Humanitarian Situation Update #241 | Gaza Strip

26 November 2024

Key Highlights

• In North Gaza governorate, more mass casualty incidents are reported, and Kamal Adwan Hospital continues to come under attack.
• Of the UN’s 41 attempts to support people besieged in North Gaza so far in November, all were either denied (37) or impeded (four).
• Families recently displaced from North Gaza governorate to Gaza city are facing critical shortages of supplies and services, severe overcrowding and dire hygiene conditions.
• With the onset of heavy rains, over 1.6 million people living in makeshift shelters — nearly half a million of whom are in flood-prone areas urgently need adequate shelter.
• Of the total number of children admitted for outpatient treatment of acute malnutrition since the beginning of 2024, two thirds were recorded in the past five months, signalling a worsening nutritional situation across Gaza.

Humanitarian Developments

• Israeli bombardment from the air, land and sea continues to be reported across the Gaza Strip, resulting in further civilian casualties, displacement, and destruction of civilian infrastructure. In the North Gaza governorate, the Israeli military has been carrying out a ground offensive since 6 October 2024, with fighting reported between Israeli forces and Palestinian armed groups. Israeli forces have continued to impose a tightened siege on Beit Lahiya, Beit Hanoun and parts of Jabalya and humanitarian assistance has been largely denied (see data below).
• On 21 November, the Humanitarian Coordinator (HC) for the Occupied Palestinian Territory (OPT), Muhannad Hadi, warned that the humanitarian operation in the Gaza Strip could come to a standstill due to insecurity that has constrained the ability of humanitarian agencies to deliver critical aid supplies, including food, water, fuel and medical supplies to two million people. Describing the situation as an “unparalleled humanitarian catastrophe,” the HC stated that at the same time that civilians are struggling to survive amid relentless hostilities, the Israeli authorities have banned commercial imports for over six weeks and armed looting of humanitarian convoys has surged. “In 2024, UN trucks have been looted 75 times – including 15 such attacks since 4 November alone – and armed people have broken into UN facilities on 34 occasions. Just last week, one driver was shot in the head and hospitalized, along with another truck driver. This Saturday, no less than 98 trucks were looted in a single attack with trucks being damaged or stolen,” Mr. Hadi added. Reiterating the UN’s call for creating conditions to facilitate “safe and unimpeded humanitarian access across Gaza,” Mr. Hadi emphasized that humanitarian agencies “remain committed to staying and delivering, but … [their] ability to do so is increasingly being called into question.”
• Between the afternoons of 19 and 25 November, according to the Ministry of Health (MoH) in Gaza, 277 Palestinians were killed and 738 were injured. Between 7 October 2023 and 25 November 2024, at least 44,249 Palestinians were killed and 104,746 were injured, according to MoH in Gaza.
• Between the afternoons of 19 and 26 November, two Israeli soldiers were killed in Gaza and one soldier succumbed to wounds sustained on 7 October 2023, according to the Israeli military. Between 7 October 2023 and 26 November 2024, according to the Israeli military and official Israeli sources cited in the media, more than 1,578 Israelis and foreign nationals were killed, the majority on 7 October 2023 and its immediate aftermath. The figure includes 378 soldiers killed in Gaza or along the border in Israel since the beginning of the ground operation. In addition, 2,456 Israeli soldiers were reported injured since the beginning of the ground operation.
• The following are some of the deadliest incidents reported between 20 and 23 November:
  • On 20 November, at about 23:30, around 66 Palestinians, including women and children, were reportedly killed and others injured when a house was hit with an explosive barrel that destroyed it along with six neighbouring houses near Kamal Adwan Hospital in Beit Lahiya (North Gaza). Due to the lack of ambulances, tools and Civil Defense crews, community responders reportedly struggled to recover bodies and rescue the injured from under the rubble.
  • On 20 November, at about 20:50, 21 Palestinians including at least four women and five children, were reportedly killed when a residential building was hit in Abu Iskandar area in northwestern Gaza city.
  • On 20 November, at about 16:40, 12 Palestinians including five children were reportedly killed and others injured when a location sheltering Internally Displaced Persons (IDPs) was hit in Al Mawasi area in western Khan Younis.
  • On 20 November, during the morning hours, 12 Palestinians, including women and children, were reportedly killed and others injured when a house was hit in Jabalya Al Balad in southern North Gaza governorate.
  • On 20 November, at about 16:05, eight Palestinians, including two children and two women, were reportedly killed and 15 others injured when Khaled Bin Al Walid School was hit in An Nuseirat refugee camp in Deir al Balah. The attack affected 200 people sheltering in the damaged rooms and tents in the school.
  • On 20 November, at about 22:40, at least six Palestinians including two children were reportedly killed and several others injured when a tent sheltering IDPs was hit in one of the sites in Al Mawasi area in western Khan Younis.
  • On 21 November, at about 22:00, at least eight Palestinians, including women and children, were reportedly killed when a residential building was hit in Ash Shuja’iyeh, east of Gaza city.
  • On 21 November, at about 9:00, at least seven Palestinians were reportedly killed in the centre of Rafah city.
  • On 22 November, at about 23:45, at least six Palestinians, including three children and two women, were reportedly killed and others injured when a house was hit in Al Buraq area in western Khan Younis.
  • On 22 November, at about 23:55, seven Palestinian family members, including three children, were reportedly killed and others injured when a house was hit in Az Zeitoun neighbourhood in southeastern Gaza city.
• On 23 November, at about 19:10, six Palestinians were reportedly killed and others injured when a house was hit in An Nuseirat refugee camp (Deir al Balah).
• On 20 November, the Palestinian Civil Defense (PCD) reported that one of its teams was directly hit while trying to rescue people under rubble in As Sabra area southwest of Gaza city, resulting in the death of a PCD member and the injury of three others. The PCD added that this was the eighteenth incident in which rescue teams had been hit during rescue missions, with a total of 87 PCD members killed to date. In a subsequent update on 21 November, the PCD reported that 304 of its members had been injured and 21 detained, and a total of 17 PCD centres had either been damaged or destroyed, along with 56 firefighting, rescue and ambulance vehicles. The statement highlighted that all Civil Defense activities remained blocked in North Gaza governorate. In a further update on 26 November, PCD announced that all of their fire, rescue, and ambulance vehicles have stopped working in Gaza governorate due to the lack of fuel.
• Also on 20 November, Médecins Sans Frontières (MSF) reported that an Israeli drone strike almost hit five Palestinian and international MSF staff while on the way home from the Nasser Medical Complex in Khan Younis, although the team was travelling in a clearly-marked MSF vehicle and the movement had been notified to the Israeli military. While the MSF team survived, the attack killed 20 people and seriously injured 10 others, added MSF, citing MoH figures. Since October 2023, at least 337 aid workers, including 330 Palestinians and seven foreigners have been killed; this includes 251 UN staff (of whom 247 were UNRWA staff members), 33 Palestine Red Crescent Society (PRCS) staff and volunteers, and at least 53 other aid workers with national and international NGOs.
• On 23 November, the Israeli military issued an evacuation order for parts of eastern Gaza city, covering an area of 1.9 square kilometres that was included under previously-issuedevacuation orders. Initial estimates indicate about 15 per cent of each of Turkuman al Jadeeda and Al Zeitoun neighbourhoods are affected by the order. Since October 2023, about 79 per cent of the Gaza Strip’s territory has been placed under evacuation orders that remain active, excluding orders that were subsequently rescinded.
• Kamal Adwan Hospital in North Gaza has continued to come under attack, with at least seven attacks recorded through open sources by the UN Human Rights Office (OHCHR) in OPT between the onset of the most recent Israeli military operation in North Gaza on 6 October and 21 November. On 21 November, a drone attack reportedly damaged the hospital’s electricity generator and water tank and resulted in the injury of four hospital staff and two patient companions. Expressing deep concern for the safety of patients and medical staff, the chief of the World Health Organization (WHO) urged “an immediate end to hostilities in the vicinity of the hospital and sustained access for humanitarian missions to provide lifesaving support.” In its statement, OHCHR stressed: “The UN Human Rights Office has received no reports suggesting combat in the vicinity of Kamal Adwan hospital or the use of its facilities for any military purposes. But even if Palestinian armed groups had failed to comply with international humanitarian law's prohibition on using the presence of civilians to prevent the targeting of a military objective, Israeli forces are still bound by their obligations under international humanitarian law, including the principles of distinction, proportionality and precautions in attack.” On 23 November, the hospital, which is already facing a dire lack of food, drinking water, medical staff and supplies, was reportedly hit once again, resulting in the injury of its director, Dr. Hussam Abu Safiya. On the same day, the Israeli military coordinated the transfer of 17 patients and caregivers from Kamal Adwan to other hospitals in Gaza. According to the Health Cluster, as of 26 November, there are 55 patients in Kamal Adwan Hospital, including five in the intensive care unit.
• Skin and respiratory infections, acute diarrheal illnesses and other viral diseases continue to rise across Gaza, with over 300 children treated daily at the Nasser Medical Complex in Khan Younis, Médecins Sans Frontières (MSF) reported on 22 November. Between June and October 2024, the NGO treated 3,421 babies and other children under the age of five at the inpatient pediatric ward of Nasser hospital, 22 per cent of them for diarrhea-related illnesses and nearly nine per cent for meningitis. During the same period, about 1,294 children between one and five years of age were admitted to the facility for lower respiratory tract infections, including pneumonia, while more than 10,800 children between one and five years of age and 168 newborns under one month old were treated in the emergency department due to upper respiratory tract infections. The International Committee of the Red Cross (ICRC) also reported that, in the six months between 9 May and 9 November, 31 per cent of all patients seen in the outpatient department of the Red Cross Field Hospital in southern Gaza were children under the age of 14, with respiratory infections, injuries and burns constituting the bulk of all cases treated.
• On 19 November, WHO reported that, with the support of Saudi Arabia, it has rehabilitated and expanded the warehouse at the Nasser Medical Complex, in Khan Younis, after it was severely damaged by a fire caused by nearby hostilities in April 2024. This will enhance storage capacity for essential medical supplies, benefiting both the Nasser Complex and other hospitals in southern Gaza. Moreover, while all regular medical evacuation corridors outside Gaza remain suspended, on 21 November, WHO and its partners evacuated six critical patients suffering from cancer or conflict-related injuries, including three children, alongside their seven companions, from Gaza to Jordan. Two patients were also planned to be further transferred to the United States, while four have remained in Jordan for specialized care. Overall, only 335 patients have been exceptionally evacuated outside the Strip since the closure of Rafah crossing in early May.
• There are clear signs of a rapidly worsening nutritional situation across Gaza, with two-thirds of the children admitted for outpatient treatment of acute malnutrition since the beginning of 2024 recorded in the past five months alone. According to the Nutrition Cluster, between 1 and 23 November, 3,410 children were admitted for outpatient treatment of acute malnutrition, and an average of 4,700 children were admitted for outpatient treatment of acute malnutrition each month between July and October. This is a total of 22,210 cases, or 67 per cent of the 32,817 cases admitted since the beginning of 2024. Moreover, between 10 and 31 October, the Nutrition Cluster has observed a significant increase in the admission of children suffering from Severe Acute Malnutrition (SAM) with nutritional edema, wherepatients show swelling caused by fluid retention in the tissues, which is an indicator of lack of protein in diets. Cases have surged from 10 per cent before October to 74 per cent of admitted cases in the two stabilization centres (SC) in the Deir al Balah governorate, highlighting a worsening in the nutritional situation and the urgent need to scale up interventions.
• WHO and Relief International have recently established a new SC for the treatment of SAM in Deir al Balah, bringing the total number of SCs presently operational throughout the Strip to four: one in each of Khan Younis and Gaza city and two in Deir al Balah. As of 13 November, 344 children suffering from SAM and complications had been admitted to the SCs, representing a 50 per cent increase compared with the 229 cases reported as of 2 October. Meanwhile, the SC at the Kamal Adwan Hospital in North Gaza remains closed since the intensification of hostilities in the governorate in early October 2024, despite spiraling needs in the governorate and the appeal by the hospital director for the immediate opening of a humanitarian corridor through which medical supplies, surgical medical delegations, baby food and therapeutic milk could enter North Gaza.
• Heavy rains hit the Gaza Strip on 25 November, marking the onset of the winter season and further worsening people’s vulnerability amid limited response capacities. The heavy rains are estimated to affect over 1.6 million people living in makeshift shelters across the Gaza Strip, with thousands of displaced families living in tents along the coast in southwest Gaza being particularly affected by flooding and rising seawater. According to preliminary assessments by humanitarian partners, about 7,000 families residing along the shoreline were affected by recent rains, with thousands of tents flooded, belongings destroyed and shelters damaged. This has been particularly the case in the Al Mawasi area, which hosts several hundred thousands of displaced people. In Deir al Balah, a partner managing 19 sites reported that 60 shelters were destroyed and 120 were damaged at two shelter sites, adding that flooded roads and pathways have created significant access challenges and resulted in further displacement of some families to nearby sites. Some other families had moved in anticipation of the heavy rain; for example, on 24 November, 150 families had already moved to a newly established site in Hamad City, in Khan Younis. Moreover, an assessment by OCHA in the southern area of Al Qarara seaport in Khan Younis, where more than 600 tents were reported to have been flooded by high tides, showed an urgent need for shelter and non-food items such as tents and clothing, as well as food assistance.
• Harsh winter temperatures compounded by heavy rains and rising sea tides are further exacerbating sewage accumulation, the spread of disease, and risk of collapse of damaged buildings where many families have sought refuge. Unlike last winter, when the majority of IDPs managed to find shelter with host families or in schools, hospitals and public buildings, hundreds of thousands of Palestinian families are surviving in small, overcrowded tents or makeshift shelters made of tarpaulins, blankets or cardboard that “will not keep them safe from strong winds, heavy rains and cold temperatures,” reports the Norwegian Refugee Council (NRC). Moreover, 14 months into the conflict, people have been forcibly displaced multiple times and over 60 per cent of all buildings have been damaged or destroyed. Some families have sewn together old rice sacks to add a layer of protection to their shelters, but the first heavy rains of the winter that struck Gaza in recent days have demonstrated how precarious conditions are. On 24 November, PCD reported that “rainfall had caused severe damage to tents housing thousands of displaced people, with water flowing inside the tents and damaging luggage and mattresses.” In a subsequent statement on 25 November, the Government Media Office (GMO) estimated that about 10,000 tents had either been “washed away or damaged by the winter storm.”
• In August, the Inter-Cluster Coordination Group (ICCG), chaired by OCHA, developed and activated a comprehensive winterization plan targeting 2.1 million people and requiring US$242 million. To prioritize the response, since August 2024, humanitarian partners have identified 100 flood-prone areas hosting over 450,000 people across Khan Younis, Deir al Balah, and Rafah, ninety per cent of which lacked contingency plans in case of flooding. During these assessments, it was identified that 1,093 tents are at risk in Deir al Balah city, 4,420 in Khan Younis - Mawasi, 730 in Zawaida (Deir al Balah), and 705 in Nuseirat (Deir al Balah), amounting to a total of 6,948 tents at risk across these areas. Yet, implementation of the plan has remained contingent on funding and facilitation by Israeli authorities to ensure the entry of supplies and equipment into Gaza. For example, sandbags have been installed at only 20 locations to mitigate potential damage, and there is a large caseload of outstanding needs that necessitate the expansion of stocks and pre-positioning of supplies. The Site Management Working Group (SMWG) and the Shelter Cluster estimate that makeshift sites require at least 3,000,000 sandbags to mitigate the risks of rain and flooding. This would necessitate 100 trucks solely dedicated to transporting sandbags, which is a logistical challenge given existing access impediments, including active hostilities, ongoing insecurity, armed looting, access restrictions, damaged roads, lack of fuel, and unexploded ordnance. Without immediate facilitation and resolution of these supply bottlenecks, the ability to respond effectively to current and future shocks will remain critically compromised.
• People across Gaza are in dire need of adequate shelter, while hundreds of thousands of tarpaulins, critical for providing temporary shelter and protecting existing structures, remain stuck outside Gaza. Despite efforts made by the Shelter Cluster to scale up assistance and shelter items continuing to be prioritized for entry into Gaza via the Fence Road, an average of 11 trucks per week have been entering southern Gaza since the beginning of September, which is far below the Cluster’s target of 25 trucks per week. As a result, only 154,000 people could be provided with shelter assistance in Khan Younis, Deir al Balah and Rafah in the past three months; 846,000 people are still in need of urgent assistance in these governorates. More than 36,000 tarpaulins and some 58,000 sealing-off kits – which would be enough for over 76,000 families or roughly 400,000 people – are currently outside the Strip, awaiting entry, with the Cluster continuing to procure more items. At a rate of 11 trucks per week, the Cluster estimates that it will take at least another eight weeks to bring these vital items into the Strip. Meanwhile, in northern Gaza (north of Wadi Gaza), 66,300 people have been assisted by Shelter cluster partners with shelter items, excluding bedding sets, since September 2024, with efforts now focused on scaling up assistance to the tens of thousands of people displaced to the Gaza governorate since October 2024, while access to North Gaza remains heavily restricted. In November, Shelter Cluster partners were able to distribute 700 tents in Gaza city, with the shelter supplies entering through Erez West crossing deeply insufficient to meet the rising needs. As a result, response is far from sufficient for displaced families, who continue to face “appalling conditions,” having no safe place where to seek shelter and lack everything, including clothes, closed shoes, blankets and mattresses, highlighted UNRWA on 25 November.
• Between 9 and 12 November, the UN and its partners conducted an inter-agency needs assessment mission to Gaza city, where more than 100,000 people have been displaced from North Gaza governorate since early October. The assessment team visited nine collective IDP centres, including two UNRWA schools-turned-shelters, hosting 2,094 households. The two UNRWA-managed shelters additionally had 698 families sheltering outside. The assessment recommended key actions to further scale up humanitarian assistance across all sectors Key observations and findings include:
  • Lack of shelter, NFIs and personal belongings — Across all sites, there is a critical lack of shelter materials and NFIs, particularly mattresses, blankets, winter clothes and shoes. Many newly displaced households fled without any belongings and are in urgent need of all essentials.
  • Overcrowding — Families are crammed in overcrowded, damaged buildings and tent sites, with conditions being particularly dire at the Palestine Stadium Collective Centre, which saw an eight-fold increase in its population size (from 100 to 800 households) in November. The majority were initially displaced from Jabalya to Beit Lahiya before arriving in Gaza city. As a result, 700 newly displaced households are living in tents in the football pitch, with up to 25 people sharing the same tent and men reportedly sleeping outside at night to leave space for women and children.
  • Insufficient and inconsistent access to drinking water — Most sites rely on water trucked by humanitarian partners, but it is insufficient to cover growing needs. Although in some cases water wells are available, people cannot utilize them due to damage to water pumps or lack of fuel to operate generators.
  • Dire hygiene conditions — Across all sites, extremely poor environmental hygiene conditions are contributing to the spread of skin diseases, pediculosis, hepatitis A and B, gastroenteritis, and respiratory tract infections. In most sites, sewage systems are nonfunctional, leading to overflows and posing public health risks. At Ramez Fakhra School, IDPs were forced to construct an open drainage system to flush wastewater in the open following the destruction of the school’s sewage system in the hostilities. The lack of adequate toilet facilities further compounds sanitation conditions. While most sites have gender-segregated toilets, the availability of toilets varies considerably. For instance, at Musaab Bin Omeer Centre, up to 125 people are sharing one toilet while at Fahed al Ahmad, there are 20 gender-specific toilets serving about 220 households, or an average of 55 people sharing one toilet. Families also face inadequate access to hygiene products, such as soap, menstrual hygiene items and diapers, forcing them to endure substandard hygiene conditions that increase their vulnerability to communicable diseases.
  • Lack of food aid and means to cook — Families across all sites face limited access to nutritious food. At Az Zahraa School, for instance, only ready-to-eat hot meals are distributed once a week, and at the Palestine Stadium, the distribution of food assistance by local charities has met only a fraction of needs, generating tensions among families. Women consulted through focus group discussions also highlighted a critical lack of infant milk and nutrition supplements. Due to the lack of both cooking gas and firewood, families across all sites are forced to rely on plastic and cardboard as combustibles to cook, resulting in cases of burns, eye injuries and respiratory problems.
  • Shortage of medication and health supplies — While all sites have access to basic medical points, including some set up by volunteer nurses sheltering inside the camps themselves, there is a severe shortage of health supplies and medicine, including for chronic diseases.
• In November, OCHA OPT launched the Humanitarian Service Directory for Palestinians, which it developed based on consultations with a wide range of humanitarian stakeholders. The directory aims to address identified gaps in the provision of key data on humanitarian services in the OPT, enhance existing accountability and community engagement mechanisms, and strengthen collective Accountability to Affected People (AAP) initiatives. The tool is part of the AAP project implemented by UN Women and funded by the Central Emergency Relief Fund (CERF) to strengthen the collective gender-responsive and inclusive accountability to people affected by the crisis in the OPT. The directory provides helpline operators with instant information on questions frequently asked by people contacting them on a range of issues, including where they can receive a certain type of assistance, thereby enabling on-the-spot closure of cases, reducing the need for individual case referrals, and easing the burden on sector resources. It allows humanitarian actors to constantly develop and update relevant content related to their specific sector, contributing to the effective execution of accountable, real-time community engagement activities.
• Between 1 and 25 November, out of 456 planned aid movements across the Gaza Strip that were coordinated with the Israeli authorities, 40 per cent (184) were facilitated, 35 per cent (158) were denied, 16 per cent (73) were impeded, and nine per cent (41) were cancelled due to logistical and security challenges. Of the 99 aid movements needed to pass through the Israeli military-controlled Al Rashid or Salah ad Din checkpoints to reach areas north of Wadi Gaza, only 25 per cent (25) were facilitated by the Israeli authorities, 25 per cent (25) were impeded, 40 per cent (40) were denied, and nine percent (nine) were cancelled. Aid missions to the North Gaza governorate were particularly disrupted, especially those seeking to reach Jabalya, Beit Lahiya and Beit Hanoun. Between 1 and 25 November, the UN attempted to reach these besieged areas 41 times. Thirty-seven of these attempts were outright denied, while four were initially approved, but then severely impeded on the ground such that the assistance could not be delivered to people trapped in the besieged area. Since the tightened siege started in early October, none of UN’s attempts to support besieged people in that area has been fully facilitated. Coordinated aid missions to areas in Rafah governorate, where there has been an ongoing Israeli military operation since early May, have faced similar challenges. Twenty-four out of 28 coordinated requests submitted to the Israeli authorities to access Rafah governorate were outright denied, one was cancelled, one was impeded and two were facilitated. This excludes 63 coordinated movements to Kerem Shalom crossing, of which 67 per cent (42) were facilitated, 17 per cent (11) were impeded and 16 per cent (10) were cancelled.

Funding

• As of 26 November, Member States have disbursed about US$2.37 billion out of the $3.42 billion (69 per cent) requested to meet the most critical needs of 2.3 million* people in Gaza and 800,000 people in the West Bank, including East Jerusalem, between January and December 2024. For funding analysis, please see the Flash Appeal Financial Tracking dashboard. (*2.3 million reflects the projected population of the Gaza Strip upon issuance of the Flash Appeal in April 2024. As of July 2024, the UN estimates that about 2.1 million people remain in the Gaza Strip, and this updated number is now used for programmatic purposes.)
• The oPt Humanitarian Fund (oPt HF) is currently managing 90 ongoing projects, totalling $79.6 million. These projects aim to address urgent needs in the Gaza Strip (91 per cent) and the West Bank (nine per cent) and are strategically focused on education, food security, health, protection, emergency shelter and non-food items, water, sanitation and hygiene (WASH), coordination and support services, multi-purpose cash assistance and nutrition. Of these projects, 49 are being implemented by international non-governmental organizations (INGOs), 29 by national NGOs and 12 by UN agencies. Notably, 32 out of the 61 projects conducted by INGOs or the UN are being implemented in collaboration with national NGOs. Moreover, in addition to the four other reserve allocations for 2024, the oPt HF is currently finalizing its critical and time-sensitive First Standard Allocation of $30 million, aligned with the 2024 oPt Flash Appeal, aiming to rapidly scale up relief efforts to meet the immediate needs of affected people in Gaza and the West Bank. The allocation includes 16 fast-tracked projects, prioritizing critical winterization preparedness and addressing urgent shelter, WASH, and other emergency needs of IDPs and other vulnerable groups in Gaza.Monthly updates, annual reports, and a list of all funded projects per year, are available on the oPt Humanitarian Fundwebpage, under the financing section.

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