UNRWA Report 146 on Humanitarian Crisis in Gaza, West Bank

UNRWA health staff provides primary healthcare to a child in and UNRWA health centre in Khan Younis, southern Gaza Strip, October 2024. © 2024 UNRWA Photo

Key Points

Gaza Strip: 

• Strikes by Israeli Security Forces (ISF) continue, with aerial, land and maritime bombardments across the Gaza Strip, resulting in civilian casualties and the destruction of residential structures and public infrastructure.

• In northern Gaza, since 6 October, the Israeli Forces have been carrying out a ground offensive and imposed a tightened siege, particularly around the area of Jabalia. Intense military operations are ongoing amid a near total lack of humanitarian aid entering, as well as severe communications and internet disruptions.

• On 28 October, the UNRWA Commissioner-General Philippe Lazzarini posted on X (formerly known as Twitter) on the Israeli Parliament (Knesset) passing legislation against UNRWA. He said the vote “is unprecedented and sets a dangerous precedent. It opposes the UN Charter and violates the State of Israel’s obligations under international law." He added that this is the latest in the ongoing campaign to discredit UNRWA and delegitimize its role towards providing human-development assistance and services to Palestine Refugees, whose status would remain unchanged even if UNRWA were to stop operating. UNRWA Commissioner-General stated that failing to push back against these bills would weaken the multilateral mechanism established after World War II.

• On 27 October, the UN Secretary-General Spokesperson Stéphane Dujarric stated that the plight of Palestinian civilians trapped in North Gaza is unbearable and added: “the Secretary-General is shocked by the harrowing levels of death, injury and destruction in the north, with civilians trapped under rubble, the sick and wounded going without life-saving health care, and families lacking food and shelter, amid reports of families being separated and many people detained.” He highlighted that repeated efforts to deliver humanitarian supplies essential to survive continue to be denied by the Israeli authorities, with few exceptions, and stated that “this conflict continues to be waged with little regards for the requirements of international humanitarian law.”

• According to OCHA, on 26 October, the Israeli Forces announced the expansion of the zone in Al Mawasi to which it has been ordering Palestinians to move; the order revokes previous evacuation notices affecting 11 square kilometres in Khan Younis and Deir Al Balah, therefore expanding the zone to 68 square kilometres or about 19 per cent of Gaza’s total area. In total, since October 2023 and as of 29 October, the Israeli Forces have issued over 65 evacuation orders, including four that were subsequently revoked. Currently, about 80 per cent of Gaza is under active evacuation orders.

• OCHA reports that, between 13 and 26 October, 31 incidents affecting 22 school premises run by UNRWA and eight managed by the Palestinian Authority were reported, with some schools impacted multiple times. Of these incidents, 20 occurred in the North Gaza governorate. In total, 57 incidents affecting schools were recorded between 1 and 26 October, including airstrikes, forced evacuations, shelling and arson.

• According to OCHA, recent attacks on water, sanitation, and hygiene (WASH) personnel and facilities, intermittent access to fuel, and military operations have significantly undermined access to clean water. A recent WASH cluster assessment found that about two thirds of families in the Gaza Strip are reported to have access to less than six litres of water per person per day, with only a quarter of families having access to soap. Nearly half the population lacks the minimum 15 litres per person per day for drinking, cooking, and hygiene. People live in inhumane conditions, often surrounded by rodents, pests, trash, solid waste, sewage, and human waste. Increasingly deteriorating water and sanitation conditions are leading to the further spread of diseases, with acute diarrhea and skin infection particularly common among children under the age of five.

• After the second round of polio vaccination campaign in northern Gaza was forcibly delayed due to escalating violence, intense bombardment, mass displacement, and lack of assured humanitarian pauses, an agreement has now been reached to undertake the vaccination drive between 2 and 4 November in the Gaza governorate.

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

• As of 29 October 2024, according to the Ministry of Health (MoH) in Gaza as reported by OCHA, at least 43,061 Palestinians have reportedly been killed in Gaza and 101,223 have been reported injured (between 7 October 2023 and 29 October 2024).

• OCHA reports that, on 20 October, the MoH 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, MoH further reported. Additionally, as of 7 October 2024, MoH noted that 35,055 children had lost one or both parents over the past year.

• As of 27 October, the total number of UNRWA team members killed since 7 October 2023 is 237.

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

• According to OCHA, only 971 humanitarian trucks were permitted to enter the Gaza Strip through the Kerem Shalom crossing from 1 to 27 October 2024. This represents a daily average of only 36 humanitarian trucks. This is well below the pre-crisis average of 500 trucks per working day. OCHA reported that, of the 580 humanitarian movements coordinated with Israeli Authorities across Gaza from 1 to 28 October 2024, 254 were denied access, 92 impeded, 22 cancelled due to logistical and security challenges and only 212 facilitated. This includes 93 coordinated aid movements aimed at providing humanitarian assistance in the North Gaza and Gaza governorates via Al Rashid checkpoint, of which only eight per cent (seven) were facilitated by Israeli authorities.

• According to OCHA, between 6 and 28 October, 36 coordination requests submitted to the Israeli Authorities for critical aid missions to Jabalia, Beit Hanoun, and Beit Lahya (all in North Gaza governorate) were denied access, 14 faced impediments, and 23 were facilitated.

• The latest information on supplies entering Gaza can be accessed through the link below:    

The West Bank, including East Jerusalem

The West Bank, including East Jerusalem update is now once a week.

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

• Between 21 and 27 October, four Palestinians, including one child, were reported killed in the West Bank, including East Jerusalem. On 22 October, a Palestinian child was killed in Nablus in an exchange of fire with  the Israeli Forces during a search operation. Two Palestinians were killed on 26 October: a Palestinian was killed in an exchange of fire with the Israeli Forces in Tulkarm, and a Palestinian was shot and killed by the Israeli Forces in the vicinity of the West Bank Barrier. A Palestinian attempted to attack ISF personnel near Hizma (outside Jerusalem) on 27 October, resulting in the alleged assailant being shot and killed.

• On 23 October, two missiles fired from Lebanon and intercepted by the Iron Dome landed near Ras ‘Atiya village near Qalqiliya, injuring two Palestinians and damaging several vehicles.

• On 27 October, an Arab citizen of Israel allegedly rammed a truck into a bus stop in Herzliya, north of Tel Aviv. At least 32 Israelis were injured, and one Israeli killed. The truck driver was shot and killed at the scene.

• Attacks on Palestinians participating in the olive harvest continued, with at least two Palestinians injured by Israeli settlers. Late on 22 October, a group of Israeli settlers reportedly kidnapped and physically assaulted a Palestinian child in Masafer Yatta in the South Hebron Hills, later releasing him. On 26 October, Israeli settlers attacked Palestinians picking olives in Qaryut in the northern West Bank, with an elderly woman injured.

Overall situation

• Gaza Strip: As of 29 October 2024, according to the Ministry of Health (MoH) in Gaza as reported by OCHA, at least 43,061 Palestinians have reportedly been killed in Gaza and 101,223 have been reported injured (between 7 October 2023 and 29 October 2024).

Humnitarian access and the 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, numerous incidents have been reported impacting UNRWA installations, including cases where internally displaced people (IDPs) sheltering there and/or UNRWA staff have been affected. The verification of details and any casualty figures are ongoing:

o On 25 October 2024, Israeli Forces artillery shells reportedly struck two UNRWA schools in Jabalia. Subsequently, the Israeli Forces ordered the IDPs sheltering in the two schools to evacuate the premises. Damage to the schools was reported, and one IDP was reportedly seriously injured. The IDPs were able to later return to the shelters.

o On 27 October 2024, the Israeli Forces reportedly  hit an UNRWA school in Gaza City with one missile hitting the third floor on the east side of the school, resulting in damage to a classroom. One person was reported killed  and another was injured. Due to the Israeli Forces’ strike, IDPs sheltering in the school reportedly had to leave and find alternative shelters.

o On 27 October 2024, the Israeli Forces reportedly directly struck an UNRWA school in Gaza City. At least four classrooms in the northern building were  destroyed. Eleven fatalities and several injuries were reported, including an UNRWA Job Creation Programme (JCP) counsellor. People are  reported to be still trapped under the rubble.

• 464* 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), including at least 74* incidents of military use and/or interference at UNRWA premises. 190* Agency installations have been impacted by munitions or subjected to armed actor interference through these incidents. UNRWA estimates that, in total, at least 563* IDPs sheltering in UNRWA installations have been killed and at least 1,790* injured since the start of the war. UNRWA is verifying the number of casualties caused by these incidents.

UNRWA’s 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 20 October 2024, UNRWA provided over 6.14 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 193,000 children have been provided with routine immunisation vaccines between the start of 2024 until 22 September 2024. In addition, around 560,000 children across the Gaza Strip have been vaccinated against polio during the first round of the vaccination campaign in September. The second round of the polio vaccination campaign took place in southern Gaza between 19-22 October. Since 14 October, UNRWA, WHO, UNICEF, and partners vaccinated over 440,000 children against polio and provided nearly 358,000 children with Vitamin A doses in Gaza middle and southern areas.

• The third phase of the polio vaccination campaign, set to begin on 23 October in norther Gaza, had to be postponed due to escalating violence, intense bombardment, mass displacement orders and lack of assured humanitarian pauses. This final phase of the campaign aimed to vaccinate 119,279 children across northern Gaza.

• As of 29 October, seven out of 27[2] UNRWA health centres were operational in Gaza. Health services were also provided by 85 mobile medical teams working in 52 medical points inside and outside IDP shelters in the middle area, Khan Younis, Mawasi and Gaza. UNRWA health facilities provide primary health care, including outpatient services, non-communicable disease (NCD) care, medications, vaccination, antenatal and postnatal health care, laboratory services, 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 October, 1,160 UNRWA health staff continued to work in health centres, temporary clinics and medical points across the Gaza Strip, providing 15,815 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 October, UNRWA teams responded to 583 cases in health centres and at medical points through individual consultations, awareness sessions and to address cases of gender-based violence (GBV).  

• On 29 October, UNRWA medical teams provided care for 501 post-natal and pregnant women at high risk.

• On 29 October, UNRWA teams provided dental and oral health services in dental stations and mobile dental clinics, reaching 662 patients, including referred cases from remote dental consultations.

• On 29 October, 284 patients received physiotherapy rehabilitation services in health centres and medical points.

• Stocks of medicines in UNRWA health facilities are low and at least 56 items will run out by November. UNRWA laboratory services are now limited to four tests out of nearly 35 that were provided before 7 October 2023 due to limited availability of stocks of most laboratory supplies. All 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 continue to be out of school since the beginning of the war. On 1 August 2024, UNRWA began to roll out 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[3]by expanding ongoing PSS activities, focusing on arts, music and sports and raising awareness on the risks of explosive ordnance, with the support of nearly 750[4]school counsellors and up to 500 teachers. UNRWA continues to provide lifesaving PSS services in Gaza, including psychological first aid (PFA), individual and group counselling, fatigue management sessions, recreational activities, Explosive Ordnance Risk Education (EORE) and protection cash assistance, reaching children, youth and adults.

• Since the onset of the conflict and up to 31 October, around 720,000 IDPs, including over 510,000 children, have benefited from 266,872 PSS sessions/activities. Between 25 and 31 October, a total of 15,621 IDPs have accessed these services.  

• More than 13,500 children, 56 per cent of whom are girls, have benefited from UNRWA “Back to Learning” programme so far. Between 25 and 31 October, 13,061 children (5,787 boys, 7,274 girls, including 377 children with disabilities) participated in a variety of “Back to Learning” activities, including basic literacy and numeracy sessions, PSS sessions, and recreational activities such as arts, music and sports. The activities were conducted daily across 78 temporary learning spaces in 38 shelters, for an average of seven hours per day.

• Between 7 October 2023 and 28 October 2024, UNRWA’s social work team has provided services to 187,925 IDPs, including psychological first aid, psychosocial support services, family and individual activities, as well as case management. These interventions aim to address family issues and strengthen relationships.

• During the same reporting period, protection services were provided to 1,540 survivors of gender-based violence (GBV) and 2,671 children, including 1,499 unaccompanied children, covering reunification, safe sheltering, medication, dignity kits and non-food items (NFIs) through referrals. The team also supported 20,104 persons with disabilities with PSS; 7,752 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 122,679 IDPs.

Food Security

• From 7 October 2023 to 30 October 2024, a total of 383,858 families (nearly 1.9 million people) have been reached with two rounds of flour; 366,944 of those families have received three rounds.

• UNRWA continues to distribute food parcels in the southern governorates. These include[5] flour, rice, chickpeas, lentils, cheese, hummus and canned fish, and are designed to cover approximately 90 per cent of daily calorific needs per quarter. To date, nearly 1.15 million people have been reached, of whom nearly 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 around 1.4 million people.

Water, Sanitation and Hygiene (WASH) 

• Since October 2023, UNRWA has carried out emergency WASH activities across the Gaza Strip. Main activities include the operation and continued maintenance of water wells, desalination systems and water through water trucking and bottled water. In addition, UNRWA continues to distribute hygiene kits and maintain hygiene in UNRWA shelters and sites through 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. Since the beginning of the war, the Agency has maintained and rehabilitated eight wells, reaching over 600,000 IDPs with access to water. In October 2024, UNRWA was able to provide over 75,000 m3 of domestic water. Over 9,000 m3 of drinking water were distributed in Jabalia, middle area, and Khan Younis. However, many water wells in the north have been destroyed during the intensified military operations in October 2024.

• With the available fleet for sanitation, UNRWA continues to provide a solid waste collection and transfer service in the Khan Younis, middle area and Gaza areas. In October, around 10,000 tons of waste were collected from camps and emergency shelters and moved to temporary dumping sites. In addition to waste management and collection, over 250 manholes have been cleaned, and 60 cleaning campaigns have been conducted around Gaza City, middle area, and Khan Younis. Environmental awareness workers and WASH staff have worked together to raise awareness on the importance of hygiene, water disinfection, and recycling of available materials.