people are burning doors and window frames to cook.
• Since 25 November, one WFP bakery has resumed operations on an ad-hoc basis, allowing the provision of bread to about 90,000 people in UN shelters in the south. Other bakeries are operating intermittently.

Hostilities and casualties (Israel)

• On 29 November, for the sixth consecutive day, no rocket fire from Gaza towards Israel was reported. In total, over 1,200 Israelis and foreign nationals have been killed in Israel, according to the Israeli authorities, the vast majority on 7 October.
• Following the release of 88 hostages since 24 November, 159 people remain captive in Gaza, including Israelis and foreign nationals, according to Israeli sources. Furthermore, on 28 November, one Israeli civilian and three soldiers, initially missing, were declared killed. Before the pause, four civilian hostages had been released by Hamas, one Israeli soldier had been rescued by Israeli forces, and three bodies of hostages had reportedly been retrieved by Israeli forces.

Violence and casualties (West Bank)

• Between 19:00 on 28 November 18:00 on 29 November, Israeli forces killed four Palestinians, including two children, in an operation in Jenin Refugee Camp, which involved armed clashes with Palestinians, and airstrikes, resulting in extensive infrastructure and residential damage. During the withdrawal of Israeli forces, an eight-year-old and a 15-year-old child were shot and killed by Israeli forces. According to medical sources, during the operation, Israeli forces impeded the work of paramedics, denied access to a hospital, and arrested an injured person while paramedics were transferring him into a hospital. Since 7 October, 51 Palestinians were killed in Jenin Refugee Camp, representing 22 per cent of the overall fatalities reported.
• Between 7 October and 29 November, 238 Palestinians, including 63 children, were killed in the West Bank, including East Jerusalem. Of those, 229 were killed by Israeli forces, eight by Israeli settlers and one either by forces or settlers. The seven-week toll represents more than half of all Palestinians killed in the West Bank this year. Already, 2023 has been the deadliest year for Palestinians in the West Bank since OCHA began recording casualties in 2005.
• Two-thirds of the fatalities since 7 October have occurred during search-and-arrest and other operations carried out by Israeli forces, including some – mainly in Jenin and Tulkarm governorates – involving exchange of fire with Palestinians. More than half of the fatalities were reported in operations that did not involve armed clashes.
• Since 7 October, Israeli forces have injured 3,128 Palestinians, including at least 508 children; 45 per cent of them in the context of demonstrations and 46 per cent in the context of search and arrest and other operations. An additional 78 Palestinians have been injured by settlers and 18 others either by forces or settlers. Some 33 per cent of those injuries have been caused by live ammunition, compared with nine per cent in the first nine months of 2023.
• OCHA has verified four settler attacks that took place on 27 and 29 November and resulted in damage to Palestinian-owned property. According to Palestinian eyewitnesses, a group of Israeli settlers vandalized 135 olive trees, stole olive produce, agricultural equipment, solar panels, and construction equipment, and set fire to three tents in the outskirts of Yanun (Nablus), Deir Istiya (Salfit), Al Janiya (Ramallah) and Ein al Hilwa (Tubas).
• Since 7 October, OCHA has recorded 295 settler attacks against Palestinians, resulting in Palestinian casualties (33 incidents), damage to Palestinian-owned property (223 incidents), or both casualties and damage to property (39 incidents). This reflects a daily average of five incidents, compared with three since the beginning of the year. 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 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.
• On 27 and 28 November, the Israeli authorities demolished, or forced people to demolish eight structures, including six homes, in East Jerusalem (three structures) and Area C (five structures) citing the lack of Israeli-issued building permits, which are almost impossible to obtain. As a result, 35 people, including 21 children, were displaced.
• On 28 November, in Deir Ammar Refugee Camp (Ramallah), Israeli forces demolished on punitive grounds the home of a family whose member was accused of killing an Israeli in August 2023. As a result, nine people, including six children, were displaced. Punitive demolitions are a form of collective punishment and are prohibited under international law.
• Additionally, 181 Palestinians, including 93 children, have been displaced since 7 October following demolitions in Area C and East Jerusalem, due to lack of permits; and 54 Palestinians, including 25 children, have been displaced following punitive demolitions.

Funding

• As of 29 November, Member States have disbursed USD$262.8 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 21 per cent of the $1.2 billion requested. An additional $250 million has been pledged by 23 November. Private donations are collected through the Humanitarian Fund.

HUMANITARIAN NEEDS AND RESPONSES: 20-26 November

Health

During the reporting period, Cluster partners have delivered the following items across Gaza:

• Various medical supplies to six hospitals and the ambulances;
• 300 Interagency Emergency Health Kits (IEHK);
• 15 Acute Watery Diarrhoea (AWD) community kit and 50 midwifery kit and 15 obstetric surgical kit; 16 Inter-Agency Emergency Health Kits (IARH)
• 72 rehabilitation and nursing sessions, and 3,177 post-natal care consultations.
• 900 family hygiene kits distributed in one IDP shelter in An Nusseirat and 120 host community shelters;
• 1,070 dignity kits to women staying in IDP shelters.

During the same period, there have been an average of 30,000 primary healthcare consultations per day through fixed and mobile clinic services; 10,156 children were vaccinated after this service resumed in November. Mental health and psychosocial services are being provided by partners, mainly in shelters, to 20,000.

An Emergency Medical Team (EMT) Coordination Cell is now operational in Cairo and will soon be active in Gaza. The strategy involves providing a surge in supplies, infrastructure, and staffing to support existing health facilities. Médecins Sans Frontières (MSF) and The International Committee of the Red Cross (ICRC) surge teams are already on the ground, offering healthcare services. The Jordanian field hospital is being set up, and 31 teams are ready to deploy with support from WHO.

Main factors that have been impeding operations include limited access to the north; shortage of fuel, medical supplies, water, food, and other essential supplies; displacement of partners, their staff and families; and overcrowding in IDP shelters. NGO partners have experienced difficulties with their logistics capacity in Egypt. So far, only 19 per cent of the funding required to respond has been committed.

Protection

Mine risk education remains a top priority right now in protection for people in Gaza. Despite challenges, during the reporting period, 21 Explosive Ordnance Risk Education (EORE) focal points were deployed in 11 UNRWA shelters in the south benefiting 4,768 people. The UN Mine Action Service is planning to send 1 million people EORE messages. Planning for the expansion of risk education outreach in non-UNRWA shelters is underway. One of the biggest challenges is reaching everyone in Gaza, both physically reaching them particularly in the north, in non UNRWA locations as well as challenges with patchy communication and electricity shortages.

A registration tool for unaccompanied and separated children is ongoing. Temporary care arrangements are being confirmed as well as coordination with Ministry of Social Development (MOSD) and WHO on children who are evacuated for medical reasons. Child protection actors in Gaza are being identified and mapping of available services is ongoing. Access challenges, including fuel shortages, and limited children related supplies in Gaza such as suitable winter clothes, recreational kits and activities continue to affect the scale of immediate child protection responses. Important also is identifying/mapping available child protection actors and services

Providing crucial support for women and girls involves addressing the depletion of local hygiene supplies, particularly dignity and menstrual hygiene kits. Despite efforts to procure these supplies, the demand exceeds the available resources, necessitating increased supplies, improved access, and additional funding. Ensuring the safety of women in shelters is paramount, prompting the GBV sub-cluster to develop an observation tool. A team of volunteers will collect observations in nearby sites, contributing valuable information on gender-related issues and needs. Challenges include reaching GBV partners, comprehensive mapping of services, and the significant impact on GBV services. Out of over 20 partners, only nine were reached, and six can assist with voluntary observational work. Re-establishing referral pathways for survivors, crucial in GBV response, requires rebuilding and coordination with UNRWA is deemed essential.

Beyond mine risk efforts, disability and inclusion initiatives concentrate on psychosocial support (PSS) recreational activities in UNRWA southern shelters. In the past week, 46 sessions were conducted across 46 shelters, benefitting 10,649 children and 316 adults (parents and caregivers participating in the activities with their children). Additionally, 108 assistive devices were distributed. More supplies, including assistive devices, hygiene kits, and wound dressing kits, are expected to arrive in Gaza in the coming days. Ongoing challenges and constraints hampering the much-needed scale-up of response efforts include insufficient fuel for movements and communication issues.

Despite extreme overcrowding at shelters, UNRWA has been able to provide some recreational activities, PSS support, and mine risk awareness sessions. They have also conducted child protection assessments and been assessing how to implement activities with children and young adults and scale up these activities across all their shelters.

Food security

Since November 24th, WFP has supported 121,161 people in shelters and host communities by distributing bread, food parcels, and e-vouchers. Additionally, one WFP bakery operates ad-hoc, reaching approximately 90,000 people in shelters with bread on Fridays.

On November 26, UNRWA extended its flour distribution to areas outside shelters in the southern governorates, reaching 20,720 families thus far.

During the current humanitarian pause, the prioritised flour distribution continued in the North and Gaza City as part of ongoing humanitarian convoys in the North of Wadi Gaza.

On November 26, at UNRWA shelters in Jabalia in the north, approximately 7.6 metric tons of high-energy biscuits provided by the World Food Programme (WFP), were distributed as ready-to-eat food. This allocation is sufficient to meet the minimal daily food intake for 23,616 people for one day.

Partners are encountering difficulties in operating, given the situation on the ground. Despite the 4-day truce, they reported difficulties in fuelling their vehicles to implement/monitor the food assistance.

• Anera, PARC, together with United Palestinian Appeal, Taawon, and Middle East Children Alliance, covered around 55,000 people with food parcels in host communities this week.
• ACF targeted host families by giving fresh vegetable parcels to 3,200 people to host families.
• OXFAM distributed 1000 Food parcels to IDPs in non-UN shelters in Rafah and Khan Younis and reached 1133 families in Rafah and Khan Younis with food vouchers.
• Beit Lahia Development Association distributed bread for host families, targeting around 6,000 beneficiaries.
• Other partners are mobilizing resources in the coming days, targeting the three governorates of the Middle Area, Khan Younis and Rafah.

Shelter and Non-Food Items (NFI)

During the reporting period, including since the humanitarian pause, Shelter Cluster partners conducted field assessments at numerous collective centres and makeshift shelters in the south, revealing a shortage of basic bedding sets (mattresses and blankets) for the majority of IDPs. There is also an urgent need for firewood as an alternative fuel source for preparing food due to a lack of other options.

Due to limited supplies, cluster partners coverage of Shelter and NFIs needs not more than 3 per cent of needs, and not more than 17 per cent if the items in the pipeline that have not arrived are considered.

Severe shortages in shelter winterization materials and essential NFIs persist, including sealing off kits for damaged houses and creating additional living spaces; there is a significant lack of bedding sets, including mattresses and blankets, to meet the needs of IDPs in various settings.

Education

Since 7 October, nine Education Cluster partners have reached 50,726 students and teachers. The main deliverables included emergency learning and recreational supplies (26,833 people reached), psychosocial support (31,318 reached), and recreational activities (49,726 reached). The response has been focusing on Khan Younis, Rafah, and Middle governorates, as North Gaza and Gaza governorates are inaccessible.

Multi-Purpose Cash assistance (MPCA)

Since the beginning of the hostilities, 66,870 households (including roughly 449,000 people) were delivered Emergency MPCA. Cash out rates across the response stand at 70-75 per cent but have been declining slightly over the past few days. While distribution is delivered across the Gaza strip, the vast majority is now concentrated in the south.

Formal market actors, such as supermarkets and retailers are largely depleted and facing major challenges in re-stocking and operating; however, informal markets, such as vendors, minimarts, carts and stalls, reportedly turned into the main source for goods. Information is still unclear on whether shops and markets actors were able to restock during the pause.

Post distribution monitoring data from recipients of cash assistance point to food, water, medicines, hygiene products, and clothing as the top expenditures reported. About 81 per cent of respondents reported that unrestricted cash helped them accessing needed goods and services, either fully or partially. Over 95 per cent reported unrestricted cash as their preference for future assistance.

Logistics

The Logistics Cluster developed and disseminated a new online reporting form to collect information regarding incoming supplies as well as the current stock levels in Egypt and other countries. The form was shared with 34 organisations that are part of the Logistics Cluster and other Clusters and is an ongoing project to be updated on a weekly basis.

On 22 November, 21 mobile storage units (MSUs) arrived in Al Arish, Egypt. The MSUs will be installed, in Egypt to augment the Egyptian Red Crescent’s (ERC) warehousing capacity, and 11 will be delivered to Gaza to expand the storage capacity in key locations. An additional three MSUs were already delivered to Gaza and are in the process of being installed. The latter MSUs will provide an additional 960 m2 of storage capacity. To further support partners inside Gaza, an International NGO will support with providing access to their storage capacity through the Logistics Cluster to receive I/NGOs’ cargo on behalf of the wider humanitarian community.

Emergency Telecommunications

The Emergency Telecommunications Cluster (ETC) coordination team continues to engage all parties ― the Egyptian Red Crescent, OCHA, the International Telecommunications Union (ITU), and the Egyptian authorities ― to fast-track the importation process of telecommunications equipment through either Egypt or Israel into Gaza. Liaison with OCHA continues the importation of equipment into Gaza via Israel. To coordinate a collective approach among partners for the importation of equipment, 11 partners have submitted their ICT equipment needs through a survey which is currently ongoing. The ETC urgently requires an initial US$250,000 out of the total requested US$800,000 in the Flash Appeal to continue its ongoing activities and address the immediate needs in Gaza.

Reliable communications networks are needed to enable humanitarians to stay connected in high-risk situations, restore security communications networks for UN staff, and coordinate response activities.

Water, Sanitation and Hygiene (WASH)

The standards for emergency water supply include aspects for water quantity, water quality and access to water. The minimum daily water needs for the population of Gaza has been agreed at 15 liters/person/day (L/D/P), whereas the pre-crisis water use was approximately 100 L/P/D.

During the reporting period, the Coastal Municipalities Water Utility and WASH agencies have produced on average over 50,327 cubic meters of water, which is the equivalent of approximately 22.6 L/P/D. Water quality and access standards, however, remain unachieved. Access is a particular challenge as the water networks are fractured, production points are reduced, power for pumping and distribution restricted and storage and outlets minimized. Many communities are isolated across Gaza but particularly north of Wadi Gaza.

WASH partners activities included the trucking of 316 cubic meters of water, the distribution of 522 cubic meters of bottled water, and 10,280 family hygiene kites, all in the south. In addition, 260 Solid Waste Containers were distributed in 13 shelters in the north.

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 counselling and referrals for affected communities to access life-saving services. The PSEA Network monitors calls daily and will increase the number of counsellors if necessary.

* Asterisks indicate that a figure, sentence, or section has been rectified, added, or retracted after the initial publication of this update.