UNRWA Situation Report 153 on Humanitarian Crisis in Gaza, West Bank

Displaced children amid makeshift tents face the rain and cold weather, Deir al-Balah, Gaza Strip, December 2024. UNRWA Photo by Ashraf Amra

All information updated for 18 December – 31 December 2024[1], Days 439- 452 of Hostilities

Highlights

Newborns in the Gaza Strip are dying from hypothermia because of the cold winter weather and lack of shelter, as supplies which would protect them  have been stuck in the region for months waiting for approval from the Israeli authorities to get into Gaza.

The World Health Organization (WHO) denounced  a raid on Kamal Adwan Hospital on 27 December which put the last major health facility in North Gaza out of service. Since early October 2024, WHO has verified at least 50 attacks on health on or near the hospital.

The United Nations Children’s Fund (UNICEF) reported that around 7,700 newborns in the Gaza Strip lack access to lifesaving care.

The UN Food and Agriculture Organization (FAO) highlighted that the war is having devastating effects on the fishing sector in the Gaza Strip, with the average daily catch between October 2023 and April 2024 dropping to just 7.3 percent of 2022 levels.

The Gaza Strip

Strikes by the Israeli Forces continued, with aerial, land and maritime bombardments across the Gaza Strip, resulting in civilian casualties and the destruction of residential buildings and public infrastructure.

In northern Gaza, since 6 October 2024, the Israeli Forces have been carrying out a ground offensive and continue to impose a tight siege. Intense military operations are ongoing amid a near total lack of humanitarian aid entering the area, in addition to severe communications and internet disruptions. Some parts of the North Gaza governorate have been under a tightened siege for more than three months. Access remains extremely challenging and partners’ ongoing attempts to deliver aid into these besieged areas continues to be largely prevented, leaving thousands of people without access to food, water, electricity or healthcare, as mass casualty incidents continue. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) reported that, between 6 October and 30 December 2024, the UN attempted to reach besieged areas in North Gaza 164 times; of these, 148 attempts were denied by the Israeli authorities and 16 were impeded.

WHO denounced a raid on Kamal Adwan Hospital on 27 December which put the last major health facility in North Gaza out of service. The Israeli authorities confirmed they detained the director of the hospital  Dr. Hussam Abu Safiyah.  Since early October 2024, WHO has verified at least 50 attacks on health on or near the hospital. With Kamal Adwan and Indonesian hospitals entirely out of service, and Al-Awda Hospital barely able to function, and severely damaged due to recent airstrikes, the healthcare lifeline for those in North Gaza is reaching a breaking point.

Babies and children in the Gaza Strip are dying from hypothermia due to cold weather and lack of shelter. At least five newborns reportedly froze to death between 24 and 29 December. UNICEF stated that, with winter weather and temperatures dropping, “it is tragically foreseeable that more children’s lives will be lost to the inhumane conditions they are enduring, which offer no protection from the cold.” UNRWA Commissioner-General Philippe Lazzarini posted on X that, meanwhile, “blankets, mattresses and other winter supplies have been stuck in the region for months waiting for approval to get into Gaza.”

UNICEF reported that around 7,700 newborns in the Gaza Strip lack access to lifesaving care. The dramatic reduction in neonatal care bed capacity has forced many families to seek urgent care in inadequate facilities. This, coupled with shortages of essential medical equipment and supplies, led to preventable neonatal deaths.

On 19 December, Médecins Sans Frontières (MSF) reported that ensuring the entry of critical medications and equipment into the Gaza Strip remains difficult, with Israel imposing strict restrictions on items deemed as having “dual use”.

According to OCHA, recent water quality surveillance conducted by the WASH cluster showed alarming rates of microbiological contamination, with nearly 73 per cent of drinking water and over 97 per cent of domestic water samples not complying with the minimum national or international standards for water chlorination.

FAO highlighted that the war is having devastating effects on the fishing sector in the Gaza Strip, with Gaza's average daily catch between October 2023 to April 2024 dropping to just 7.3 percent of 2022 levels causing a USD 17.5 million production loss. This has further exacerbated an already dire food security situation.

Food security continues to deteriorate. A survey conducted by UNICEF between 20 and 26 November revealed that about 80 per cent of the households surveyed across the Gaza Strip had at least one child going without food in the three days prior to the survey. Overall, more than 96 per cent of all children aged six to 23 months and pregnant and breastfeeding women are not meeting their basic nutrient requirements, with a sharp deterioration in dietary diversity observed over the past four months, particularly in Deir al-Balah and Khan Younis.

Meanwhile, OCHA reported that the energy crisis continues to worsen. Cooking gas remains completely unavailable in northern Gaza and is sold in limited quantities and at exorbitant prices in central and southern Gaza.

OCHA reported that, since October 2023, the North Gaza governorate has been placed under five major evacuation orders. Dozens of other orders have been issued for different parts of the governorate.

On 18 December, the Israeli Forces issued an evacuation order for the Bureij area in the Middle Area, where seven UNRWA installations are located.

On 22 December, the Israeli Forces reportedly dropped leaflets in Beit Hanoun, north Gaza, containing the same information as the Israeli Forces evacuation order issued on 15 December. Twelve UNRWA installations are located within the area impacted by the evacuation order.

On 28 December, the Israeli Forces issued an evacuation order impacting northern Gaza, affecting an area where 56 UNRWA installations are located.

On 29 December, the Israeli Forces issued an evacuation order for areas of north-western Gaza, particularly Al-Nasr areas, Al-Awda City and Al-Murabidin neighbourhood. Five UNRWA installations are located in the area, and ten more UNRWA installations are located in its close proximity.

According to OCHA, as of 31 December, around 80.5 per cent of the Gaza Strip is under active evacuation orders from the Israeli authorities.

According to the UN, at least 1.9 million people – or about 90 per cent of the population – across the Gaza Strip are displaced. Many have been displaced repeatedly, some 10 times or more.

Between 7 October 2023 and 30 December 2024, according to the Ministry of Health (MoH) in Gaza as stated by OCHA, at least 45,541 Palestinians have reportedly been killed in Gaza and 108,338 have been injured.

OCHA reports that, o the MoH in Gaza published the breakdown of 40,717 out of 42,010 fatalities as of 7 October 2024. These reportedly include 13,319 children, 7,216 women, 3,447 elderly, and 16,735 men. Among the child fatalities, 786 children are under one year of age, representing about six per cent of killed children whose full identification details have been documented, the MoH further reported. Additionally, as of 7 October 2024, the MoH noted that 35,055 children had lost one or both parents over the past year.

As of 29 December, the total number of UNRWA team members killed since 7 October 2023 is 263.

Several challenges continue to stand in the way of collecting much needed humanitarian supplies from the Kerem Shalom/Karem Abu Salem crossing point in southern Gaza. These include deteriorating law and order, war and insecurity, damaged infrastructure, fuel shortages and access restrictions.

According to OCHA, between 1 and 29 December, 2,205 humanitarian trucks were permitted to enter the Gaza Strip. This represents a daily average of only 76 humanitarian trucks, well below the pre-war average of 500 trucks per working day.

OCHA reported that, of the 569 humanitarian movements coordinated with Israeli authorities across Gaza from 1 to 30 December 2024, 224 were denied access, 103 faced impediments, 53 cancelled due to logistical and security challenges and only 189 facilitated.

Out of the 127 aid movements needed to pass through the Israeli military-controlled Al Rashid or Salah Ad Din checkpoints to reach areas north of Wadi Gaza between 1 and 30 December, 43 were denied, 31 faced impediments, 17 had to be cancelled and 36 were facilitated.

Aid missions to the North Gaza governorate were particularly disrupted, especially those seeking to reach Jabalia, Beit Lahiya and Beit Hanoun. Between 1 and 30 December, the UN attempted to reach besieged areas in North Gaza 60 times, 55 of which were denied, and five were allowed to proceed but faced impediments.

OCHA reported that coordinated aid missions to areas in Rafah governorate, which has been under an ongoing Israeli military operation since  May 2024, have faced similar challenges, with 36 out of the 38 coordinated requests submitted to Israeli authorities between 1 and 30 December denied, one facing impediments, and one facilitated. This excludes 67 coordinated movements to Kerem Shalom/Karem Abu Salem crossing, of which two were denied, 21 impeded, five cancelled and 39 facilitated.

The latest information on supplies entering Gaza can be accessed through the link: Gaza Supplies and Dispatch Tracking | UNRWA 

The West Bank, including East Jerusalem

According to OCHA, between 7 October 2023 and 31 October 2024, 736 Palestinians have been killed in the West Bank, including East Jerusalem, of those, 430 Palestinians were killed since the beginning of 2024.

Between 16 and 22 December, 12 Palestinians were killed in the West Bank, including East Jerusalem. Of these, three were shot and killed by Israeli Forces in the vicinity of the West Bank Barrier in two incidents: in Qalqiliya on 17 December; and in Faqqu’a on 21 December. One Palestinian was killed in an exchange of fire between Palestinians and Israeli Forces in Nablus on 16 December, and one Palestinian died of injuries incurred during clashes between Palestinians and Israeli Forces on 17 December. On 19 December, two Palestinians were killed in clashes between Israeli Forces and Palestinians in Balata Camp, which also left four Palestinians injured. On the same day, four Palestinians were killed in an Israeli Forces drone strike on a Palestinian vehicle in the vicinity of Tulkarm Camp. A Palestinian child was killed by unexploded ordinance in Arab ar Rashayida village on 21 December.

The large-scale Palestinian Security Forces (PSF) operation in and around Jenin Camp in the northern West Bank continued between 16 and 22 December, with UNRWA forced to completely suspend services to the camp. The Jenin Camp Health Centre was subject to unauthorised entry and use by Palestinian armed actors, with UNRWA unable to access and regain control over the installation owing to the security situation in the camp.

Armed clashes between Palestinian armed actors and the PSF continued between 16 and 22 December, with at least one PSF personnel killed on 22 December during such clashes. At least two child bystanders were injured in Jenin Camp during this period. Reports suggest that the PSF has detained more than 50 Palestinians since 14 December.

Overall situation

The Gaza Strip

Between 7 October 2023 and 30 December 2024, according to the MoH in Gaza as stated by OCHA, at least 45,541 Palestinians reportedly have been killed in the Gaza Strip while 108,338 have been reported injured.

Humanitarian access and protection of civilians

UNRWA is working to verify the details of incidents that reportedly impact UNRWA premises. Further information will be provided once it becomes available*.

During the reporting period, several new armed conflict-related incidents have been reported impacting UNRWA installations and displaced people sheltering there, including UNRWA personnel:

On 27 December, after forcefully evacuating the Kamal Adwan Hospital, the Israeli Forces reportedly entered an UNRWA school and an UNRWA store facility in Jabalia and detained patients, medical staff and displaced people inside the two UNRWA installations. According to reports that UNRWA received,  men were stripped of their clothes, separated from women and brought by the Israeli Forces to the UNRWA school while the women were brought to the other UNRWA installation where they were kept for hours.

On 22 December, 10 displaced people were moderately injured in an UNRWA school in  Nuseirat, as a result of a bomb from an Israeli Forces quadcopter on the schoolyard. The injured were transferred to hospital.

On 22 December, Israeli Forces quadcopters reportedly opened fire at displaced people inside the same UNRWA school in the northwest of Nuseirat. Two displaced people were reportedly killed, including a child, and 12 others were injured. Additionally, initial reports indicate that displaced people could not leave the school, and the injured could not be transferred to hospital as a result of the Israeli Forces’ military activity.

On 19 December, the Israeli Forces reportedly directly struck an UNRWA school in the Shaja’ya area in Gaza City. Fifteen displaced people were reportedly killed, and thirty others were injured.

On 17 December, Israeli Forces troops reportedly opened fire towards the Mawasi area in Rafah, resulting in the complete destruction of an UNRWA international staff guesthouse.

As of 23 December, 648*incidents impacting UNRWA premises and the people inside them have been reported since the beginning of the war (some with multiple incidents impacting the same location). 201* UNRWA installations have been impacted by armed conflict-related incidents since the beginning of the war, some on multiple occasions. UNRWA estimates that, in total, at least 745*persons sheltering in UNRWA installations have been killed and at least 2,202* injured since the start of the war. UNRWA continues to verify and update the number of casualties caused by these incidents.

* Since the start of the war in October 2023, the latest casualty figures are continuously under review as UNRWA gains access to locations that were previously inaccessible and as further verifications occur. The summary figures will be published/updated as information becomes available, noting that these numbers are subject to change once verifications are concluded.

UNRWA response

The Gaza Strip

Health

According to the Health Cluster, UNRWA remains one of the largest health actors operating in the Gaza Strip, contributing to over half of the people reached with health services since 7 October 2023. Between 7 October 2023 and 22 December 2024, UNRWA provided over 7 million medical consultations across the Gaza Strip.

In addition to medical consultations, UNRWA (in partnership with and support from other UN agencies, including UNICEF and WHO) continues to provide vaccines to children. Over 231,000 routine immunisation vaccines have been administered to children from the start of 2024 until 22 December 2024. In addition, around 560,000 children under the age of 10 across the Gaza Strip have been vaccinated against polio.

As of 29 December, only three out of 22 UNRWA health centres and three additional rented facilities used as temporary health centres were operational in Gaza. Health services were also provided by 97 mobile medical teams working in 53 medical points inside and outside shelters in the middle area, Khan Younis, Al Mawasi and Gaza. UNRWA health facilities provide primary health care, including outpatient services, non-communicable disease care, giving out medications, vaccination, antenatal and postnatal health care, laboratory and dental services, physiotherapy and dressings for the injured. The number of operational health facilities changes constantly based on demand, access and security.

As of 29 December, 1,189 UNRWA health staff continued to work in health centres, temporary clinics and medical points across the Gaza Strip, providing 14,952 medical consultations on that day.

UNRWA continued to provide mental health and psychosocial support (MHPSS) services in the middle and Khan Younis areas, with teams of psychiatrists and supervisors to assist special cases referred from UNRWA health centres and shelters. On 29 December, UNRWA teams responded to 479 cases in health centres and at medical points through individual consultations, awareness sessions and to address cases of gender-based violence (GBV).  

On 29 December, UNRWA medical teams provided care for 492 post-natal and pregnant women at high risk.

On 29 December, UNRWA teams provided dental and oral health services in dental stations and mobile dental clinics, reaching 542 patients, including referred cases from remote dental consultations.

On 29 December, 253 patients received physiotherapy rehabilitation services in health centres and medical points.

If not replenished, at least 60 items in the stocks of medicines in UNRWA health facilities  are likely to run out within a month. UNRWA laboratory services are now limited to three tests out of nearly 35 that were available before 7 October 2023. This is due to limited availability of stocks of most laboratory supplies. Laboratory equipment requires maintenance or replacement.

Psychosocial Support and Learning

UNRWA remains the largest provider of emergency learning and psychosocial support (PSS) across the Gaza Strip. Around 660,000 children are out of school due to the war. On 1 August 2024, UNRWA began its first phase response of “Back to Learning” with a focus on mental health activities. This is taking place in up to 45 UNRWA schools-turned-shelters[2]by expanding ongoing PSS activities, focusing on arts, music and sports and raising awareness on the risks of explosive ordnance, with the support of up to 750[3]school counsellors and hundreds of teachers. UNRWA continues to provide lifesaving PSS services in Gaza, including psychological first aid, individual and group counselling, fatigue management sessions, recreational activities, Explosive Ordnance Risk Education and protection cash assistance, reaching children, youth and adults.

Since the onset of the conflict and up to 29 December, around 730,000 displaced people, including over 520,000 children, have benefited from 278,981 PSS sessions and activities. Between 16 and 29 December, a total of 14,029 displaced people accessed these services.  

More than 18,000 children, over half of them girls, have benefited from UNRWA’s “Back to Learning” programme so far. Between 16 and 29 December, 13,719 children (5,507 boys, 8,212 girls, including 378 children with disabilities) participated in  “Back to Learning” activities, including basic literacy and numeracy sessions, PSS sessions, and recreational activities including  arts, music and sports. The activities were conducted daily across 86 temporary learning spaces in 40 shelters, for an average of seven hours per day. This is thanks to 963 UNRWA teachers, with support from counsellors, aiming to address the psychosocial needs of children and adolescents.

Between 7 October 2023 and 30 December 2024, UNRWA’s social work team has provided services to 200,158 displaced people, including psychological first aid, PSS services, family and individual activities, as well as case management. During the same reporting period, protection services were provided to 1,898 survivors of GBV and 3,052 children, including 1,494 unaccompanied children, covering reunification, safe sheltering, medication, dignity kits and non-food items through referrals. The team also supported 21,823 persons with disabilities with PSS; 7,753 of these individuals received assistive devices and rehabilitation services. Awareness sessions on GBV, child protection, disability and special needs, as well as managing social and psychological stressors, were conducted for 144,609 displaced people.

Food Security

From 7 October 2023 to 31 December 2024, a total of over 388,000 families (nearly 1.9 million people) have been reached with two rounds of flour; over 374,000 of those families have received three rounds.

UNRWA continues to distribute food parcels wherever possible. These include[4]rice, chickpeas, lentils, oil, salt, sugar, milk powder, hummus and canned fish, and are designed to cover approximately 90 per cent of daily calorific needs per quarter. To date, around 1.46 million people have been reached, of whom 215,000 people have received two rounds of food parcels since the war started.

In addition to the distribution of UNRWA food parcels, the Agency distributes food parcels on behalf of other UN organisations, reaching over 1.4 million people.

Water, Sanitation and Hygiene (WASH)

Since October 2023, UNRWA has carried out emergency WASH activities across the Gaza Strip.  The main activities include operating and maintaining water wells and desalination systems and supplying water with water trucks and bottled water. In addition, UNRWA continues to distribute hygiene kits and maintain hygiene in UNRWA shelters and sites by providing cleaning supplies, community-based solid waste management and pest control.

UNRWA continues to be one of the largest WASH actors in the Gaza Strip. Between August and mid-November, UNRWA accounted for around 44 per cent of water, sanitation and hygiene activities reported in the Gaza Strip, Including access to water (56 per cent), access to sanitation and solid waste management (42 per cent), and flood mitigation and prevention (66 per cent).

Since the beginning of the war, the Agency has maintained and rehabilitated eight wells, providing over 600,000 displaced people with access to water. In the first two weeks of December, around 38,000 cubic metres of water – both potable and domestic – were distributed across the Gaza Strip.

Winterization efforts are ongoing in southern Gaza and the middle area, with over 215 manholes cleaned in the first two weeks of December. 84 cleaning and pest and rodent control measures were completed. Moreover, UNRWA conducted 45 awareness sessions and distributed over 1800 litres of cleaning liquids for shelters across the Gaza Strip.

UNRWA continues to provide a solid waste collection and transfer service in southern Gaza and the middle area. Over the first two weeks of December, 1,972 tons of solid waste have been collected and transported to the temporary dumping sites.

Tweet from Philippe Lazzarini, UNRWA Commissioner-General:

“Fifteen months on the war in Gaza,horrors continue unabated under the world’s watch.”

#HearTheirVoices