Humanitarian Needs and Response Update | 9–15 April 2024

Needs

• Enhance preparedness in the coastal areas of Rafah. 
• Support the expansion of the capacity of the remaining key hospitals across the Gaza Strip. 
• Expand access to all levels of essential healthcare services for internally displaced persons (IDPs) and host communities, particularly those most vulnerable, such as children, pregnant and breastfeeding women (PBW), and people with chronic illnesses. 
• Expand routine immunization, disease surveillance, diagnostics and laboratory capacity.  
• Establish field hospitals in northern Gaza, given the significant pressure on the five remaining partially functioning hospitals. 

Response

• Six field hospitals (four in Rafah and two in Khan Younis) continue to provide trauma care and other essential services.  
• Partners continue to expand health service delivery points in the coastal areas of Rafah and some locations in Deir al Balah, as part of contingency planning efforts.  
• An inter-agency assessment mission on 11 April to Nasser Medical Complex, Al Amal Hospital, and Al Kheir Hospital.  
• A mission to Al Ahli Hospital on 13 April delivered fuel and evacuated three patients to field hospitals in Rafah.

Challenges

• Limited access to fuel continues to pose major challenges, especially to local NGOs. 
• Poor living conditions and limited or no access to proper water, sanitation, and hygiene (WASH) facilities continue to fuel a high risk of disease outbreak. 
• Denial of missions to northern Gaza is putting patients’ lives at risk, in addition to being daunting and mentally draining for patients’ families and companions. 

Needs

• An intact supply pipeline of ready-to-eat therapeutic food (RUTF) and of preventative nutrition commodities. The latter include high-energy biscuits, lipid-based nutrient supplements (MQ-LNS), and micronutrient supplements. These supplies are essential for over 160,000 PBW and some 346,000 children under the age of five, who are at the greatest risk of malnutrition and preventable mortality, including about 135,000 children under the age of two who are highly vulnerable to acute malnutrition. Overall, some 50,400 children under the age of five are estimated to be acutely malnourished. 
• Immediate humanitarian access to address increasing acute malnutrition. The rate of malnutrition is particularly high in northern Gaza, where an alarming 31 per cent of children under the age of two suffer from severe wasting. 
• Continued active identification of nutrition cases to ensure timely detection, referral, and treatment of acutely malnourished children. 
• Scale up preventive nutrition interventions, including infant and young child feeding (IYCF) and the provision of age-appropriate supplementary feeding products for people in need. 
• Expand the Outpatient Therapeutic Programme (OTP) targeting children with acute malnutrition to ensure greater proximity of nutrition treatment services to affected people. 
• Strengthen partners’ capacity to provide nutrition-in-emergency services, including community-based management of acute malnutrition (CMAM) and IYCF practices in emergencies. 
• Enhance the mapping of service coverage as well as monitoring and reporting systems to identify gaps and ensure effective coordination and a streamlined nutrition response.

Response

• Overall, Nutrition Cluster partners are providing nutrition services at 21 health facilities, 235 formal and informal shelters, and 37 sites in host communities.  
• Since mid-January, 43,355 children aged 6-59 months have undergone Mid-Upper Arm Circumference (MUAC) screenings at shelters and healthcare facilities and, with UNICEF’s support, are currently receiving treatment in accordance with the simplified protocols. To date, 2,932 children have been diagnosed with acute malnutrition, including 2,168 with Moderate Acute Malnutrition (MAM) and 764 with Severe Acute Malnutrition (SAM).  
• UNICEF and 13 partners have so far expanded the outpatient therapeutic programme to 85 sites: 26 in North Gaza, 11 in Deir al Balah, 2 in Khan Younis, and 46 in Rafah. 
• Referral of children who were undergoing treatment at the IMC field hospital, which is in the process of relocating, to other appropriate healthcare centres in Rafah.   
• Ongoing establishment of a stabilization centre at Kamal Adwan Hospital for acute malnutrition cases with medical complications. An international NGO, supported by WHO and UNICEF, is providing the needed supplies and technical support and scaling up screening services and outpatient treatment.  
• WFP and seven partners have so far distributed MQ-LNS to 30 per cent of children under five and PBW across Gaza, with access challenges limiting reach despite sufficient stocks. Between 7 and 9 April, 1,192 PBW and 2,757 children under five received a 15-day allocation of MQ-LNS.  
• During the first two weeks of April, 5,354 PBW and other caregivers of children under two received sensitization sessions on IYCF practices in emergencies (IYCF-E). 
• A local NGO, with support from Save the Children, is currently establishing 10 mother-baby areas to strengthen IYCF interventions in Rafah, Deir al Balah, and Gaza city. 

Challenges

• Limited humanitarian access throughout Gaza, particularly in the northern areas, continues to exacerbate the catastrophic levels of food insecurity already faced by people and to prevent the urgent delivery of life-saving nutrition commodities. This dynamic, compounded by deteriorating health and (WASH) services, is resulting in an increasing number of acutely malnourished children.  
• Continued displacement undermines the effective provision of nutrition services.  
• Extreme fear and stress, malnutrition, and complex living conditions due to protracted hostilities have resulted in mothers being unable to breastfeed their newborn babies. 

Needs

• Immediate, uninterrupted, and safe access across Gaza to address catastrophic levels of food insecurity, scale up the delivery of life-saving aid, and ward off famine. 
• A continuous supply of fuel and cooking gas to sustain humanitarian operations and keep essential services, such as mills and bakeries, operational.  
• Revitalizing agriculture, livestock and fishing activities to restore livelihoods and ensure a sustained supply of nutritious food.

Response

• During the first two weeks of April, about 15 partners provided food assistance across Gaza, including food parcels, hot meals, bread and flour.   
• The distribution of fodder is ongoing in Rafah, with people each receiving a 50-kilogramme sack, sufficient to feed five sheep for five days. 
• Efforts are underway to support bakeries in resuming operations, but more fuel is needed to achieve significant results. 
• Since November, 1.9 million people have received flour in southern Gaza, of whom 1.2 million people received a second round and 172,000 people are now receiving a third round.

Challenges

• Limited humanitarian access throughout Gaza, particularly in the north, continues to exacerbate the catastrophic levels of food insecurity already faced by people and to prevent the urgent delivery of life-saving food commodities. Failure to provide assistance could exacerbate displacement, increase vulnerability to exploitation, and perpetuate cycles of instability. 
• Distribution efforts in the first half of April continued to face access challenges. In northern Gaza, food distribution reached about 15 per cent of the population, with only a limited number of humanitarian partners able to provide assistance. In Deir al Balah and Khan Younis, food assistance reached 45 per cent of the population, while in Rafah, where more than a million people are concentrated, only 30 per cent of the population was reached. 
• The limited number of entry points into Gaza and sub-optimal operating hours at crossings and checkpoints continue to constrain the ability to expand supply routes. 
• Infrastructural and security hurdles continue to hinder mobility and safe humanitarian access within Gaza, with escorts necessary to safeguard convoys. 
• The lack of sufficient fuel for essential services and operations. 

Response

• Shelter Cluster partners are currently distributing 17,500 blankets, 2,125 mattresses, 1,875 sealing-off kits and 300 tents that entered Gaza between 7 and 13 April.  
• Ongoing work to develop technical guidance to ensure the safety of shelters in all large, unfinished buildings and identify the most appropriate shelter options for IDPs returning to Khan Younis.  
• Preparatory work has commenced to design shaded areas and implement other adaptations to shelters to mitigate projected high temperatures. 
• For more information on Shelter Cluster activities, please visit: Shelter Cluster: Response Palestine.

Needs

• A tailored protection response, tents, clothing, and psycho-social support (PSS) for an increasing number of detainees released by Israel at Kerem Shalom Crossing. 
• Child Protection (CP): i) the provision of specialized counselling and PSS to address severe levels of trauma; ii) scaling up case management services, including for unaccompanied and separated children (UASC); and iii) clothing/shoes for hundreds of thousands of children. 
• Gender-Based Violence (GBV): i) scaling up GBV prevention and response services, including case management, MHPSS, legal support, and referrals; ii) conducting a safety audit/GBV assessment; Emergency GBV risk mitigation interventions, including provision of dignity kits, clothing kits, and Cash and Voucher Assistance (CVA); iii) strengthening life-saving specialized services in response to GBV, including the establishment of mobile safe spaces for women and girls, especially in hard-to-reach areas; iv) capacity support for GBV case workers; and v) the development and updating of referral pathways.  
• Mine Action (MA): address the scale of Explosive Ordnance (EO) contamination in the immediate and long terms, including through: i) deployment of Explosive Ordnance Disposal (EOD) operators to conduct Explosive Threat Assessments (ETA) and the marking, removal, and destruction of UXOs; ii) Explosive Ordnance Risk Education (EORE) and Conflict Preparedness and Protection (CPP) messages tailored to different groups and needs; iii) Victim Assistance (VA) services for survivors of shelling and explosive ordnance related accidents; and iv) geographic information systems mapping and information management of UXO threats to inform effective mine action response.

Response

• Support for over 100 people released at Kerem Shalom Crossing between 2 and 8 April, including reception, case management, and referral. 
• Ongoing efforts to enhance protection monitoring, assessments, and coordination.
• CP: A range of child protection services have been provided to date to more than 370,000 children and 70,000 caregivers (see here for data on the response); and advocacy on programmatic priorities, such as the UASC advocacy note.   
• GBV: Dignity kits, PSS, individual and group counseling, recreational activities, and CVA for women, girls and GBV survivors; and the operation of two safe spaces for GBV survivors in Al Mawasi/Rafah and Deir Al Balah. 
• MA: emergency risk education; continuously increasing the number of EOD officers to advise humanitarian actors on safe practices around UXOs and, where access permits, conduct ETA; delivering EORE-CPP sessions in Rafah and Deir al Balah, including for humanitarian workers, children, and local partners; developing standardized forms to coordinate requests for mine action support; mass media campaigns (radio/SMS/social media); a mapping tool to capture suspected UXO threats and high risk areas; and broadening MA integration through various clusters and working groups, such as the distribution of 20,000 stickers to local partners and 20,000 leaflets in food and NFI distributions.

Challenges

• Denial of entry of critical supplies with limited or no availability on the local market, such as MA supplies to properly equip EOD experts and recreational materials for children to support the implementation of PSS activities. Combined with soaring market prices of available items, the importation of materials from Egypt, Jordan, or Israel is critical.   
• Administrative hurdles, such as registration of organizational entities and delayed provision of visas, interrupt the deployment of EOD specialists, while the prohibited entry of some items (such as satellite phones, VHF radios, and armored vehicles) limits the number of experts able to deploy safely. 
• Continued denials of fuel requests.     
• Logistic and security constraints make it difficult to establish spaces for confidential GBV case management activities and set up adolescent alternative care options for unaccompanied children.

Needs

• Establish Temporary Learning Spaces (TLSs) in shelters and provide emergency supplies and learning kits to school-age children to urgently commence non-formal learning, in light of the large-scale damage to education infrastructure. During the reporting period, there have been reports of damage to several schools in Khan Yunis, adding to the hundreds of schools that have already been assessed through the Satellite-derived Damage Assessment conducted by the Education Cluster.  
• More than 625,000 students, who have no access to education or a safe learning environment as a result of school closures and attacks on education, require a range of support services. Moreover, according to the Ministry of Education, as of 16 April, some 6,237 students and 296 educational staff have been killed, and 10,300 students and 973 teachers have been injured in the Gaza Strip since 7 October.   
• Provide tailored support for children with disabilities and other special needs to ensure continuity of their learning

Response

• Since October 2023, 26 partners have reached more than 233,000 students and teachers, providing them with psychosocial support, emergency learning, recreational supplies and activities, and awareness-raising sessions (source: Education Cluster 5W dashboard). Most cluster response activities continue to be delivered by local partners, who, despite facing large-scale constraints, are doing everything possible to support students in need.  
• The Cluster continues to prioritise 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) to help children cope with trauma and build resilience so they can thrive in the long term.  
• Ongoing work to establish TLS for school-aged children in and around IDP shelters.

Challenges

• The absence of schooling in Gaza, with eight out of 10 schools destroyed, is depriving children of opportunities for their social, emotional and cognitive development. With limited humanitarian aid and education supplies, over 625,000 children are also at risk of permanently dropping out of school, rendering them vulnerable to exploitation, child labour, early marriage, and other forms of abuse. 
• The education response remains significantly underfunded, with less than 17 per cent of the required funds received as of 15 April.  
• Lack of approvals to date of fuel requests submitted by cluster partners, undermining their capacity to implement planned activities. 
• Restrictions on the entry of recreational and psychosocial support kits, which are also unavailable on the local market, hindering the implementation of critically needed response activities. 

Needs

• Urgently increase the storage and transport capacity inside Gaza, particularly in the northern areas, Deir al Balah and Khan Younis.

Response

• To date, the Logistics Cluster has facilitated storage services (with pick-up at the Rafah transshipment point) for over 14,316 cubic metres of humanitarian supplies at four warehouses in Rafah. 
• The Cluster-operated cargo notification system has so far benefited 30 organizations, informing them once their cargo arrives at the Rafah transshipment point and is ready for pick up. 
• On 11 April, the second direct convoy, comprising 50 trucks, was dispatched from Amman through the Jordan Corridor without any cross-loading of the trucks prior to reaching Kerem Shalom Crossing. The convoy transported 847.4 metric tons of food supplies provided by two partners.  
• The pipeline forecast over the next three months stands at 291,028 metric tons of humanitarian aid, including 99,735 metric tons through the Egypt corridor, 35,126 metric tons through the Jordan corridor and an additional 26,167 metric tons, exclusively of flour, from the Ashdod port. 

Challenges

• Infrastructural damage, access challenges and the lack of logistical supplies, assets and spare parts continue to limit storage and transport capacity within Gaza.
• Uncertainty about the opening of additional entry points, such as the Erez Crossing, undermines the effective prepositioning of cargo and international procurement plans.
• Access to northern Gaza continues to be extremely limited.

Needs

• Provide humanitarian responders with access to independent and reliable communication platforms to coordinate emergency response and deliver life-saving aid, amid ongoing communication challenges and intermittent access to telecommunications services. 
• Increase mainstreaming of PSEA messages and strengthen knowledge of safeguarding practices.

Response

• Preparing maps that detail Security Communications Systems (SCS) coverage in the Gaza Strip to inform contingency planning efforts by UN agencies.  
• Carrying out an assessment concerning the availability of Wi-Fi hotspots in Deir al Balah, Khan Younis and Rafah and sharing the findings with UN agencies and partners in support of their ability to access reliable communication platforms, toward improving the overall humanitarian response in these areas. 
• 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.  
• The import of telecommunications equipment into Gaza. 

Needs

• Increase mainstreaming of PSEA messages and strengthen knowledge of safeguarding practices. 
• Ensure safe and accessible community reporting mechanisms, which are trusted by at risk people and victims of sexual exploitation and abuse (SEA).  
• Enhance support services for people at risk of SEA.

Response

• Between 1 and 7 April, the SAWA helpline answered 1,114 calls, delivered 467 psychosocial counselling sessions and referred 201 cases to formal protection mechanisms. 
• On 9 April, 271 people at risk of SEA in Gaza were referred to Cash for Protection schemes. 
• Over 50,000 printed Arabic-language communication materials on PSEA are being delivered to NGOs operating in northern Gaza, for subsequent distribution. As of 15 April, Sanad’s Instagram, Facebook, and Telegram accounts had a total of 6,500 followers, about 70 per cent being women. 
• In-person awareness sessions on PSEA continue to be regularly conducted for humanitarian responders and service providers. Between 6 and 27 March, 37 aid workers attended sessions in Gaza.

Challenges

• Internet and telecommunication blackouts continue to hinder awareness raising on SEA at community level as well as effective reporting of potential SEA cases.