Nasser hospital, one of three hospitals in the Deir Al Balah and Khan Younis governorates that are at risk of closure due to the issuance of evacuation orders in adjacent areas and ongoing conduct of hostilities nearby. Photo by WHO, 4 January 2024

Hostilities in the Gaza Strip and Israel | Flash Update #88

09 Jan 2024

Key points

Intense Israeli bombardments from air, land, and sea continued across much of the Gaza Strip on 9 January, particularly in the Deir al Balah and Khan Younis governorates. The offensive in these areas results in the killing and injury of many people and having devastating consequences for tens of thousands of civilians, many of whom had already fled for safety from Gaza city and the north to central and southern Gaza. The firing of rockets by Palestinian armed groups into Israel also continued. Ground operations and fighting between Israeli forces and Palestinian armed groups were reported across much of the Gaza Strip, particularly in the Deir al Balah and Khan Younis governorates, resulting in additional casualties.
Between the afternoons of 8 and 9 January, according to the Ministry of Health (MoH) in Gaza, 126 Palestinians were reportedly killed, and another 241 people were reportedly injured. Overall, between 7 October and 12:00 on 9 January, at least 23,210 Palestinians were killed in Gaza and 59,167 Palestinians were reportedly injured according to the MoH in Gaza.
Since 8 January and as of 9 January, nine Israeli soldiers have been killed in Gaza, according to the Israeli auhotirities. Since the start of the ground operation, 183 soldiers have been killed, and 1,065 soldiers have been injured in Gaza, according to the Israeli military.
Humanitarian partners report that denials of coordinated movement requests are critically inhibiting a time-sensitive response. On 8 January, a planned mission by OCHA and WHO to deliver urgent medical supplies to the Central Drug Store in Gaza city and Al Awda Hospital in Jabalya, as well as planned missions to deliver vital fuel to water and sanitation facilities in Gaza city and the north, were denied by the Israeli authorities. This marked the fifth denial of a mission to Al Awda Hospital in Jabalya and Central Drug Store in Gaza city since 26 December, leaving five hospitals in northern Gaza without access to life-saving medical supplies and equipment. At the same time, the continued denial of fuel delivery to water and sanitation facilities is leaving tens of thousands of people without access to clean water and increasing the risk of sewage overflows, significantly heightening the risk of the spread of communicable diseases.
On 9 January, 131 trucks with supplies entered the Gaza Strip through the Rafah and Kerem Shalom crossings.
On the morning of 8 January, a shell penetrated the wall of a shelter in Khan Younis housing over 100 Médecins Sans Frontières (MSF) staff and their families. Four people were injured, including a five-year-old child of one of the staff members, who subsequently died of her injuries. According to MSF, the shell did not detonate on impact, otherwise more fatalities would most likely have occurred. Four MSF staff have been killed since 7 October in Gaza, in addition to numerous family members. Expressing its outrage at the death, MSF stated “that it doesn’t matter where you are in Gaza, nowhere is safe,” and reiterated a call for an immediate and sustained ceasefire.

Hostilities and casualties (Gaza Strip)

The following are among the deadliest incidents reported between 8 January and 9 January:
- On 8 January, at about 15:30, four people were reportedly killed and tens injured when a house northwest of Deir Al Balah, was struck.
- On 8 January, overnight, eight people were reportedly shot and killed in An Nuseirat Camp, Deir al Balah. governorate
- On 8 January, at about 18:30, 12 people were reportedly killed, and 40 people injured, when a house west of An Nuseirat Camp was struck.
- On 9 January, at about 10:15, 10 people were reportedly killed when a car in An Nuseirat Camp, was struck.

Displacement (Gaza Strip)

By the end of 2023, according to UNRWA, 1.9 million people, or nearly 85 per cent of the total population of Gaza, were estimated to be internally displaced, including many who have been displaced multiple times, as families are forced to move repeatedly in search of safety. Nearly 1.4 million internally displaced persons (IDPs) are sheltering in 155 UNRWA facilities across all five governorates; facilities are far exceeding their intended capacity. Rafah governorate has for a while been the main refuge for those displaced, with over one million people squeezed into an extremely overcrowded space, following the intensification of hostilities in Khan Younis and Deir al Balah and the Israeli military’s evacuation orders. Obtaining an accurate figure of the total number of IDPs remains challenging.
Some 220 incidents affecting UNRWA premises and people inside them have been reported since 7 October (some with multiple incidents affecting the same location), including at least 23 incidents of military use and/or interference at UNRWA premises. This includes 63 direct hits on UNRWA installations and 69 different UNRWA installations sustaining damage when a nearby object was hit. In total, at least 319 IDPs staying in UNRWA shelters have been killed and at least another 1,135 were injured since 7 October.

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 were depleted. The communications and fuel shutdown continues to significantly hinder the aid community’s efforts to assess the full extent of needs in Gaza and to adequately respond to the deepening humanitarian crisis. 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), 15 out of Gaza’s 36 hospitals are partially functional; nine in the south and six in the north.
Hospitals in the north have been offering maternity, trauma, and emergency care services. However, they face challenges such as a shortage of medical staff, including specialized surgeons, neurosurgeons, and intensive care staff, as well as a lack of medical supplies, and have an urgent need for fuel, food, and drinking water. The nine partially functional hospitals in the south 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 reaching 206 per cent in inpatient departments and 250 per cent in intensive care units.
In Deir Al Balah and Khan Younis, three hospitals – Al Aqsa, Nasser, and Gaza European – are at risk of closure due to the issuance of evacuation orders in adjacent areas and the ongoing conduct of hostilities nearby. On 9 January, shelling was again reported in the vicinity of the Al Aqsa Hospital in Deir al Balah, from where most medical staff and many patients had evacuated on 7 January. Reportedly, only one emergency doctor and two surgeons remain, to respond to hundreds of patients who require treatment in the hospital. On 7 January, staff from WHO and OCHA visited the Al Aqsa Hospital, and delivered medical supplies to support 4,500 patients needing dialysis for three months and 500 patients requiring trauma care. The WHO Director-General, Dr. Tedros Adhanom Ghebreyesus stated that “Al Aqsa is the most important hospital remaining in Gaza’s Middle Area [Deir al Balah] and must remain functional, and protected, to deliver its lifesaving services. Further erosion of its functionality cannot be permitted – doing so in the face of such trauma, injury and humanitarian suffering would be a moral and medical outrage.”

Food security

The Famine Review Committee (FRC), activated due to evidence surpassing the acute food insecurity Phase 5 (Catastrophic threshold) in the Gaza Strip, warns that the risk of famine is increasing daily amid intense conflict and restricted humanitarian access. The FRC stated that, to eliminate the risk of famine it is imperative to halt the deterioration of the health, nutrition, food security, and mortality situation through the restoration of health, water, sanitation, and hygiene (WASH) services. The FRC has also called for the cessation of hostilities and the restoration of humanitarian space for delivering multisectoral assistance as vital first steps to eliminate any risk of famine.

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.
The Israeli authorities estimate that about 136 Israelis and foreign nationals remain captive in Gaza. During the humanitarian pause (24-30 November), 86 Israeli and 24 foreign national hostages were released.

Violence and casualties (West Bank)

On 9 January, Israeli forces at a checkpoint in Ein Siniya village (Ramallah) shot and killed a Palestinian man who, they say, attempted to stab an Israeli soldier.
This raises to 330 the number of Palestinians killed in the West Bank, including East Jerusalem, since 7 October 2023 and as of 9 January 2024. Among the fatalities are 84 children. 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 (330); 321 were killed by Israeli forces, eight by Israeli settlers and another one by either Israeli forces or settlers. The number of Palestinians killed in the West Bank, including East Jerusalem, in 2023 (507) marks the highest number of Palestinians killed in the West Bank since OCHA started recording casualties in 2005.
Since 7 October 2023 and as of 9 January 2024, five Israelis, including four members of the Israeli forces, have been killed in Palestinian attacks in the West Bank, including East Jerusalem. Another four Israelis were killed in an attack carried out by Palestinians from the West Bank in West Jerusalem (one of the four was killed by Israeli forces who misidentified him). The number of Israelis killed in the West Bank and Israel in 2023 in attacks by Palestinians from the West Bank (36) was the highest since OCHA started recording casualties in 2005.
Since 7 October 2023 and as of 9 January 2024, a total of 4,097 Palestinians, including 622 children, were injured in the West Bank, including East Jerusalem. Of them, 3,983 have been injured by Israeli forces, 93 by settlers and 21 by either Israeli forces or settlers. Of the total injuries, 52 per cent were reported in the context of search-and-arrest and other operations, 36 per cent in demonstrations and 8 per cent during settler related attacks against Palestinians. 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

Since 7 October 2023 and as of 9 January 2024, OCHA has recorded 391 Israeli settler attacks against Palestinians, resulting in Palestinian casualties (37 incidents), damage to Palestinian-owned property (305 incidents), or both casualties and damage to property (49 incidents). This reflects a daily average of four incidents since 7 October 2023 until 9 January 2024, compared with seven daily incidents reported between 7 October and 10 November 2023, which was the highest daily average of settler-related incidents affecting Palestinians since 2006.
One-third of the settler attacks against Palestinians after 7 October involved firearms, including shootings and threats of shootings. In nearly half of all recorded incidents after 7 October, Israeli forces were either accompanying or reported to be supporting the attackers.
In 2023, 1,229 incidents involving settlers in the West Bank, including East Jerusalem (with or without Israeli forces), resulted in Palestinian casualties, property damage or both. Some 913 of these incidents resulted in damage, 163 resulted in casualties and 153 resulted in both. This is the highest number of settler attacks against Palestinians in any given year since OCHA started recording incidents involving settlers in 2006.

Displacement (West Bank)

Since 7 October 2023 and as of 9 January, at least 198 Palestinian households comprising 1,208 people, including 586 children, have been displaced amid settler violence and access restrictions. The displaced households are from at least 15 herding/Bedouin communities. More than half of the displacements occurred on 12, 15, and 28 October, affecting seven communities. The displacement toll since 7 October 2023, represents 78 per cent of all displacement reported due to settler violence and access restrictions since 1 January 2023 (1,539 people, including 756 children).
Additionally, 444 Palestinians, including 224 children, have been displaced since 7 October and as of 9 January, following the demolition of their homes, due to lack of Israeli issued permits in Area C and East Jerusalem, which are almost impossible to obtain.
A total of 19 homes have been demolished and 95 Palestinians, including 42 children, displaced due to punitive demolitions in the last three months of 2023. The numbers exceed those reported in the past nine months of the same year, during which 16 homes demolished and 78 people displaced.
Another 587 Palestinians, including 257 children, have been displaced since 7 October following the destruction of 92 homes during other operations carried out by Israeli forces across the West Bank. About 95 per cent of the displacement was reported in the refugee camps of Jenin and Nur Shams and Tulkarm, both in Tulkarm. This represents 65 per cent of all displacement reported due to the destruction of homes during Israeli military operations since January 2023 (908 people).

Funding

As of 9 January, Member States have disbursed $638.6 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 53 per cent of the $1.2 billion requested. Private donations are collected through the Humanitarian Fund.

HUMANITARIAN NEEDS AND RESPONSES: 3 January to 7 January

Health

Since the start of hostilities, Health Cluster partners have provided healthcare and medical services to an estimated 500,000 people.
The Health Cluster estimated that about 5,000 beds and adequate human resources are required to meet trauma and emergency needs. Only 1,000 beds are available as of 9 January, compared with 3,500 beds available before the beginning of hostilities. A total of 59 out of 77 primary health centres are not functioning leaving many without access to basic health services.
Only 26 per cent of the requested medical supplies needs have been met and only 120 out of 353 formal and informal IDP shelters have access to medical points.
About 350,000 people with chronic illnesses and about 485,000 people with mental health disorders continue to experience disruptions in their treatments.
1.9 million IDPs remain at high risk of communicable disease due to poor living conditions, notably overcrowding of IDP sites and lack of access to proper water sanitation and hygiene facilities.

WASH

Of the 23 active partners of the Water, Sanitation and Hygiene (WASH) Cluster, few are able to operate across the Gaza Strip. Between 1 and 7 January, WASH partners delivered 3,720 cubic metres of water per day through two of the three partially operating short term, low volume diesel plants south of Wadi Gaza. Partners provided 6,300 cubic metres of water and 13,900 litres of fuel to support water supply and distribution.
The combination of water trucking, water from the functional desalination plant, and the restoration of one of the three main water supply lines on 30 December has yielded only seven per cent of water production in Gaza, compared with the pre-October 2023 supply. Water quality indicators also remain a major concern, with limited large-scale water quality testing campaigns or activities being undertaken.
Through the efforts of the Coastal Municipalities Water Utility (CMWU) and UNICEF, The Wastewater Treatment Plant in Rafah's “Philadelphi Corridor” has resumed full operation.
Heavy rainfall last week has led to flooding in various locations, including Jabaliya Camp, raising concerns about potential sewage contamination in the floodwaters.
WASH Cluster partners are attempting to expand sanitation-related response activities for IDPs in Rafah and Khan Younis. However, challenges remain due to material shortages, especially for dual-use items; logistical difficulties in transporting supplies; limited space for latrine construction; and the absence of community support and fecal sludge management systems.
Overall, 1.4 million people in Gaza have been reached with partial water and sanitation assistance at least once since October 2023.

Protection

Mine Action partners have continued to provide Explosive Ordinance Risk Education (EORE) and Explosive Remnant of War (ERW) awareness and guidance about preparedness since the start of the hostilities, reaching over 1.1 million IDPs through in person sessions in shelters, and via SMS, radio, and social media campaigns.
The situation in Gaza is complex and challenging for mine action activities, because of substantial contamination from various sources of explosive ordnance (EO). Ongoing hostilities, including airstrikes, shelling, and the use of rockets is causing widespread contamination, posing significant risk. The presence of ERW significantly hinders access and humanitarian efforts, as many areas are inaccessible or dangerous for aid workers to respond safely to humanitarian needs. A comprehensive and multi-faceted mine action response is needed to address, not only the immediate threats, but also the long-term implications for the community.
The main challenges Mine Action actors face include shortage of Explosive Ordnance Disposal (EOD) experts in Gaza. As a result, a comprehensive ERW assessment, and provision of support on access for humanitarian response have been delayed.
Child Protection partners continued to provide awareness raising interventions, mental health and psycho-social support services (MHPSS) for children and caregivers, child protection case management and distribution of clothing kits.
Gender-based violence (GBV) partners continued to highlight and address the increased psychological stress among displaced women and girls and increased protection and GBV risks. GBV prevention, response, and risk mitigation interventions remain extremely difficult given the collapse of services and displacement of service providers, and movement restrictions.

Shelter and Non-Food Items (NFI)

As of 7 January, it is estimated that about 69,000 housing units across the Gaza Strip have been destroyed or rendered uninhabitable and over 290,000 housing units have been damaged, according to the Government Media Office in Gaza. It is estimated that over 500,000 people will have no home to return to, and that many more will be unable to return immediately, due to the level of damage to surrounding infrastructure, as well as the risk posed by ERW.
Since the start of the hostilities, shelter partners have cumulatively provided 11,500 dignity kits; 36,000 sealing off kits; 650,000 bedding set items (blankets and mattresses); 26,709 tents; 11,500 kitchen sets; and 17,250 winter clothing kits to a total of 914,500 IDPS in UNRWA and non-UNRWA shelters.
There is a high shortage of all essential NFIs for IDPs inside and outside the shelters. This includes 1,200,000 mattresses and blankets, 200,000 emergency shelter kits, including tarpaulin and plastic sheets, at least 50,000 winterized family tents, and 200,000 winter clothes.
Shelter partners report that tents and self-built makeshift shelters are over-crowded as more than 15 people live in one tent, making the space available per person less than the minimum Sphere Standards. This exposes IDPs to unhygienic conditions and communicable diseases. Self-built makeshift shelters are constructed from salvaged materials and are inadequate to withstand current weather conditions.
The Shelter Cluster reports that, based on an IDPs survey conducted in Rafah, rental apartments cost over 800 per cent the normal price due to lack of residential units in the south.

Nutrition

UNICEF and other nutrition partners continued their efforts to address the nutritional needs of children and mothers through delivery of key nutrition commodities to the Gaza Strip. Partners are providing therapeutic services and supplies for children with acute malnutrition, alongside preventative nutrition supplies, including High Energy Biscuits (HEBs).

During the first week of January 2024, nutrition partners delivered the following:

One month supply of ready-to-Use Infant Formula (RUIF) to nearly 2,300 children under five months of age.
Therapeutic milk to some 560 children with severe acute malnutrition (SAM) and medical complications.
Multiple Micronutrients tables (MMS) to more than 18,000 pregnant and nursing mothers.
Vitamin A supplementation to more than 30,000 children under-one year; and
Iron-folate supplementation to some 40,000 pregnant and nursing mothers.

Juzoor, a local partner, distributed 29 pallets of RUIF to several clinics. Additionally, four pallets of Ready-to-Use Therapeutic Foods (RUTF)were also provided to the Rafah Central, Deir al Balah, Al Zawaydeh and Tall as Sultan clinics.

More than 135,000 additional cartons of HEBs have been ordered and are expected to reach some 200,000 children under-five and more than 155,000 pregnant and nursing mothers.

Education

The Education Cluster reports that more than 625,000 students and close to 23,000 teachers in the Gaza Strip have been affected by attacks on education and school closures since October 2023, and
The Education Cluster reports that more than 625,000 students and close to 23,000 teachers in the Gaza Strip have been affected by attacks on education and school closures since October 2023, and remain with no access to education or a safe place.
Between 7 October 2023 and 2 January 2024, the Ministry of Education reports that 4,119 students and 221 teachers have been killed, while 7,536 students and 703 teachers have been injured across the Gaza Strip.
90 per cent of all school buildings in Gaza are being used as shelters for IDPs and have sustained varying levels of damage. Of these, 135 schools sustained minor damage; 126 schools sustained moderate damage; 99 schools sustained major damage and 12 were fully destroyed. Combined, these schools previously served some 433,000 children and more than 16,200 teachers. The Khan Younis, North and Gaza governorates have the highest proportion (three quarters) of all damaged schools.
The Cluster’s response is guided by a three-phased response plan – supporting conflict-affected children, teachers and care givers in shelters and in host communities; preparing a safe learning environment and re-establishing a sense of normalcy as soon as hostilities stop; and preparing to restore the formal education system through the reconstruction of education infrastructure after a reduction in hostilities.
Since October 2023, nine Education partners have reached close to 93,000 students and teachers with psychosocial support, emergency learning and recreational supplies and activities in the Khan Younis, Rafah, and Middle governorates. Most of the cluster respons is delivered by local partners but no activities have been able to be delivered in the three northern governorates of Gaza.
In the first week of January, the education response remains severely underfunded – receiving only three per cent of its requirements in the Flash Appeal. Education actors and donors are urged to mobilise rapid resources to meet immediate response requirements and start planning for reconstruction in the medium- to long- term, when hostilities subside.

Multi-purpose Cash Assistance (MCPA)

Since the beginning of the hostilities, 111,254 households (comprising almost 750,000 people) have received emergency MPCA. With about 81,941 households (54,926 people) having already cashed out their assistance. Cash out rates by users stand at 73 per cent and are declining slightly.
While distribution has been across the whole Gaza Strip, the vast majority is now concentrated in the southern governorates.
While formal markets are largely depleted, informal markets are now the key sources of basics goods and services. This includes trading of personal belongings, small household-based production (bread, vegetables), humanitarian assistance, and other items.
Post distribution monitoring data from recipients of cash assistance point to food, medicines, debt repayment, drinking water, and transportation as the top expenditures reported. The percentage of expenditures on food has further decreased over the past weeks, while the percentage of expenditures on medicines has doubled. Some 70 per cent of the respondents report that unrestricted cash has helped them access needed goods and services, either fully or partially, while 87 per cent preferred unrestricted cash for future assistance.

Logistics

Logistics Cluster partners provided a total of 20 trucks to the Egyptian Red Crescent (ERC) to support the humanitarian convoys from Al Arish (Egypt) to Rafah.
In addition, ERC storage capacity in Al Arish to receive and consolidate cargo was expanded by 3,200 m2 with the installation of 10 Mobile Storage Units (MSUs), with a dedicated set-up for the temperature-controlled cargo through four inflatable cold rooms.
In the Gaza Strip, the Logistics Cluster has handed over and installed a total of 18 MSUs (5,760 m2) that have augmented the offloading capacity in the Rafah handover point, Kerem Shalom crossing, and the storage capacity of four UN Agencies and International NGOs.

Emergency Telecommunications

The Emergency Telecommunications Cluster (ETC) and its partners continue to engage with the Israeli Coordinator of Government Activities in the Territories (COGAT) for authorization to import telecommunications equipment and set up an independent, efficient, and reliable communications platform for humanitarian responders.
The ETC deployed an ICT Specialist to Gaza on 8 January for an initial technical engagement with local actors to plan initial ICT needs assessment and to set up technical coordination processes for the response.

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.