Hostilities in the Gaza Strip and Israel | Flash Update #105

Key points

• Intense Israeli bombardment from air, land, and sea continued across much of the Gaza Strip on 28 and 29 January, resulting in further civilian casualties, displacement, and destruction. Hostilities were particularly intense in Khan Younis, with heavy fighting reported near Nasser and Al Amal hospitals, and reports of Palestinians fleeing to the southern town of Rafah, which is already overcrowded, despite the lack of safe passage. Rocket fire from Gaza into Israel continued as well. Ground operations and fighting between Israeli forces and Palestinian armed groups were also reported across much of Gaza.
• Between the afternoons of 28 and 29 January, according to the Ministry of Health (MoH) in Gaza, 215 Palestinians were reportedly killed, and 300 Palestinians were injured. Between 7 October 2023 and 12:00 on 29 January 2024, at least 26,637 Palestinians were killed in Gaza and 65,387 Palestinians were injured, according to the MoH.
• Between the afternoons of 28 January and 29 January, no Israeli soldier was reportedly killed in Gaza. As of 29 January, 218 soldiers were killed, and 1,267 soldiers injured in Gaza, according to the Israeli military.
• On 29 January, the Israeli military ordered the neighbourhoods of An Nassar, Ash Sheikh Radwan, Ash Shati Refugee camp, Rimal Ash Shamali and Al Janubi, Sabra, Ash Sheikh ‘Ajlin, and Tel Al Hawa in western Gaza city to evacuate towards the south. The new order covered an area of 12.43 square kilometres, which amounts to 3.4 per cent of the Gaza strip. This area was home to almost 300,000 Palestinians before 7 October and, subsequently, 59 shelters with an estimated 88,000 IDPs sheltered there. On 14 October, the Israeli military ordered the two northern governorates of Gaza, then home to a projected 1,206,963 people (Palestinian Central Bureau of Statistics) to evacuate to the south of Wadi Gaza.
• Since 1 December, when the Israeli military started ordering specific areas to evacuate, 158 square kilometres, which amount to 41 per cent of the Gaza strip, have been put under such orders. This area was home to 1.38 million Palestinians before 7 October and, subsequently, it contained 161 shelters hosting an estimated 700,750 internally displaced persons (IDPs).
• During the past week, large numbers of Palestinian men have been observed being detained at a checkpoint within the city of Khan Younis. People evacuating the area that pass through the checkpoint were checked by the Israeli military. Many of the men were stripped to their underwear, blindfolded and taken away.
• In the second half of January, humanitarian partners continue to observe an increasing trend in denied and restricted access to the northern and central areas of Gaza. The reasons include excessive delays for humanitarian aid convoys before or at Israeli checkpoints and heightened military activity in central Gaza. Threats to the safety of humanitarian personnel and sites are also frequent, not only impeding the delivery of time-sensitive and life-saving aid but also posing serious risks to those involved in humanitarian efforts.
• On 29 January, at about 14:00, the Palestine Red Crescent Society (PRCS) reported that the surgical ward at Al Amal Hospital had ceased operations due to the depletion of oxygen supplies. PRCS also reported at least three fatalities and four injured IDPs being treated, with many more injured in the vicinity who could not be reached due to heavy fighting. Furthermore, many more people had evacuated towards the organization’s headquarters and the health facility. Continued bombardments jeopardize the safety of medical staff, the wounded, patients, and the estimated 7,000 IDPs who had sought refuge there.
• The PRCS stated that the continuing fighting and the siege of the facilities is hindering the movement of ambulances and emergency medical teams in Khan Younis, and preventing medical teams from reaching the injured and transporting them to the hospital for necessary medical care.
• On 29 January, the transfer of humanitarian supplies into Gaza through Kerem Shalom crossing with Israel was resumed after four days of disruption by Israeli protests.

Hostilities and casualties (Gaza Strip)

• The following are among the deadliest incidents reported on 28 and 29 January:
  • On 29 January at about 18:00, six Palestinians, including four children, were reportedly shot and killed while driving in their vehicle in Khan Younis, according to PRCS. A six-year-old girl survived but emergency medical services were unable to reach her for three hours due to fighting.
  • On 29 January, at least 20 Palestinians were reportedly killed, and others injured, when a residential building was struck in Gaza city, according to Palestinian media.
  • On 29 January, 25 Palestinians were reportedly killed, and others injured, when a residential building was struck in the east of Gaza city, according to Palestinian media.
  • On 29 January, two Palestinians were reportedly killed, and others injured, after a residential building was struck in Nuseirat refugee camp, Deir al Balah, according to Palestinian media.

Displacement (Gaza Strip)

• 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 Deir al Balah in recent days, as well as new Israeli military evacuation orders, a significant number of displaced people have moved further south.

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.

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, on average, occupancy rates are reaching 206 per cent in inpatient departments and 250 per cent in intensive care units.
• As of 25 January, according to the WHO, only 14 of 36 hospitals in Gaza are 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,’ providing available services to patients in its care, but no longer able to receive patients or supplies, as it is surrounded by the Israeli military and experiencing intense fighting. 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.

Humanitarian Access

• Between 1 and 25 January, 51 missions to deliver humanitarian aid were planned for the north of Wadi Gaza; however, only eight were facilitated by the Israeli military while 29 were denied access. Most of the missions that were facilitated access were related to food distribution, while those intended to support critical hospitals and Water, Hygiene and Sanitation (WASH) facilitates were largely denied access. The access of two missions was partially facilitated (e.g., only the assessment components were facilitated, without a planned delivery of aid supplies) and another four were postponed (due to security and other requirements). In an emerging pattern, the access of an additional eight planned missions was initially facilitated, but subsequently impeded as routes designated by the Israeli military proved to be unpassable, or the imposition of excessive delays prior to the departure of the missions or at checkpoints en route.
• Between 1 and 25 January, humanitarian partners coordinated 87 humanitarian missions to the Deir al Balah governorate of Gaza, of which 63 per cent (55 missions) were facilitated and 25 per cent (22 missions) were denied access. Due to increasing military activity, ten missions were postponed. Postponement of humanitarian movements to and from hospitals and humanitarian sites has been an emerging trend since 12 January due to increased military activity. The need to coordinate movement to areas south of Wadi Gaza has only been a requirement by the Israeli authorities since December.
• None of the 22 requests by the United Nations to the Israeli military to open checkpoints early to access areas north of Wadi Gaza were facilitated. Given the heavy congestion around UN warehouses and the high levels of needs, early movement is essential for security, programmatic and protection reasons. The humanitarian community has consistently called for both main supply routes to be open in Gaza, and for checkpoints to open at 6:00 every day. Only one of the two main supply routes has been made available for aid missions so far.
• In addition to widespread attacks on health care facilities and workers, 12 incidents of attacks against, and access constraints on, Emergency Medical Teams (EMTs) 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 (including to members of EMTs, patients and other people within the vicinity) and two entry blockages. These teams have been undertaking life-saving surgeries in partially functioning over-congested hospitals across Gaza.

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)

• On 29 January, Israeli forces shot and killed five Palestinians, including two children, in four separate incidents.
• Israeli forces shot and killed a Palestinian man during a raid in the village of Al Yamun, Jenin. Palestinians threw stones and pipe bombs at Israeli forces and the latter used live ammunitions, tear gas and sound bombs.
• Israeli forces shot and killed two Palestinian men in confrontations with Israeli forces in Dura village in Hebron. The confrontation took place during an Israeli raid, where Palestinians threw stones and Israeli soldiers shot live ammunition.
• Israeli forces shot and killed a 16-year-old Palestinian child, and withheld his body in Khirbet ad Deir village, Bethlehem. According to Israeli sources, the boy was shot while attempting to stab soldiers. Another boy was injured as Israeli forces shot at residents gathering in the area.
• Israeli forces shot and killed a 17-year-old child during a search and arrest operation in Silwad village, Ramallah. Reportedly, confrontations took place between the Israeli military and the Palestinian residents.
• In a previous incident that has now been verified, on 24 January, a Palestinian woman with an Israeli citizenship, residing in the West Bank, died of wounds she sustained during a shooting attack carried out by Palestinians on 7 January while she was driving on a bypass road between Ramallah and Nablus. In the same incident, a Palestinian man from East Jerusalem driving in a car ahead of her was killed after the perpetrators mistook him for a settler.
• Since 7 October 2023 and as of 29 January 2024, 367 Palestinians have been killed, including 94 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 367 fatalities, 357 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 29 January), 59 Palestinians, including at least 13 children, have been killed.
• Since 7 October 2023 and as of 29 January 2024, six 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. On 24 January, a Palestinian woman with Israeli citizenship, residing in the West Bank, was killed by Palestinians. 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 29 January 2024, 4,382 Palestinians, including 660 children, have been injured in the West Bank, including East Jerusalem. Of them, 4,246 have been injured by Israeli forces, 115 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 29 January 2024, OCHA has recorded 472 Israeli settler attacks against Palestinians, resulting in Palestinian casualties (48 incidents), damage to Palestinian-owned property (368 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 29 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 29 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. About 100 Palestinian homes have been demolished on the same grounds between 7 October 2023 and 29 January 2024.
• 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 29 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 29 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 28 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: 21-28 January

Health

Needs

• Primary health services are critically needed in informal shelters across the Gaza Strip. In addition, routine immunization, sexual and reproductive care, and medication for non-communicable diseases and psychotropics are essential to address the population's medical needs. Establishing field hospitals in different areas of the Gaza Strip will be a crucial enabler to accommodate the local population's medical needs.
• Some 6,000 patients are still on the waiting list to be evacuated outside of Gaza for tertiary medical care.
• There is an urgent need for laboratory equipment and reagents to enable accurate diagnosis and testing; blood products to support medical procedures and surgeries; and a humanitarian corridor for referral of critical patients from Nasser Hospital to the Jordanian field hospital in Khan Younis.
• Health facilities, including hospitals, urgently need fuel, medical supplies, and food to continue to provide medical services across the Gaza Strip.

Response

• Since the start of hostilities, in Gaza, 25 partners have established presence and have provided health services to over 500,000 people.
• Some 12 Emergency Medical Teams (EMTs) are currently operational, with two additional teams scheduled to arrive next week. As of end of January 2024, these EMTs have treated some 12,410 patients requiring emergency surgeries and treatment for non-communicable diseases and severe acute malnutrition.
• During the reporting period, 53 patients, including 15 critical cases, were successfully evacuated from UNRWA’s Khan Younis Training Centre.
• The International Medical Corps (IMC) Field Hospital has now expanded its health services to include a maternity ward and pediatrics unit.
• In the West Bank, mobile clinics have provided healthcare services to about 83,000 Palestinians in 86 communities have access to mobile clinic services, with more than 25,000 Palestinians across 36 communities expected to gain access at the beginning of February.

Challenges and Gaps

• In Gaza, the escalation of hostilities in Khan Younis has resulted in a significant increase in attacks against the few remaining partially and minimally functional health facilities and an increase in the number of IDPs seeking refuge in Rafah.
• Ongoing fighting in the vicinity of Al Amal and Al Kheir hospitals have severely affected their functionality and accessibility. Al-Kheir hospital, a critical facility for maternal and newborn care, is currently non-operational due to extensive damage.

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 Municipality of Gaza city estimates that approximately 50,000 tons of solid waste remain unmanaged, exacerbating environmental and health concerns.

Response

• About 23,000 cubic metres of water per day were accessible through water lines, municipal wells, as well as trucking and bottled water (estimated 10,000 cubic metres) between 22 and 28 January.
• Some 6,000 cubic metres of water per day were accessible through the only functional Israeli water pipeline, in contrast to close to 53,000 cubic metres that used to be available through all pipelines prior to the current hostilities.
• Some 3,200 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 2,500 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.

Challenges and Gaps

• In Gaza, due to access restrictions, 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. As of 29 January, only 27 per cent of WASH’s requirement ($148.6M) is funded, according to the FTS.

Protection

Needs

• Unaccompanied and separated children require urgent protection, including family tracing and provision of shelter, winter clothing, blankets, water, and food.
• Protection partners report having observed increased risk-taking behaviour during a food distribution in Gaza city, with displaced people hasting towards aid trucks, amid attacks.
• Released detainees urgently need winter clothes and shoes, and tents, in addition to cash assistance. Released detainees asked for assistance in retrieving their personal belongings, that were confiscated while detained by the Israeli military.
• Reports indicated that pregnant women have been unable to reach health facilities or call ambulances to be transferred to health facilities, and thus have been forced to give birth in UNRWA shelters, which are not equipped with the necessary medical and sanitation facilities to ensure safe births. Protection focal points have provided hygiene and dignity kits, amid scarcity of kits; however, women’s specific needs after childbirth remain unmet.
• UNRWA reports increased levels of domestic violence, against women, in instances where they were unable to obtain food and NFIs from partners.
• Due to constant hostilities, 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 among the population affected by shelling and/or explosive contamination, including internally displaced persons (IDPs), in the event they will return to potentially contaminated areas, after the hostilities.
  • EORE and CPP training for humanitarian actors.
  • Victim Assistance services for survivors of shelling and explosive ordnance related accidents.

Response

• During the reporting period, UNRWA documented the release of 60 detainees (all males) from Gaza at Kerem Shalom, including an unaccompanied minor and one injured person; the Agency provided non-food items and coordinated with the International Committee of the Red Cross (ICRC) to support the released detainees with cash assistance and clothing. Some 28 released detainees were released in two UNRWA schools in Rafah and were assisted with medical care and psychological first aid. Six were transferred to a health facility, while the remaining 27 were reconnected with their families.
• The UN Mine Action Service (UNMAS) continued providing explosive ordnance disposal (EOD) support to ensure the safe passage of convoys; in particular, UNMAS EOD Operators supported three convoys to the north, including two food convoys and one fuel delivery to Shifa Hospital. Two explosive threat assessments were conducted in Khan Younis, including one at the Khan Younis Training Centre.
• Humanity and Inclusion (HI) coordinated and prepared to mobilize staff for future EORE/CPP sessions – some sessions were already held in Rafah and Dir Elbalah. HI is also working on a mass media EORE/CPP campaign.

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 and communications challenged.

Shelter and Non-Food Items (NFI)

Needs

• It is estimated that over 650,000 people will have no home to return to, and that many more will be unable to return immediately, due to the level of damage to surrounding infrastructure, as well as the risk posed by explosive remnants of war.
• Partners estimate that the amount of debris generated by the destruction of residential housing units will exceed 8,000,000 metric tons and will take over three years to remove it, given Gaza's current capabilities.
• Displaced people residing in both formal and informal emergency shelters still lack basic NFIs, and hundreds of thousands lack proper and adequate shelter.
• Tents, timber sections, and tarpaulin sheets are highly needed to allow the displaced communities to protect themselves and their children from harsh weather conditions and to minimize overcrowded and unhygienic conditions in the current makeshift shelters.
• The lack of proper informal settlement planning has led to makeshift shelters and tents flooding on rainy days, further exacerbating the suffering of the people displaced.
• Urgent funding is needed to address the key gaps in the supply of shelter and NFIs. As of 29 January, only 24 per cent of the Shelter Cluster funding requirement (209.2M) has been funded.

Response

• During the reporting period, cluster partners distributed about 1,040 family tents in Mawasi (Khan Younis) and Mawasi (Rafah) for unsheltered IDPs. Some 1,450 bedding items, including blankets, mattresses, and mats, were distributed to IDPs in Rafah.
• Shelter partners indicate that the Egyptian Red Crescent (ERC) and the Palestine Re