Humanitarian Needs and Response Update | 5-11 March 2024

Needs

• Expanding essential healthcare services is critical to safeguard public health and mitigate the spread of infectious diseases especially amongst IDPs. This includes provision of medication supplies, redoubling immunization rates, enhancing access to reproductive and maternal health services, and ensuring the availability of laboratory equipment and reagents critical for precise diagnostics and testing, and blood products in hospitals.
• Ongoing military operations, particularly in and around hospitals, have resulted in a reduction in their capacity, which necessitates the establishment of field hospitals across the Gaza Strip.
• Reports of death and threat of death among children who suffer from Severe Acute Malnutrition (SAM) due to inadequate food and nutrition supplies necessitate urgent access to the northern governorates of the Strip to supply food and establish SAM stabilization centres, and outpatient therapeutic feeding programs.
• There is a need to improve access to safe drinking water and proper sanitation facilities to prevent water-borne diseases among affected people, particularly IDPs.

Response

• A WHO-led mission, in collaboration with OCHA, UNFPA and UNICEF, delivered over 40,000 litres of fuel, medicine, and medical supplies to Kamal Adwan, Al Ahli, As Sahaba and Al Awda hospitals.
• Kuwait Hospital's bed capacity was expanded from 60 to 132 with support from WHO and partners due to congestion at An Najjar Hospital.
• Partners established a medical point at the World Central Kitchen Welcome Center in Deir al Balah and which is providing food and non-food items (NFIs) to displaced people fleeing from Gaza city and the northern governorates.
• The SAM Stabilization Center in Rafah began providing care for children suffering from SAM with medical complications.
• WHO provided rapid diagnostic tests for meningitis at Al Aqsa and European Gaza hospitals to improve disease surveillance.
• WHO and PRCS evacuated 96 critical patients from An Najjar Hospital to Rafah IMC Field Hospital.
• UNICEF hired a cleaning company to manage cleaning and waste disposal at Rafah and Deir al Balah hospitals.
• MedGlobal deployed an Emergency Medical Technician to support maternity services in Al Awda Hospital in An Nuseirat refugee camp.
• UNFPA delivered inter-agency reproductive health kits to As Sahaba Hospital in northern Gaza and conducted a needs assessment to identify crucial maternity and reproductive health needs.
• UNICEF prepositioned 50 incubators for premature infants in Rafah and distributed them to the European Gaza and Al Aqsa hospitals, with plans to deliver incubators to Kamal Adwan Hospital to support the resumption of neonatal unit services.
• WHO and UNFPA developed a community-sensitive Clinical Management of Rape and Gender-Based Violence strategy and will preposition PEP kits at medical points in Rafah, Khan Younis, and Deir Al-Balah.

Challenges

• Al Awda, Al Ahli, As Sahaba and Kamal Adwan hospitals in northern Gaza face challenges due to recent military operations and limited access to the area. They are in dire need of fuel, medical supplies, and specialized medical staff. Operating with limited resources, all four hospitals experience electricity shortages and an increase in trauma cases and malnutrition. Continued cross-sectoral support is urgently needed.
• There is limited access to the northern governorates of Gaza, preventing the   provision of adequate healthcare.
• Continuous hostilities across the Gaza Strip pose significant barriers to accessing healthcare service points.
• Increases in cases of acute jaundice syndrome and bloody and watery diarrhoea, due to the unavailability of safe drinking water and poor and lack of sanitation facilities, continue to pose a significant public health challenge.
• The absence of segregated sanitation facilities and electricity within shelters presents a considerable safety risk for women and girls.
• The MoH in Gaza reports that 346 healthcare workers have been killed since the beginning of the war.

Needs

• The food situation in Gaza is alarming, with reports of hunger impacting the entire population and a growing risk of famine-like conditions.
• In northern Gaza, recent airdrops have delivered thousands of meals but remain insufficient to meet the soaring needs of some 300,000 people in the area.
• The situation is similarly critical in the middle and southern governorates, with most of the population queuing for hours to receive food when trucks manage to enter. Partners report a lack of food to distribute and existing stocks lasting only for a short time period.
• In Rafah, more than a million people are striving to find safety in densely populated areas and a rise in the number of undernourished children.
• There is urgent need to import the agricultural inputs necessary for reactivating domestic production of essential fresh foods such as eggs, vegetables, meat, fish, and milk.
• There is a need to establish secure and uninterrupted humanitarian corridors, with the support of the private sector.

Response

• Between 4 and 10 March, 19 partners provided food assistance, including food parcels and hot meals, across the Gaza Strip, reaching a daily average of 200,000 people (around 10 per cent of the population) at least once: 68 per cent were in Rafah governorate, 14 per cent in Deir al Balah, 8 per cent in Khan Younis, one per cent in Gaza, and nine per cent in northern Gaza.
• Since 21 November, 373,193 households have received flour, with 35 per cent receiving two rounds of assistance.

Challenges

• Hostilities, frequent border closures, access constraints, and insecurity continue to impede the establishment of sustainable and dependable modalities for the flow of food aid, the resumption of food production, as well as the safe and efficient delivery of humanitarian assistance.

Needs

• It is critical to expand nutritional assessments across the Gaza Strip, including through strengthening capacities of primary healthcare staff, to detect cases of acute malnutrition, and administer treatment using the simplified CMAM protocol until recovery (spanning 8-12 weeks).
• It is necessary to increase the number of service points for the Outpatient Therapeutic Programme (OTP), establish four additional stabilization centers to manage a growing number of SAM cases with medical complications, and strengthen partners' capabilities to handle the growing caseload of acute malnutrition.

Response

• The MUAC screenings continue to target children aged 6 to 59 months in shelters and healthcare facilities to detect acute malnutrition. Children found to have acute malnutrition are referred for treatment, adhering to a simplified CMAM treatment protocol. In total, 14,794 children aged 6-59 months underwent MUAC screening, including 1,246 cases of children with acute malnutrition (MAM- 911, SAM- 255) who are currently undergoing treatment using the simplified protocol. 
• Curative and preventive nutritional supplies have been distributed, such as Ready-to-Use Therapeutic Food (RUTF), Lipid-based Nutrient Supplements (LNS), and High Energy Biscuits. 
• Med-global, under the guidance of WHO, has established a Stabilization Centre at the Khan Sultan Clinic in Rafah. Another center is in the process of being established by the International Medical Corps (IMC), with WHO’s support.

Challenges

• Limited access to northern Gaza and insufficient supplies of nutrition commodities for prevention and treatment are hindering nutrition response activities.

Needs

• Identification of, and alternative care arrangements for, unaccompanied, previously detained and separated children.
• Assistance to children injured by the conflict, including by Explosive Remnants of War (ERWs). 
• Scaling up life-saving services for GBV survivors, including the need for prefabricated structures to serve as safe spaces for women.
• Ensuring a continued pipeline supply of dignity kits and menstrual hygiene supplies. 
• Provision of mental health and psycho-social support MHPSS services, including for children who face neglect and exploitation.
• Winter clothing and blankets for children and infants.
• Immediate action to enable large-scale assessments of the scale of Explosive Ordnance (EO) contamination, including through: the deployment of Explosive Ordnance Disposal (EOD) operator; Explosive Ordnance Risk Education (EORE) and Conflict Preparedness and Protection (CPP) messages tailored to different groups and needs.
• EORE and CPP training for humanitarian workers; and Victim Assistance (VA) services for survivors of shelling and explosive ordnance related accidents.

Response

• Child Protection partners have, since 7 October, reached 294,818 people (267,511 children and 27,307 caregivers) across the Gaza Strip with child protection services, including MHPSS, winter clothes and awareness raising on EORE and Child Rights. Also see data on the response.
• The GBV sub-cluster has developed and disseminated Emergency Referral Pathways to enhance access to essential services for GBV survivors. 
• Mine Action partners are carrying out Explosive Threat Assessments for prioritized humanitarian sectors; delivering EORE and CPP sessions, producing educational materials, and conducting digital, Radio and SMS campaigns tailored to people with disability; and exploring partnerships with local organizations to enhance their reach and impact. A bi-weekly technical working group on EORE-CPP was also established.

Challenges

• Fuel shortages limit staff transportation, preventing the implementation of a comprehensive case management response, and putting at risk the operation of the temporary shelter for unaccompanied children. 
• Partners are also facing difficulty in bringing psychosocial support kits into Gaza to support the implementation of activities.
• The need for authorization to deploy specialized Mine Action personnel, especially EOD operators for EO contamination assessments, restrictions on the import of essential humanitarian mine action supplies, and unreliable communication systems continue to hinder Mine Action response.

Needs

• More than 625,000 students and nearly 23,000 teachers in the Gaza Strip have been affected by school closures and attacks on education, with no access to education or a safe place.  
• Some 92 per cent of all school buildings in Gaza are being used as shelters for IDPs and/or have sustained damage ,with 76 per cent of damaged schools in  North, Gaza, and Khan Younis governorates  (source: Education Cluster Damaged School Dashboard). 
• Some 45 per cent of school buildings used as shelters were either directly hit or damaged.
• At least 55 per cent of schools will either need full reconstruction or major rehabilitation to be functional again, according to the Satellite-derived Damage Assessment conducted by the Education Cluster.
• UNRWA reports at least 51 incidents of military use and/or interference at UNRWA premises, the majority in schools.
• Key priorities include: the provision of Education in Emergencies (EiE) recreational activities and psychological support, including Social Emotional Learning (SEL) activities to children in shelters and designated emergency shelters (DESs); establishing Temporary Learning Spaces (TLS) in shelters/DESs to start non-formal learning for children; provision of emergency supplies and learning kits; and identification of children with disabilities and provision of assistive devices to ensure learning continuity.

Response

• Since the onset of hostilities, 17 partners have reached more than 201,327 students and teachers (source: Education Cluster 5W dashboard) with psychosocial support, emergency learning, recreational supplies and activities, and awareness sessions in Deir al Balah, Khan Younis, and Rafah governorates. Most cluster response activities are delivered by local partners. 
• Some recreational and psychosocial support activities in Gaza governorate have been initiated by a group of youth volunteers, under remote supervision by cluster partners.
• UNICEF, Teacher Creativity Centre and partners are working on establishing TLS to start non-formal education activities with displaced children in shelters/DESs.

Challenges

• There are no educational activities in the northern Gaza due to ongoing hostilities and access challenges.  
• As of 10 March, the education response remains significantly underfunded, receiving less than 15 per cent of its requirements, requiring urgent funding.

Needs

• The storage and transport capacity inside Gaza remains challenging due to infrastructure damage, access constraints, and the lack of supplies.

Response

• Since 7 October, the logistics Cluster has received 10,197 cubic metres of cargo from 21 organisations in Gaza, and has supported 23 organisations with cargo notification services at the Rafah transshipment point. 
• To map additional gaps and identify shared resources, the Logistics Cluster is collecting data from its partners on their storage capacity through a survey (also available in Arabic).
• Regarding the Jordan corridor, the Logistics Cluster has been supporting humanitarian organisations with cargo consolidation in Amman and transport services through the Amman – King Hussein Bridge – Gaza route. 
• On 5 March a 24-truck convoy carrying 427.9 metric tons of relief items was dispatched on behalf of three partners.  Data on the convoys can be found on  the inter-active dashboard.
• The Logistics Cluster is collecting the pipeline for incoming cargo through the Egypt and Jordan corridors.  As of 5 March, it is anticipated that 241,936 metric tons of cargo will pass through the corridors of Jordan and Egypt in the next three months. This volume marks a 6% rise from the figures recorded in the week prior.  Notably, this data is based on inputs from participating organizations only.
• The Logistics Cluster is working with partners and WFP to facilitate access of humanitarian organisations to the WFP-led convoys inside Gaza. 
• Partners` needs can be provided through the online form. The Logistics Cluster is also collecting information on Physical Access Constraints and damage to roads from partners.

Challenges

• Approval for the deployment of two Temperature-Controlled Units (mobile storage units for health cargo) in Gaza is pending.
• Storage assessments across Gaza remain challenging due to security and access constraints.

Needs

• There is an urgent need for independent and reliable communication platforms for humanitarian responders in Gaza to coordinate emergency response and deliver lifesaving aid.

Response

• On 6 March, the ETC launched a survey among UN agencies operational in Gaza to collect Security Communication Services (SCS) needs, focal point details, and desired quantities of Very High Frequency (VHF) handheld radios. The survey will facilitate the distribution of the approved 30 digital VHF radios, donated by the ETC to the UN Department of Safety and Security (UNDSS), for use in Gaza. 
• According to the Palestine Ministry of Telecommunications and Information Technology (MTIT), the Coordination of Government Activities in the Territories (COGAT) has authorized telecommunications operators in Gaza to import essential spare parts―primarily cables—to enable critical repairs, restore services, and improve the available communications services. 
• The ETC continues to support humanitarian agencies in Gaza with Information and Communication Technology (ICT) assessments, technical advice and information, repairs, and guidance on the use of ICT equipment. 
• Since 9 January, the ETC has conducted 18 Information and Communications Technology (ICT) assessments in 14 locations and supported 17 humanitarian agencies across Gaza to maximize the available telecommunications resources on the ground.
• For more information on ETC activities, please visit: Palestine: Conflict | Emergency Telecommunications Cluster (ETC) (etcluster.org).

Challenges

• Limited access to electricity, fuel, and telecommunications services continues to impede the humanitarian response in Gaza. 
• Import of telecommunications equipment is challenging.

 Response

• Between 5 and 11 March, 4,752 households received one round of emergency MPCA. Cash out operations are concentrated in the governorates south of Wadi Gaza, with the majority  in Rafah. 
• As of 11 March, one round of emergency MPCA was delivered to some 167,267 households, a top-up was delivered to 34,000 people, including people with disabilities and nursing mothers, and over 21,267 households have received a second round. 
• Since 7 October, some 119,289 households have cashed out their assistance, and about 5,400 payments have been cancelled after not being cashed out for months mainly due to the lack of connectivity and available agents (especially north of Wadi Gaza). 
• Based on the last post-distribution monitoring (PDM) data collected between mid-January and mid-February, food remains the most purchased item with humanitarian cash (80 per cent), followed by medicines (39 per cent), water (23 per cent), hygiene bedding (10 per cent), and transportation. PDM data show that cash remains a relevant modality of assistance which can be used by recipients to access goods and services that remain available.

 Challenges

• Poor electricity supply and connectivity is affecting the ability of financial service providers to make cash accessible, compromising the encashment of the MPCA package.
• Provided assistance falls well short of needs, given market collapse and price volatility. 
• Since late December, commercial trucks have entered Gaza, with 923 trucks recorded as of 02 March. Informal markets are the primary source of accessible goods, which complicates efforts to track distributions and gather market data.

Needs

• There is a need to mainstream PSEA messages and safeguarding practices across the Gaza Strip and West Bank, including East Jerusalem.  
• There is a pressing need to prioritize protection interventions at large. Safeguarding and SEA risk have become prominent in a context of severe aid dependency. The lack of safe aid delivery increases vulnerability and leads to exploitation and abuse.   
• Provide safe and accessible reporting channels, that lead to assistance and investigations of PSEA allegations.   
• Ensure that services are available for people at risk of sexual exploitation and abuse (SEA).  

Response

• Since October 2023, more than 2,000 cases have been referred by specialized counsellors. 
• More than 800 at-risk people in Gaza were referred to Cash for protection schemes.  
• The PSEA Network has launched new rounds of PSEA training sessions for 2024. 
• Due to communication cuts in Gaza, a range of public communication materials were developed and distributed.   
• The PSEA Network has made available MHPSS support and remote counselling sessions for PSEA focal points on the ground in Gaza, who are documenting complaints and feedback.

 Challenges

• Identifying cases and reaching vulnerable individuals remain challenging, due to internet and telecommunication blackouts. Electricity and communication cuts also make it challenging to establish contact with on-the-ground PSEA focal points.