Hostilities in the Gaza Strip and Israel | Flash Update #103

Key points

• Intense Israeli bombardment from air, land, and sea continued across much of the Gaza Strip on 26 January, resulting in further civilian casualties, displacement, and destruction. Rocket fire from Gaza into southern Israel resumed as well. Ground operations and fighting between Israeli forces and Palestinian armed groups were also reported across much of Gaza. Hostilities were particularly intense in Khan Younis, with heavy fighting reported.
• Between the afternoons of 25 and 26 January, according to the Ministry of Health (MoH) in Gaza, 183 Palestinians were reportedly killed, and 377 Palestinians were injured. Between 7 October 2023 and 12:00 on 26 January 2024, at least 26,083 Palestinians were killed in Gaza and 64,487 Palestinians were injured, according to the MoH.
• Between the afternoons of 25 January and 26 January, one Israeli soldier was reportedly killed in Gaza. As of 26 January, 218 soldiers have been killed, and 1,269 soldiers have been injured in Gaza, according to the Israeli military.
• On 25 January and 26 January, Israeli protestors blocked aid trucks from accessing Gaza through the Kerem Shalom crossing. These trucks contained flour, food , hygeine items, tents and other non-food items. The trucks have not been able to access Gaza. The inability to deliver food, water and medical aid will exacerbate the already dire humanitarian situation of those in need of assistance.
• In the second half of January, humanitarian partners continue to observe a declining trend in access to northern and central areas of the Gaza Strip. Reasons for this include excessive delays for humanitarian aid convoys before or at checkpoints and heightened military activity in the Middle Area of the Gaza Strip. Threats to the safety of humanitarian personnel and sites are also rife, not only hindering the delivery of time-sensitive and life-saving aid but also posing serious risks to the lives of those involved in humanitarian efforts.
• As of 25 January, according to the WHO, 14 of 36 hospitals in Gaza are only partially functional; seven in the north and seven in the south. ‘Partial functionality’ indicates that a hospital is accessible to people in need of health care; it can admit some new patients and can undertake some level of surgery. In addition, Nasser Hospital in Khan Younis is, ‘minimally functioning,’ as it is surrounded by the Israeli military and is experiencing intense fighting and is no longer able to receive patients or supplies. On 24 January, the MoH in Gaza reported that the Nasser Hospital was besieged, and that no one was able to enter or exit the facility due to ongoing bombardment in the vicinity. Israeli authorities refute this, claiming they are facilitating access. Health staff were reported to be digging graves on the hospital grounds due to the large numbers of anticipated fatalities and the need to manage burials. Al Kheir Hospital in Khan Younis, which was previously designated as ‘minimally functioning,’ and one of only three in the Gaza Strip that provides maternity services, is no longer operational, with reports of patients, who had just undergone critical operations, having to flee the facility.
• On 26 January, the Palestine Red Crescent Society (PRCS) reported that Israeli forces are continuing to besiege their ambulance headquarters and the nearby Al Amal Hospital in Khan Younis, restricting all movement in the area. Israeli authorities refute this, claiming they are facilitating access. On the same day, PRCS reported damages to the hospital building and fragments of artillery shelling scattered inside it due to a reported attack in the vicinity of the hospital. On 24 January, the entrance of the PRCS headquarters was reportedly struck, killing at least three Palestinians: on 23 January, another Palestinian was reportedly killed at the entrance to the hospital due to shelling amid intense fighting around the hospital. The PRCS stated that they have been forced to ask IDPs taking shelter in the compound to donate blood, as staff are unable to access blood banks and treat the wounded.
• UNRWA reports that between 3 and 24 January, over 13,700 children were vaccinated against diseases such as measles, mumps and rubella, and others, as vaccines were supplied by UNICEF. However, only 4 out of 22 UNRWA health centres are still operational. Continued bombardment and access restrictions prevent the provision of life-saving health services.

Hostilities and casualties (Gaza Strip)

The following are among the deadliest incidents reported on 25 and 26 January:

• On 25 January, in the afternoon, 11 Palestinian IDP corpses who were thought to have been displaced from Jabalya, were reportedly recovered from under the rubble, in Al Maghazi, Deir al Balah. Another 26 IDPs still remain under the rubble.
• On 25 January, at about 20:00, three Palestinians, including one child, were reportedly killed, and several others were injured, after a residential building in Deir al Balah was struck.
• On 25 January, at about 20:00, 11 Palestinians, among them one journalist and children, were reportedly killed, after a residential building in Deir al Balah was struck.
• On 25 January, at about 12:000, two Palestinians were reportedly killed, and several others injured, in a strike in Al Bureij, Deir al Balah.
• On 25 January, at about 15:00, three Palestinians were reportedly killed, and several others injured, in a strike in Al-Dahra, Khan Younis.
• On 25 January, two Palestinian brothers, one of whom was a child, were shot and killed with live ammunition while evacuating from their home in Al Amal neighbourhood, western Khan Younis, following the evacuation order issued by the Israeli military. The child was reportedly shot three times while carrying a white flag, and his brother was shot while attempting to rescue him.
• On 25 January, at about 16:25 hours, Israeli forces reportedly detonated an entire residential neighbourhood in Al-Nimsawi area in Khan Younis. No casualties were reported.

Displacement (Gaza Strip)

• On 26 January, Ajith Sunghay, Head of the UN Human Rights Office (OHCHR) for the Occupied Palestinian Territory said that the people displaced who reached Rafah are resorting to living in the street, with sewage running in the streets and “conditions of desperation conducive to a complete breakdown in order”. Overspilling of violence into Rafah would have severe implications to more than 1.3 million people, already crowded there.
• As of 26 January, according to UNRWA, there are an estimated 1.7 million IDPs in Gaza. Many of them have been displaced multiple times, as families have been forced to move repeatedly in search of safety. Due to continued fighting and evacuation orders, some households have moved away from the shelters where they were initially registered. Rafah governorate is where over one million people are squeezed into an extremely overcrowded space. Following intense Israeli bombardment and fighting in Khan Younis and the central area of the Gaza Strip in recent days, as well as new Israeli military evacuation orders, a significant number of displaced people have moved further south.
• On 23 and 25 January, the Israeli military issued new evacuation orders via social media to Palestinians in a number of city blocks in Khan Younis. The affected area covers some four square kilometres. There are about 88,000 residents in the area, in addition to an estimated 425,000 internally displaced people (IDPs) seeking shelter in 24 schools and other institutions. The affected area includes Nasser Hospital (475 beds), Al Amal Hospital (100 beds) and the Jordanian Hospital (50 beds), representing almost 20 per cent of the remaining partially functioning hospitals across the Gaza Strip. Three health clinics are also located in the affected area. Some 18,000 IDPs are reported to be in the Nasser Hospital, with an unknown number of IDPs seeking shelter in the other health facilities. On 25 January, the Israeli military reissued the same evacuation orders via social media.

Electricity

• Since 11 October 2023, 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 industrial fuel shutdown continue 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.
• Since 19 November, limited fuel amounts have entered the Gaza Strip from Rafah. However, since these are insufficient, hospitals, water facilities and other critical facilities are still only operating at limited capacity. A Rapid Disaster Needs Assessment team has identified about 570 kilometres of electricity feeder lines that have been damaged as of 12 January. This represents some 57 per cent of feeder lines, with damage expected to have increased further since then. Fuel is urgently needed for the Gaza Electricity Distribution Company (GEDCO) teams to conduct damage assessments and field repairs.

Health care, including attacks (Gaza Strip)

• According to WHO, health care in Gaza remains extremely fragile. The seven partially functional hospitals in the north have been offering limited 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 seven partially functional hospitals in the south are operating at three times their capacity, while facing critical shortages of basic supplies and fuel. Hospitals in Khan Younis are at risk of closure due to intense hostilities and the issuance of evacuation orders in adjacent areas. Over 90 health facilities and over 80 ambulances have been impacted since the escalation of hostilities. Other factors include power supply disruptions and fuel shortages. According to the MoH in Gaza, occupancy rates are reaching 206 per cent in inpatient departments and 250 per cent in intensive care units.

Humanitarian Access

• Between 1 and 25 January, 51 movements of humanitarian aid were planned for the north of Wadi Gaza; however, only eight were facilitated while 29 were denied. Most of the missions that were facilitated were related to food distribution, while support to critical hospitals and WASH facilitates were largely denied. Two missions were partially facilitated (e.g., assessments only instead of a planned delivery of aid supplies) and another four were postponed (due to security and other competing medevac requirements). In an emerging pattern, an additional eight planned missions were initially facilitated, but subsequently impeded through the provision of unpassable routes, or the imposition of excessive delays at checkpoints or prior to departure.
• Between 1 and 25 January, humanitarian partners coordinated 87 humanitarian aid movements to the middle area, of which 63 per cent (55 missions) were facilitated and 25 per cent (22 missions) were denied. Due to increasing military activity, ten missions were postponed. This has been an emerging trend since 12 January where increased military activity is hindering humanitarian movements both to and from hospitals and humanitarian sites. The need to coordinate movements to south Wadi Gaza was also not a requirement prior to December.
• On 22 occasions, requests by the United Nations to the Israeli military to open checkpoints early to access north of Wadi Gaza were not facilitated. Given the heavy congestion around UN warehouses and the high levels of needs, early movements are essential for security, programmatic and protection reasons. The humanitarian community has consistently called for both main supply routes (MSRs) to be open in Gaza, and for checkpoints to open at 6:00 every day.
• In addition to widespread attacks on health care facilities and workers, 12 incidents of attacks against and access constraints on humanitarian Emergency Medical Teams were recorded between 7 November 2023 and 24 January 2024. These included ten instances of direct and indirect fire resulting in seven deaths and 12 injuries and two entry blockages. These teams have been undertaking life-saving surgeries in partially functioning over-congested hospitals across the Strip.

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

Violence and casualties (West Bank)

• Since 7 October 2023 and as of 26 January 2024, 361 Palestinians have been killed, including 92 children, across 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 these 361 fatalities, 351 were killed by Israeli forces, eight by Israeli settlers and two 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. So far in 2024 (as of 26 January), 52 Palestinians, including at least 11 children, have been killed.
• Since 7 October 2023 and as of 26 January 2024, five Israelis, including four members of Israeli forces, have been killed in Palestinian-perpetrated attacks in the West Bank, including East Jerusalem. In addition, 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) on 30 November 2023. Another Israeli woman was killed in another attack perpetrated by Palestinians in Israel on 15 January 2024. The number of Israelis killed in the West Bank and Israel in 2023 in attacks perpetrated by Palestinians from the West Bank (36) was the highest since OCHA started recording casualties in 2005.
• Since 7 October 2023 and as of 26 January 2024, 4,358 Palestinians, including 657 children, have been injured in the West Bank, including East Jerusalem. Of them, 4,223 have been injured by Israeli forces, 114 by settlers and 21 by either Israeli forces or settlers. Of the total injuries, 54 per cent were reported in the context of search-and-arrest and other operations, 34 per cent in demonstrations and 8 per cent during settler 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 26 January 2024, OCHA has recorded 460 Israeli settler attacks against Palestinians, resulting in Palestinian casualties (45 incidents), damage to Palestinian-owned property (359 incidents), or both casualties and damage to property (56 incidents).
• One-third of the settler attacks against Palestinians after 7 October 2023 have 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 Israeli 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 26 January 2024, 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 displacement 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).
• Since 7 October 2023 and as of 26 January 2024, 495 Palestinians, including 246 children, have been displaced following the demolition of their homes due to lack of Israeli-issued building permits in Area C and East Jerusalem, which are almost impossible to obtain.
• A total of 22 homes have been demolished and 105 Palestinians, including 45 children, displaced due to punitive demolitions from 7 October 2023 and as of 26 January 2024. The numbers exceed those reported in the first nine months of 2023, during which 16 homes were punitively demolished and 78 people displaced.
• Since 7 October 2023 and as of 26 January 2024, 743 Palestinians, including 311 children, have been displaced, following the destruction of 116 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, Nur Shams and Tulkarm. This represents 82 per cent of all displacement reported due to the destruction of homes during Israeli military operations since January 2023 (908 people).

Funding

• As of 26 January, Member States have disbursed $700.3 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 people in the West Bank. This constitutes 58 per cent of the $1.2 billion requested.
• Private donations are collected through the Humanitarian Fund. A private foundation in Australia has donated $2.2 million. Since 7 October, the Humanitarian Fund has disbursed about $55 million.

HUMANITARIAN NEEDS AND RESPONSES: 14-21 January

Health

Needs

• According to WHO, only 16 of Gaza’s 36 hospitals are partially functional - nine in the south and seven in the north.
• According to the MoH in Gaza, there is a shortage of available hospital beds, as occupancy rates in these hospitals are reaching 206 per cent in inpatient departments and 250 per cent in intensive care units.
• Food, drinking water, fuel, medical supplies, and support to health workers through rotations and additional personnel, are urgently needed in healthcare facilities across Gaza.
• During missions to Shifa, Al Helou, Al Aqsa and Nasser hospitals to deliver supplies, fuel, and conduct assessments on 13 January, the WHO team observed the following:
  • A significant decrease in the number of health personnel in some of the hospitals.
  • Only 12 medical doctors are still working at the Al Aqsa hospital, which is about 10 per cent of the staff who operated before the start of the hostilities.
  • The maternity unit at Al Aqsa Hospital is not operating and is referring all pregnant women to Al Awda Hospital, which is further away, putting patients at risks during the additional travel time, due to ongoing hostilities.
  • Nasser Hospital is currently experiencing a significant decrease in staff and patient numbers, with over 50 per cent of staff leaving and only 400 out of 750 patients remaining, some seeking care elsewhere or remaining at home. The hospital's capacity including maternity services, where only two obstetricians remain, have been severely impacted.
• Poor living conditions in shelters have resulted in a rise in water-borne diseases among IDP.
• Health Cluster’s partners report that there is no access to Al Amal Hospital in Khan Younis, where an estimated 13,000 displaced people have sought refuge. The hospital is still providing emergency consultations and maternity services.

Response

• To compensate for staff shortages at Nasser Hospital, additional medical personnel from Al Quds Hospital were reassigned and two Emergency Medical Teams (EMTs) were deployed to Nasser Hospital.
• In Al Amal Hospital, emergency consultations and maternity services are still being provided.
• The Health and WASH Clusters are working together to respond to the surge in Hepatitis A cases and to prepare for other outbreak-prone diseases linked to poor living conditions and lack of access to proper WASH facilities.
• The mapping exercise to identify formal and informal shelters that do not have access to primary healthcare services is ongoing; the mapping will help identify actors who can fill gaps.
• Eleven EMTs are present in Gaza Strip and have been providing support to hospitals across the Strip.

Challenges and Gaps

• The high insecurity and limited access to health facilities in the northern governorates and Deir al Balah continues to present major challenges to partners’ response activities.
• Partners’ operations continue to be adversely affected due to the displacement of staff, social stresses, and telecommunication challenges.

WASH

Needs

• People in Gaza do not have access to adequate quantity and quality of water and lack hygiene materials, which has consequences on their wellbeing, including physical health.
• The accumulation of solid waste on the streets, around hospitals, IDP shelters, and various sites remains a priority concern, as tens of thousands of tons of uncollected public waste are intensifying public health risks. The Gaza Municipality estimates that approximately 50,000 tons of solid waste remain unmanaged, exacerbating environmental and health concerns.

Response

Information regarding water production from the Gaza Municipality wells between 15 and 21 January is very limited due to the communication blackout, with data available from only two wells. During the reporting week:

• Some 3,100 cubic metres were accessible through the short-term desalination plants each day, in contrast to the pre-hostilities period when 22,000 cubic metres were available daily.
• Some 560 cubic metres of water is accessible through the municipal wells daily, while the production capacity was up to 255,000 cubic metres each day.
• The UAE's small desalination plant located in Egyptian Rafah continues to operate below capacity, providing 1,140 cubic metres per day out of a possible 2,400. All desalinated water from this plant is distributed via tankers.
• The construction of a 3-kilometre transmission line extending to the Saudi Water Reservoir within the Philadelphia corridor is underway and expected to be completed in early February.
• Provision of 10,000 cubic metres of water to affected and displaced people through trucking and bottled water continues daily.

Challenges and Gaps

• In Gaza, humanitarian partners have not been able to assess or resupply fuel to the Jabalya area, where sewage flooding was reported in the refugee camp on 5 January. At least 100,000 IDPs are estimated to reside in the UN and public shelters in this area.
• Markets are not functioning and construction materials for latrines, desludging services and other essential supplies for sanitation are not available for purchase.
• Import restrictions, as well as complex and unpredictable clearance procedures for critical items considered by Israel as dual use, such as generators, pumps, and pipes are preventing a scale up of the WASH response.
• Most partners face resource shortfalls, with no commitment to new funding, particularly in camps and other areas where many IDPs are settled.
• In the West Bank, the closure of Khirbet ‘Atouf in Tubas since 7 October has restricted access to water for herding, severely affecting several communities in the area. Checkpoint delays cause significant water shortages for residents and livestock, necessitating urgent WASH intervention.

Protection

Needs

• Unaccompanied and separated children require urgent protection, including family tracing and provision of shelter, winter clothing, blankets, water, and food.
• Even in the absence of formal assessments, the scale of explosive contamination will require, at a minimum:
  • Explosive Ordnance Disposal.
  • Explosive Ordnance Risk Education (EORE) and Conflict Preparedness and Protection (CPP) messages, including tailored to different groups and needs.
  • EORE and CPP training for humanitarian actors and widespread risk education.
  • Victim Assistance services for survivors of shelling and explosive ordnance related accidents.

Response

• Since 7 October 2023 and as of 22 January, Child Protection partners have reached more than 93,000 boys and girls, and nearly 20,000 women and men across the Gaza Strip with awareness raising interventions; Mental Health and Psychological Support (MHPS) for children and caregivers–mainly as part of group or family activities– child protection referrals for education services; registration and alternative care for unaccompanied and separated children; and distribution of clothing kits.