Hostilities in the Gaza Strip and Israel | Flash Update #99

Key points

An updated section on humanitarian needs and responses during 14-21 January is included further down.

• Intense Israeli bombardments from air, land, and sea continued across much of the Gaza Strip on 22 January, resulting in further civilian casualties and displacement, as well as destruction. Ground operations and fighting between Israeli forces and Palestinian armed groups were also reported across much of Gaza.
• Between the afternoons of 21 and 22 January, according to the Ministry of Health (MoH) in Gaza, 190 Palestinians were killed, and another 340 people were injured. Between 7 October 2023 and 12:00 on 22 January 2024, at least 25,295 Palestinians were killed in Gaza and 63,000 Palestinians were injured, according to the MoH.
• Between 21 January and 22 January, three Israeli soldiers were reportedly killed in Gaza. Since the start of the ground operation and as of 22 January, 196 soldiers have been killed, and 1,222 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 – was gradually restored to most of Gaza, with the exception of some services in the north. However, internet 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.
• On 22 January, ground operations, fighting and attacks intensified in the Khan Younis area, destroying several residential houses, buildings, towers and residential squares, reportedly killing at least 45 Palestinians, including IDPs, women and children.
• On 22 January, the Palestine Red Crescent Society (PRCS) reported that Israeli forces had surrounded their ambulance headquarters in Khan Younis; restricting ambulances from providing support in the area. Reportedly, Israeli forces struck the vicinity of Al Amal hospital and the ambulance headquarters, as intense fighting continued in the area, including dozens of casualties. Patients, wounded people and an estimated 13,000 displaced people who have taken shelter in Al Amal Hospital and the PRCS headquarters were unable to leave. According to humanitarian partners on the ground, people in the vicinity and Al Kheir area east of Al Mawasi have lost access to the health facility and have no alternatives for medical assistance in the area.
• The World Health Organization (WHO) reports that attacks on health care continue to rise. In the Gaza Strip, more than 300 attacks have been verified since the beginning of the hostilities on 7 October. In the West Bank too, WHO reports a significant rise in attacks against health care, with over 330 attacks reported since 7 October.
• Humanitarian health partners report on a severe shortage of medical staff in some of the hospitals in Gaza. Only 12 medical doctors are still working at Al Aqsa hospital, which is about ten per cent of the doctors who operated before the start of the hostilities. Nasser Hospital has experienced a significant decrease in staff and patient numbers, as over 50 per cent of staff have left and only 400 out of 750 patients remaining, some seeking care elsewhere or remaining at home.
• 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. For more information, see the Humanitarian Access Snapshot.

Hostilities and casualties (Gaza Strip)

• The following are among the deadliest incidents reported on 21 and 22 January:
  • On 22 January, four Palestinians were reportedly struck and killed as they were trying to recover corpses, following heavy shelling in the area in Al Balad area in Khan Younis.
  • On 21 January, two Palestinians were reported to have bled to death following previous strikes and were left for days in the street.
  • On 22 January, at about 8:30, ten Palestinians were reportedly killed when Al Mawasi School was hit in western Khan Younis.
  • On 21 January, at about 16:00, three women were reportedly killed by artillery shells which hit a house in Al Rimal neighbourhood of Gaza city.
  • On 21 January, at about 16:30, four Palestinians were reportedly killed, including one woman and one child, in western An Nuseirat Camp, Deir Al Balah.
  • On 21 January, at about 19:45, three Palestinians were reportedly killed, including one woman and two children, when a residential building housing IDPs was struck in An Nuseirat Camp, Deir Al Balah.
• On 22 January, at about 10:30 hours, Israeli forces reportedly exhumed graves in the Khan Younis cemetery, southern Gaza.

Displacement (Gaza Strip)

• As of 20 January, according to UNRWA, there are 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. 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 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. 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. More than 90 health facilities and more than 80 ambulances have been affected since the start of the hostilities in October, due to the impact of hostilities, disruption to power supply, fuel shortages and other factors. 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 22 January, WHO Director-General Dr Tedros Ghebreyesus expressed concern over the reports of “continuous fighting in the vicinity of Al Amal Hospital and today's raid at Al Kheir Hospital.” He further stated that fighting puts patients and people seeking safety within (health) facilities at risk and prevents newly injured people outside health facilities from receiving care.
• Communicable diseases are on the rise in Gaza with more than 223,000 cases of acute respiratory infections, or 10 per cent of the population; more than 158,000 cases of diarrohea (of which 53 per cent in children under five), and more than 7,500 cases of acute jaundice (several of these acute cases have been confirmed as Hepatitis A). The situation for people with long-term medical conditions, including cancer, diabetes, high blood pressure, cardiovascular diseases, and mental health disorders, will be further aggravated by the impact of the conflict and displacement.
• 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 (WASH)

• 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 158,000 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.

Food Insecurity

• 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), by providing wheat flour, salt, yeast and sugar. Through this initiative, about 250,000 people were able to purchase bread at a subsidized price. Before 7 October, a total of 97 bakeries were operative overall in the Gaza Strip, in particular: 25 in Deir al Balah, 20 in Khan Younis, 19 in Rafah, eight in North Gaza and 25 in Gaza city.

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 22 January, 66 truckloads of food, medicine and other supplies entered the Gaza Strip through Rafah and Kerem Shalom crossings.

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.
• 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.

Violence and casualties (West Bank)

• Since 7 October 2023 and as of 22 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 22 January), 49 Palestinians, including at least ten children, have been killed.
• Since 7 October 2023 and as of 22 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, 4,334 Palestinians, including 654 children, have been injured in the West Bank, including East Jerusalem. Of them, 4,200 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 22 January 2024, OCHA has recorded 444 Israeli settler attacks against Palestinians, resulting in Palestinian casualties (45 incidents), damage to Palestinian-owned property (344 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 22 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 22 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.
• On 21 January, the Israeli authorities demolished on punitive grounds two residential structures comprising three apartments, and caused damage to a fourth apartment, displacing five people, including two children, in Hebron city. The houses belonged to the families of two of the three Palestinians who were shot and killed while they were carrying out a shooting attack against Israeli forces stationed at the Beit Jala checkpoint near Bethlehem. A total of 21 homes have been demolished and 100 Palestinians, including 44 children, have been displaced due to punitive demolitions from 7 October 2023 and as of 22 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 22 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: 14-21 January

Health

Needs

• According to WHO, only 16 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:
  • 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.
  • 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.
• 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 unaddressed public waste are intensifying public health risks. The Gaza Municipality estimates that approximately 50,000 tons of solid waste remain unmanaged. This significant buildup contributes to the already critical situation, exacerbating environmental and health concerns in Gaza.

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 Strip, 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 remain 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.
• Some Mine Action partners were able to operate, amid the ongoing blackout, in the reported period. UNICEF and other implementing partners conducted direct Explosive Ordnance awareness sessions, continued disseminating EORE-awareness messages and distributed 20,000 EORE leaflets in shelters.
• The UN Mine Action Service (UNMAS) continued providing explosive ordnance disposal (EOD) support to ensure the safe passage of convoys.
• Humanity and Inclusion are conducting needs assessments for emergency rehabilitation and MHPSS and preparing a refresher training EORE package for their teams.
• The Legal Task Force, together with the Norwegian Refugee Council (NRC) is working on providing substitute identifications cards for Palestinians arriving through the Karem Shalom Crossing without IDs, including providing attestations that can serve as substitute identity documentation.

Challenges and Gaps

• The communications blackout and the continued restrictions on access and safe movement directly affected the delivery of planned child protection interventions, and the reporting of ongoing interventions.
• Mine Action partners report challenges in obtaining authorization to deploy personnel, especially EOD specialists, to carry out contamination assessments; further challenges include access restrictions on equipment, movement concerns due to insecurity. In the reporting period, the communication blackout interfered with risk education, messaging, and coordination of mine action partners.
• The Legal Task Force and its partners report major challenges, stemming from a lack of clear information and/or data on the people who have lost their documents following their displacement. Further, the auth