Hostilities in the Gaza Strip and Israel | Flash Update #98

Key points 

• Intense Israeli bombardments from air, land, and sea continued across much of the Gaza Strip on 20 and 21 January, resulting in further civilian casualties and displacement, as well as destruction. The indiscriminate firing of rockets by Palestinian armed groups from Gaza continued. Ground operations and fighting between Israeli forces and Palestinian armed groups were also reported across much of Gaza.  
• Between the afternoons of 19 and 21 January, according to the Ministry of Health (MoH) in Gaza, 343 Palestinians were killed (178 between 20 and 21 January; 165 between 19 and 20 January), and another 573 people were injured (293 and 280 injuries, as per the same timeframe). Between 7 October 2023 and 12:00 on 21 January 2024, at least 25,105 Palestinians were killed in Gaza and 62,681 Palestinians were injured, according to the MoH.  
• On 20 January, the UN Secretary-General stated: “People are dying not only from bombs and bullets, but from lack of food and clean water, hospitals without power and medicine, and gruelling journeys to ever-smaller slivers of land to escape the fighting. This must stop. I will not relent in my call for an immediate humanitarian ceasefire and the immediate and unconditional release of all hostages.” 
• Between 19 January and 21 January, two Israeli soldiers were reportedly killed in Gaza. Since the start of the ground operation and as of 21 January, 193 soldiers have been killed, and 1,203 soldiers have been injured in Gaza, according to the Israeli military. 
• Since the evening of 19 January, mobile phone communication – which had been down since 12 January – has been restored to most of Gaza, with the exception of some services in the north. However, tinternet remains down across the whole of Gaza. The blackout of telecommunications restricts people in Gaza from accessing lifesaving information and impedes other forms of humanitarian response. 
• Beyond telecommunication shutdowns, the capacity of humanitarian agencies to operate safely and effectively anywhere in Gaza remains heavily compromised by recurrent denials of access to the north, restrictions on the import of critical equipment, and the intensity of hostilities, among other factors. 
• Humanitarian partners report that, as of 17 January, only 15 bakeries were operational across the Gaza Strip; six in Rafah and nine in Deir al Balah. No bakeries are functioning north of Wadi Gaza. The World Food Programme (WFP) has been supporting eight of the functional bakeries (six in Rafah and two in Deir al Balah), providing them with wheat flour, salt, yeast and sugar. Through this initiative, about 250,000 people were able to purchase bread at a subsidized price. 
• At a press briefing in Geneva on 19 January, upon the conclusion of her visit to Gaza, a UNICEF Communication Specialist stated: “In the 105 days of this escalation in the Gaza Strip, nearly 20,000 babies have been born into war. That’s a baby born into this horrendous war every 10 minutes. Mothers face unimaginable challenges in accessing adequate medical care, nutrition, and protection before, during and after giving birth. Becoming a mother should be a time for celebration. In Gaza, it's another child delivered into hell. Humanity cannot allow this warped version of normal to persist any longer. Mothers and newborns need a humanitarian ceasefire.” 
• On 19 January, about 100 Palestinians were released back to Gaza by the Israeli military through the Kerem Shalom crossing. Speaking to the head of the UN Human Rights Office in the occupied Palestinian territory, men who had been detained by Israeli forces in unknown locations for 30 to 55 days described “being beaten, humiliated, and subjected to ill-treatment, and to what may amount to torture. Such allegations are consistent with reports our Office has been gathering of the detention of Palestinians on a broad scale, including many civilians, held in secrecy, often subject to ill-treatment, with no access to their families, lawyers or effective judicial protection. Israel must take urgent steps to ensure that all those arrested or detained are treated in line with international human rights and international humanitarian law norms and standards, notably with full respect for their due process rights.” 
• As of noon on 15 January, 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. Israeli media has reported that an agreement had been reached for medicine to be delivered to some of the hostages still held in Gaza, but there is no confirmation yet if this has been implemented. The UN Secretary-General has again reiterated his call for the immediate and unconditional release of all hostages. 

Hostilities and casualties (Gaza Strip) 

• The following are among the deadliest incidents reported on 19 and 20 January:  
  • On 19 January, at about 14:30, seven Palestinians were reportedly killed when a house was struck in Al Maghazi Camp, Deir al Balah governorate. 
  • On 19 January, at about 18:00, five Palestinians were reportedly killed when a house was struck in An Nuseirat Camp, Deir al Balah governorate. 
  • On 20 January, at about 15:15, five Palestinians were reportedly killed when a residential building was struck in Jabalya, northern Gaza. 
  • On 20 January, at about 17:10, four Palestinians were reportedly killed when a car was struck in the centre of Rafah.  

Displacement (Gaza Strip)

• As of 20 January, according to UNRWA, there aree an estimated 1.7 million internally displaced persons (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 the continued fighting and evacuation orders, some households have moved away from the shelters where they were initially registered. These resulted in multiple registration of the same IDPs in different shelters. The ability of UNRWA to provide humanitarian support and updated data on the number of internally displaced people (IDPs) has been severely restricted and there are plans to conduct a more accurate count of IDPs in shelters, including informal shelters as soon as the security situation allows. Rafah governorate is 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.  
• According to a new report by UN Women, “displacement exacerbates people’s vulnerability, erodes their coping mechanisms, and impacts them differently based on gender. Since the ground operation started in Gaza, it has been reported that men faced arbitrary detention and enforced disappearance. According to media reports, while on the displacement journey, women also faced risks of arbitrary detention and harassment. For families with elderly relatives or family members with disabilities who simply cannot move, it is women who disproportionately stay behind as caregivers.” 

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 (RDNA) 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 the World Health Organization (WHO), health care in Gaza remains extremely fragile. Only 16 out of Gaza’s 36 hospitals are functional, albeit partially: partial functionality indicates that a hospital is accessible to people in need of health care, can take in new patients and can undertake some level of surgery. According to the MoH in Gaza, occupancy rates are reaching 206 per cent in inpatient departments and 250 per cent in intensive care units. 
• The 16 hospitals that are still partially functional include nine in the south and seven in the north. This is an increase of one more hospital in the north – Kamal Adwan – which has been functioning again to some degree since mid-January. 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 nine partially functional hospitals in the south are operating at three times their capacity, while facing critical shortages of basic supplies and fuel. 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 19 January, Israeli forces reportedly carried out an attack in the vicinity of Al Amal Hospital in Khan Younis, where one Palestinian was reportedly killed. On 20 January, strikes around both Al Amal and the European Hospital continued, with casualties reported. 
• Reporting that cases of Hepatitis A have been confirmed in Gaza through test kits supplied by WHO, the Director-General, Dr. Tedros Ghebreyesus warned that “inhumane living conditions –- barely any clean water, clean toilets and possibility to keep the surroundings clean – will enable Hepatitis A to spread further ... The capacity to diagnose diseases remains extremely limited. There is no functioning laboratory. The capacity to respond remains limited too. We will continue to call for unimpeded and safe access of medical aid and for health to be protected.” 

Water, Sanitation and Hygiene 

• The availability of water in Gaza is shrinking. According to WASH humanitarian partners, water availability through the municipal wells is presently at 21,200 cubic metres a day, which is tenth of their production capacity of 255,000 cubic metres a day prior to the escalation of hostilities. Water from these wells is known to be substandard given it is brackish (salty), whereas water from the Israeli-operated lines yielded the optimal safe drinking water prior to the hostilities. At present, only one of the three Israeli lines – the Bani Sa’id point – is functional, yielding 22,000 cubic metres a day, which is less than half of what would have been available if all lines were working. 
• Furthermore, water availability through the short-term desalination plants presently stands at 1,600 cubic metres per day, which is 7 per cent of the pre-crisis capacity of 22,000 cubic metres per day. Due to import restrictions on critical items, water testing kits and chlorine to treat the water across Gaza are presently unavailable. Furthermore, the amalgamation of solid waste and fecal waste, exacerbated by rains and floods, is giving rise to severe health and environmental threats. With WHO already reporting 152,000 cases of diarrhoea, the inability to perform water chlorination to kill bacteria is exacerbating the already concerning situation. At present, Health and WASH partners have developed an Acute Watery Diarrhoea preparedness and response plan. Barriers to the import of critical items must be removed to enable adequate response. 

Humanitarian Access 

• In the first two weeks of January, humanitarian agencies planned 29 missions to deliver lifesaving supplies to areas to the north of Wadi Gaza. Only 7 of the 29 (24 per cent) were accomplished, either fully or partially. The remainder of the missions were denied access by the Israeli authorities. This is a significant increase in denials compared with the previous months; between October and December 2023, only 14 per cent (6 out of 43) of missions planned to the north were denied, while the remaining 86 per cent (37 out of 43 missions) were facilitated. These denials prevent a scale-up in humanitarian assistance and add significant cost to the overall response. The capacity of humanitarian agencies to operate safely and effectively also remains heavily compromised by the long-term restrictions applied by the Israeli authorities on the import of critical humanitarian equipment into Gaza. 
• On 18 January, UNICEF Deputy Executive Director Ted Chaiban said: “Once aid enters the Gaza Strip, our ability to distribute it becomes a matter of life and death. It is essential to lift access restrictions, ensure reliable ground communications, and facilitate the movement of humanitarian supplies to ensure that those who have been without assistance for several days receive much-needed assistance. We have to get commercial traffic flowing in Gaza, so that markets can reopen, and families are less dependent on relief.” 
• On 20 and 21 January, 325 truckloads of food, medicine and other supplies entered the Gaza Strip through Rafah and Kerem Shalom crossings (174 on 20 January and 151 on 21 January). Since the opening of Kerem Shalom crossing, almost 22 per cent of aid trucks have come in through that entry point. 

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. 

Violence and casualties (West Bank)

• Since 7 October 2023 and as of 21 January 2024, 358 Palestinians have been killed, including 91 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 358 fatalities, 348 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 21 January), 49 Palestinians, including at least ten children, have been killed. 
• Since 7 October 2023 and as of 21 January 2024, five Israelis, including four members of Israeli forces, have been killed in Palestinian 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 21 January 2024, 4,313 Palestinians, including 647 children, have been injured in the West Bank, including East Jerusalem. Of them, 4,179 have been injured by Israeli forces, 113 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, 35 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 21 January 2024, OCHA has recorded 441 Israeli settler attacks against Palestinians, resulting in Palestinian casualties (45 incidents), damage to Palestinian-owned property (341 incidents), or both casualties and damage to property (55 incidents). This reflects a daily average of four 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 21 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 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).  
• Since 7 October 2023 and as of 21 January 2024, 479 Palestinians, including 239 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 19 homes have been demolished and 95 Palestinians, including 42 children, displaced due to punitive demolitions from 7 October 2023 and as of 20  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.  
• The Israeli military operations, which took place in the refugee camps of Nur Shams and Tulkarm (both in Tulkarm) on 17 and 18 January, resulted in damage to homes and infrastructure, in addition to the fatalities and injuries already recorded. At least 21 homes were rendered uninhabitable due to explosions and bulldozing, displacing 137 people, including 46 children. Since 7 October 2023 and as of 21 January 2024, 739 Palestinians, including 309 children, have been displaced, following the destruction of 115 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 81 per cent of all displacement reported due to the destruction of homes during Israeli military operations since January 2023 (908 people).  

Funding

• As of 20 January, Member States have disbursed $693.3 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. 

HUMANITARIAN NEEDS AND RESPONSES: 7-14 January

Health 

Needs: 

• According to WHO, only 15 of Gaza’s 36 hospitals are partially functional - nine in the south and six 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: 
  • Poor living conditions in shelters have resulted in a rise in water-borne diseases.  
  • A drastic 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. 

Response: 

• Eleven Emergency Medical Teams (EMTs) are present in Gaza Strip and have been providing support to hospitals across the Strip. 
• Health and WASH partners are finalizing an inter-cluster outbreak preparedness and response plan; and are mapping out formal and informal shelters which are without access to primary healthcare services, to identify partners to cover the gaps. 

Challenges and Gaps: 

• The security situation, access, transport, and deconfliction remain extremely challenging, especially hospitals in the northern governorates.  
• Partners’ operations continue to be adversely affected by the displacement of staff and also telecommunication challenges. 
• There is an urgent need to conduct assessments on the outbreak of communicable diseases, such Hepatitis A, to identify the most affected groups, hotspot locations and other key epidemiological information. This is essential to tailor a proper response plan to address identified cases and prevent the spread of disease

WASH 

Needs: 

• Flooding is being reported across different parts of the Gaza Strip due to winter weather, extensive infrastructure damage and destruction and the clogging of sewage systems and wastewater.  
• Rainwater lagoons have been contaminated by wastewater and several lagoons are at risk of flooding if the rainfall intensifies. This poses a serious environmental and public health concern.  
• WHO reported an increase in Hepatitis A cases in the Middle Area and Rafah governorates, with the current water and sanitation conditions proving a high risk for further spread. 
• To manage water supply and waste-management alone, 22 generators have been requested. These items are pending entry into Gaza.  
• Only one of the three water pipelines from Israel is currently functioning. The Middle Area water pipeline, with a production capacity of close to 17,000 cubic metres of water per day, needs repairs. It is estimated that repairs would take up to four weeks, even given sustained access and necessary supplies.  
• Only two of the remaining three main low-capacity water desalination plants in Deir al Balah and southern Gaza are currently operational and are producing up to 2,400 cubic metres each day. 

Response: 

• Despite these challenges, WASH partners have undertaken the following responses since October 2023:  
  • Some 34,000 cubic metres of water have been delivered through water trucking and 2,400 metres through bottled water.  
  • More than 53,000 jerrycans and more than 40 storage tanks have been distributed.  
  • Nearly 145,000 hygiene kits and 1,800 cleaning kits have been distributed.  

Challenges and Gaps:  

• 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.  

Protection 

Needs:  

• Hundreds of detainees who have been released and returned to Gaza since December 2023, need support. Some were able to return to families while others moved to shelters. 
• There is a need for safe shelters for women at risk of gender-based violence (GBV)