Nine out of 36 hospitals in Gaza are operational, although only partially. They are functioning at triple their bed capacity, grappling with no electricity and little fuel for backup generators, and confronting critical scarcities of essential supplies. Photo of Shifa by WHO, 16 December 2023
Nine out of 36 hospitals in Gaza are operational, although only partially. They are functioning at triple their bed capacity, grappling with no electricity and little fuel for backup generators, and confronting critical scarcities of essential supplies. Photo of Shifa by WHO, 16 December 2023

Hostilities in the Gaza Strip and Israel | Flash Update #73

Key points

  • On 19 December, heavy Israeli bombardments from air, land, and sea, continued across Gaza, with the most intense shelling reported in Beit Hanoun, Jabaliya, and Beit Lahiya, all in the north. Intense ground operations and fighting between Israeli forces and Palestinian armed groups continued on 19 December, especially in the Middle Area and Khan Younis, in southern Gaza. The firing of rockets by Palestinian armed groups into Israel continued. 
  • On 19 December, for the sixth day in a row, most areas of the Gaza Strip had no telecommunications or internet services severely affecting emergency operations and access to information. Services in the southern area were partially restored on 18 December. 
  • According to the Ministry of Health (MoH) in Gaza, between 7 October and 19 December afternoon, at least 19,667 people Palestinians have been  killed in Gaza. About 70 per cent of those killed are said to be women and children. As of then, about 52,586 people have been injured, according to the MoH. Many other people  are missing, presumably buried under the rubble, waiting for rescue or recovery.  
  • Between 18 December and 19 December, three Israeli soldiers were reported killed in Gaza. Since the start of the ground operations, 132 soldiers have been killed in Gaza, and 719 soldiers have been injured, according to the Israeli military. 
  • On 19 December, according to the World Food Programme’s (WFP) Regional Director for the Middle East and North Africa, half of Gaza’s population is starving in a situation of extreme or severe hunger, and 90 per cent of the population regularly go without food for a whole day.  Only ten per cent of the food currently required for 2.2 million people has entered Gaza in the last 70 days. On 17 December, media reported people jumping onto aid trucks, attempting  to secure food and other supplies. 
  • On 18 and 19 December, multiple health facilities and personnel were attacked across the Gaza strip (see Health Care section for more details). On 18 December, Israeli forces troops reportedly raided the vicinity of Al Awda hospital in Jabalya (the north). Males over 16 years old, including medical staff, patients and internally displaced persons (IDPs) were taken out of the hospital and arrested, stripped, bound and interrogated, according to Médecins Sans Frontières (MSF). While most of them were sent back into the hospital, the hospital administration and MoH reported that six people, including medical staff and the hospital director, remain in Israeli custody. The hospital was besieged for 14 days, where the 240 people inside, including 80 medical staff, 40 patients, and 120 IDPs, faced severe shortage of food, water and medicine.  
  • The UN's Human Rights Office (OHCHR) issued a press statement on 16 December,  citing reports from the north of Gaza, about mass detentions, ill-treatment, and enforced disappearances of potentially thousands of Palestinians, including children and women by the Israeli forces. Detentions occurred during the evacuations to the south of Gaza or during military operations conducted in homes, hospitals, schools, and other places sheltering IDPs in the north of Gaza. Allegations include serious ill-treatment which in some instances may amount to torture. Further reports also allege Palestinians being stripped, blindfolded, tightly handcuffed, filmed and photographed in humiliating positions. Detained people were reportedly transported to an unknown location without clothing, and with limited food, and water. 
  • On 18 December, 60 trucks carrying supplies entered Gaza through Rafah crossing and 64 trucks entered through Kerem Shalom crossing. On 19 December, initial reports indicate that 104 trucks entered through Rafah and 60 through Kerem Shalom This is well below the daily average of 500 truckloads (including fuel and private sector goods) that entered every working day prior to 7 October.  
  • On 18 December, 55 injured people, 56 of their accompaniers and 548 dual nationals, were evacuated from Gaza to Egypt. The total number of wounded Palestinians and other medical cases evacuated since 7 October represents one per cent of the reported injury toll.  
  • The occupied Palestinian territory Humanitarian Fund (oPt HF) launched a US$40 million allocation on 19 December in line with the updated Flash Appeal launched by the UN and its partners to implement a response plan in support of 2.2 million people in the Gaza Strip and 500,000 in the West Bank. This allocation represents the first phase of planned responses for the evolving situation. 

Hostilities and casualties (Gaza Strip)

  • The following are among the deadliest incidents reported on 18 and 19 December: 
    • On 18 December, at about 21:00, at least eight people were reportedly killed, including at least three children, with many others injured, when a residential building in Bashit Refugee Camp, central Rafah, southern Gaza, was hit. 
    • On 19 December, at about 1:00, at least 30 people, including at least three children and a journalist, were reportedly killed, and many others were injured, when three residential buildings in Rafah city, were hit. 
  • On 17 December, several strikes hit UNRWA facilities sheltering IDPs; two IDPs were killed and others, including at least three children sheltering in schools in Khan Younis, were injured by shrapnel due to a direct hit into these shelters or nearby strikes. In another incident, a school in Gaza city sheltering about 2,500 IDPs sustained damage, reportedly due to a direct hit by a tank shelling, with no reported casualties.  
  • According to UNRWA as of 18 December, 55 different UNRWA installations were directly hit, and 62 others sustained collateral damage, resulting in the killing of at least 299 of IDPs who were sheltering in UNRWA shelters. Additionally, at least another 1,037 IDPs have been injured since the beginning of hostilities. 

Displacement (Gaza Strip)

  • Areas encompassing nearly 30 per cent of the Gaza Strip (excluding the orders to evacuate the areas north of Wadi Gaza) have been marked for evacuation on the Israeli military’s online map. Access to this information is impaired by recurrent interruptions in telecommunications and the lack of electricity. 
  • Obtaining an accurate figure of the total number of IDPs remains challenging. According to UNRWA, almost 1.9 million people in Gaza, or nearly 85 per cent of the population, are estimated to be internally displaced, including people who have been displaced multiple times. 
  • Nearly 1.4 million of these IDPs are registered in 155 UNRWA facilities across Gaza, including more than 1.2 million in 98 UNRWA shelters in the Middle Area, Khan Younis and Rafah governorates. The average number of IDPs in UNRWA shelters located south of Wadi Gaza is about 12,400 people, more than four times their capacity. 
  • Rafah governorate has become the most densely populated area in the Gaza Strip, with hundreds of thousands of IDPs squeezed into extremely overcrowded spaces and in dire living conditions. Population density is assessed to now exceed 12,000 people per square kilometre, a fourfold increase prior to the escalation. Thousands of people line up before aid distribution centres in need of food, water, shelter, and protection, amid the absence of latrines and adequate water and sanitation facilities in informal displacement sites and makeshift shelters. The suffering of displaced people is compounded by the cold winter and rain that flooded tents and other makeshift shelters over the past week. 
  • Lack of food, basic survival items, and poor hygiene, exacerbate dire living conditions, amplify protection and mental health issues, and increase the spread of disease. More than 360,000 cases of infectious diseases including acute respiratory infections, meningitis, jaundice, impetigo, and chickenpox, have been recorded in UNRWA shelters.  


  • 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 were depleted. For more information on electricity supply to the Gaza Strip, please see this dashboard.

Health care, including attacks (Gaza Strip) 

  • According to the World Health Organization (WHO), as of 19 December,  nine out of Gaza’s 36 hospitals are partially functional, all in the south. These hopsitals are operating at three times their  capacity, while facing critical shortages of basic supplies and fuel. According to the MoH in Gaza, occupancy rates are now reaching 206 per cent in inpatient departments and 250 per cent in intensive care units. 
  • According to WHO, four hospitals in the north are providing extremely limited services to patients who have already been admitted. These hospitals are not accessible and are unable to admit new patients,Israeli tanks and troops are surrounding their vicinities, and the hospitals  do not have electricity or supplies. 
  • On 19 December, according to the MoH in Gaza, Israeli forces raided the premises of Al Ahli Hospital in the east of Gaza city, destroying the main entrance and reportedly arresting several  medical staff and patients.  
  • On 18 December, in Jabalya, in the north, shelling and live ammunition reportedly hit the vicinity of Al Yaman as Saeed Hospital, injuring Palestinian Civil Defence personnel. 
  • On 19 December, UNICEF’s spokesperson warned that the risk of disease would have a devastating impact on children, stating: “Without sufficient safe water, food and sanitation that only a humanitarian ceasefire can bring – child deaths due to disease could surpass those killed in bombardments.”  

Food security

  • On 19 December, WFP delivered food parcels to 2,350 people and hot meals to 1,750 people in Rafah. These were done in addition to the distribution of food parcels, wheat flour, and date bars in shelters located in Rafah and the Middle area. 
  • On 18 December, Human Rights Watch accused the Israeli government of, “using starvation of civilians as a method of warfare,” in Gaza and of, “deliberately blocking the delivery of water, food, and fuel, while wilfully impeding humanitarian assistance, apparently razing agricultural areas, and depriving the civilian population of objects indispensable to their survival.” 

Hostilities and casualties (Israel)

  • Over 1,200 Israelis and foreign nationals have been killed in Israel, including 36 children, according to the Israeli authorities, the vast majority on 7 October.  
  • During the humanitarian pause (24-30 November), 86 Israeli and 24 foreign national hostages were released. The Israeli authorities estimate that about 129 Israelis and foreign nationals remain captive in Gaza. 

Violence and casualties (West Bank)

  • Since 7 October, 291 Palestinians, including 75 children, have been killed in the West Bank, including East Jerusalem. Additionally, two Palestinians from the West Bank were killed while carrying out an attack in Israel on 30 November. Of those killed in the West Bank, 281 were killed by Israeli forces, eight by Israeli settlers and another two either by forces or settlers. This toll represents more than half of all Palestinians killed in the West Bank this year. With a total of 491 Palestinians killed in the West Bank, 2023 is the deadliest year for Palestinians in the West Bank since OCHA began recording casualties in 2005. 
  • Since 7 October, four Israelis, including three members of the Israeli forces, have been killed in attacks by Palestinians in the West Bank, including East Jerusalem. Another four Israelis were killed in an attack by Palestinians from the West Bank in West Jerusalem (one of the four was killed by Israeli forces who misidentified him).  
  • Seventy-one per cent of the Palestinian fatalities in the West Bank 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 exchanges of fire with Palestinians. Half of the fatalities were reported in operations that did not involve armed clashes. 
  • Since 7 October, Israeli forces have injured 3,659 Palestinians, including at least 562 children; 51 per cent in the context of search-and-arrest and other operations and 41 per cent of them in the context of demonstrations and. Another 88 Palestinians have been injured by settlers and 18 other Palestinians injured either by Israeli forces or settlers. Some 33 per cent of those injuries have been caused by live ammunition, compared with 9 per cent in the first nine months of 2023. 

Settler Violence

  • On 18 December, an Israeli – reportedly from Rotem settlement – stabbed and injured a Palestinian herder and rammed over its livestock, killing two goats, in Area C of Al Farisiya-Nab'a al Ghazal, Tubas. Additionally, between 17 and 18 December, three settler attacks resulting in damage to Palestinian-owned property were reported. In two of the incidents, Israeli settlers vandalized at least 220 olive trees and agricultural equipment in the Palestinian communities of Susiya and Ar Rakeez (both in Hebron). 
  • Since 7 October, OCHA has recorded 351 Israeli settler attacks against Palestinians, resulting in Palestinian casualties (35 incidents), damage to Palestinian-owned property (270 incidents), or both casualties and damage to property (46 incidents).  
  • The weekly average of incidents since 7 October stands at 33, compared with 21 incidents per week between 1 January and 6 October 2023. The number of incidents since 7 October has declined from 80 incidents in the first week (7-14 October) to 21 incidents between 9 and 14 December. One-third of these incidents included firearms, including shootings and threats of shootings. In nearly half of all recorded incidents, Israeli forces were either accompanying or reportedly seen as supporting the attackers. 

Displacement (West Bank)

  • Since 7 October, at least 189 Palestinian households comprising 1,257 people, including 582 children, have been displaced amid settler violence and access restrictions. The displaced households are from 15 herding/Bedouin communities. More than half of the displacements occurred on 12, 15, and 28 October, affecting seven communities. 
  • Also, since 7 October, 378 Palestinians, including 198 children, have been displaced following the demolition of their homes in Area C and East Jerusalem, due to lack of Israeli-issued building permits in Area C of the West Bank and East Jerusalem, which are almost impossible to obtain. The monthly average of displacement between 7 October and 7 December represents 27 per cent increase compared with the monthly average of displacement in the first nine months of the year.  
  • Another 86 Palestinians, including 40 children, have been displaced following the demolition of 18 homes on punitive grounds since 7 October, compared with 16 homes punitively demolished in the first nine months of the year. The Human Rights Committee, in its review of the fourth periodic report of Israel, in 2014, concluded that punitive demolitions are a form of collective punishment and as such are illegal under international law.  
  • Another 451 Palestinians, including 207 children, have been displaced since 7 October following the destruction of 69 residential structures during other operations carried out by Israeli forces across the West Bank; 55 per cent of the displacement was reported in Jenin Refugee Camp, and 39 per cent in Nur Shams and Tulkarm Refugee Camps (both in Tulkarm). 


  • As of 19 December, Member States have disbursed US$551.5 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 nearly 45 per cent of the $1.2 billion requested. Private donations are collected through the Humanitarian Fund.



UNRWA carried out the following health activities across Gaza between 7 and 9 December:

  • Eight out of 22 UNRWA health centres are still operational in the middle and southern areas of Gaza. On 13 December, 8,265 refugees and non-refugees received health care in these centres.  
  • Midwives are providing care for post-natal and high-risk pregnant women at the eight operational health centres. There are an estimated 50,000 pregnant women in Gaza, with more than 180 giving birth every day. A total of 124 post-natal and high-risk pregnancy cases were attended to at health centres.  
  • UNRWA continued providing health care to IDPs at shelters through 97 medical teams. Each team is composed of one or two doctors and a nurse. Some 591 health workers in health centres and shelters provided support to 12,305 patients.  


  • The situation in Gaza has deteriorated to the point whereby protection actors are largely unable to operate, due to communication outages, safety and security risks and the lack of access to northern Gaza, as well as severe constraints on the activities of service providers and frontline actors.  
  • There are major and mounting protection concerns for vulnerable groups, including children separated from their families, pregnant and lactating women (PLWs), newborns, persons with disabilities (PwDs), and the elderly.  
  • The following activities were undertaken during past week included: 
    • The Palestine Medical Relief Society distributed 1,616 dignity kits to PwDs and vulnerable women/girls in UNRWA shelters in Khan Younis 
    • The Treatment and Rehabilitation Centre for Victims of Torture provided 25 people with remote psychological first aid support. 

Food security

  • Between 7 October to 10 December, UNRWA distributed flour to about 160,000 people north of Gaza. In the south, flour distribution reached about 1,153,020 people, including 75,000 families outside shelters.  
  • Since the beginning of December, WFP distributed high energy biscuits (HEB) to about 600,000 internally displaced people (IDPs) in designated shelters. WFP has also distributed food parcels or wheat flour to about 110,000 IDPs during the past two week.  
  • Some 11,385 IDPs residing in host communities received food parcels to support their food needs for 15 days. 
  • Throughout the reporting week, only two partners—UAWC and Taawon—managed to implement operations in the northern area of Gaza; they distributed food parcels to approximately 46,250 IDPs in public shelters. 
  • In the southern area, 11 partners have provided ready-to-eat (RTE) food, food parcels, flour, and hot meals to about 2.5 million people over the past week.  
  • World Central Kitchen (WCK), in partnership with ANERA and MECA, provided hot meals and RTE to a variety of family sizes. WCK plans to provide community kitchen kits, wood pellets or charcoal, and food products for 28,000 meals.  
  • The Food Security Cluster (FSS) has set a primary objective to meet the daily food needs of 2.2 million people, for a weekly cumulative target of 15.4 million people. In the current reporting week, FSS partners achieved a coverage of only 18 per cent of the cumulative weekly target.  


Nutrition partners provided the following essential nutrition preventive and curative supplies during the reporting period to prevent malnutrition among children and mothers: 

  • UNICEF delivered Ready to Use Therapeutic Food (RUTF) quantities to its partners, Juzour and UNRWA, to launch the implementation of the simplified approached for the management of wasting, for children under five with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM).  
  • UNICEF managed to deliver Lipid-based supplements (SQ-LNS) covering the need of 61,600 children (6-24 months) inside shelters for one month; micronutrient supplements for 1,660 pregnant and breastfeeding women; and Vitamin A supplements for 3,370 infants (6-11 months). 
  • UNRWA distributed HEBs to 320,000 people and 27,184 date bars to people in shelters, as an immediate urgent food response in emergency. 

Water, Sanitation and Hygiene (WASH)

  • A total of 20 WASH partners are currently active and operating across the Gaza Strip. Several organizations are trying to reactivate their operations in Rafah (15), Khan Younis (15), Gaza City (10), and northern Gaza (7). 
  • The constraints on the import of dual-use items inhibits an adequate WASH response. A consignment of piping and generators were not allowed into Gaza during the humanitarian pause. During the pause, few WASH supplies entered Gaza, despite the use of the prioritization list for entry. No new storage tanks, jerry cans, or cleaning kits entered through Rafah crossing. No latrines were built.  
  • Water quality and access standards remain unachieved. Access is a key challenge. Water networks are fractured, production points are reduced, power for pumping and distribution is restricted, and storage and outlets are minimized. Many communities are isolated across Gaza, particularly north of Wadi Gaza.  
  • The CMWU and WASH agencies have produced on average 41,068 cubic metres of water, and have distributed around 80,000 litres of fuel, approximately 11,430 litres daily. 

Shelter and Non-Food Items (NFI)

  • During the reporting period, despite some progress in delivering and distributing basic NFIs, including bedding, there remains   significant shortages of shelter winterization materials, including tents, tarpaulins, and plastic sheeting for use as sealing off kits.  
  • IDPs are increasingly seeking shelter in large ad hoc sites.  
  • Shelter Cluster partners distributed the following items inside and outside collective centres in the southern governorates: 
    • 2,300 kitchen kits  
    • 56,800 blankets and 27,450 mattresses 
    • 2,000 mats  
    • 7,300 tarpaulin sheets 


  • The Logistics Cluster, together with HELP Logistics and JSI, coordinated an assessment of the Gaza public health capacity for warehousing and logistics between November-December 2023, available here.
  • The Cluster has handed over and installed a total of 14 Mobile Storage Units (MSUs) that have augmented the offloading capacity in the Rafah handover point and the storage capacity of four UN Agencies and International NGOs.  
  • In Al Arish, Egypt, the Logistics Cluster augmented the ERC storage capacity with the installation of 10 MSUs with a dedicated set-up for the temperature-controlled cargo through four inflatable cold rooms, in addition to eight prefabs and four ablution units. 

Prevention of Sexual Exploitation and Abuse

  • To enhance communication with communities, the PSEA network adopted a new visual identity named 'Sanad,’ which regularly disseminates safeguarding messages through various mediums, including printed brochures, stickers, and radio spots tailored to the emergency context. 
  • Given communication challenges in Gaza and limited internet access, the network predominantly relies on printed brochures and stickers to reach the population. UNICEF sent 500,000 Sanad brochures to Gaza for distribution, alongside hygiene kits. 
  • Sanad initiated social media channels to convey safeguarding messages. In the initial two weeks, messages on these platforms reached about 150,000 users, with over 90 per cent from the West Bank. There are further plans to increase the reach of these channels to a broader audience in the weeks ahead. 

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.