IFRC Operation Update: Middle East Crisis Operation (MDRS5002) - One Year of Response

SITUATIONAL OVERVIEW: OPT

Since October 7, 2023, hostilities in the Gaza Strip and the West Bank have escalated to unprecedented levels, resulting in immense humanitarian needs in the occupied Palestinian territories (oPt). The situation continues to deteriorate rapidly, drastically affecting security, social and economic conditions and stability, and aid channels to Gaza from neighboring countries.

GAZA

The Gaza Strip, a densely populated area 41km (25 miles) long and 10km wide, bordered by the Mediterranean Sea on one side and fenced off from Israel and Egypt, has been described by United Nations officials as having "simply become uninhabitable". As of November 27, 2024, the conflict has resulted in more than 44,000 Palestinian deaths, and more than 100,000 injured, highlighting the severe impact on civilians. Approximately 1.9 million people –almost 90% of the population- have been displaced, often several times, and around 380,000 housing units have been damaged (UNRWA). Hostilities continue unabated with high-casualty incidents occurring monthly, driving surges in displacement and increasing humanitarian needs.

The consequences of the conflict are far-reaching and will lead to prolonged hardship in Gaza. As per a World Bank report published in September 2024, the Palestinian Authority's (PA) funding shortfall is expected to reach US$1.86 billion in 2024, more than twice the gap experienced in 2023, potentially increasing the risk of a systemic collapse, particularly in public service provision.

This devastation includes homes, hospitals, schools, and essential utilities, severely disrupting daily life and critical services. Over 80% have been damaged or destroyed, affecting more than 625,000 students and 23,000 teachers. The absence of safe learning environments not only hampers academic progress but also worsens the psychological trauma faced by children (ReliefWeb).

The humanitarian consequences of the ongoing hostilities are exacerbating gender-specific and intersectional risks and vulnerabilities. Women, men, boys, girls, people of diverse gender identities and people with vulnerabilities face different and often disproportionate impacts due to pre-existing inequalities, roles, and societal expectations. As the war continues, people in Gaza are experiencing an almost complete erosion of individual and collective coping mechanisms. Tensions within families and communities are increasing, which in turn increases the risks of child protection issues and gender-related protection concerns, including GBV. GBV prevention and response services have collapsed, with safe houses forced to close and the GBV Sub-Cluster unable to provide comprehensive support due to displacement and destruction. Despite the high caseload of women and girls in critical need of health and psychosocial services and dignity kits, partners continue to face logistical challenges preventing the scaling-up of support. Moreover, numerous sources, including multiple and consistent testimonies from released detainees, testimonies of Israeli whistle-blowers such as medics who had access to detainees, as well as photo and video material leaked to media, indicate an extremely worrying increase of mass and arbitrary detentions in inhuman conditions and contravention of violation of all minimum safeguarding standards.

UNICEF estimates at least 17,000 children in Gaza are orphaned or separated from their families, leaving them highly vulnerable and with increased risk of starvation, among other protection concerns. Children in Gaza are exposed to alarming levels of violence in addition to the indiscriminate conflict violence harming them physically and mentally.

The health sector in Gaza is on the verge of collapse, with only limited capacity to provide life-saving services. According to UNRWA, 94% of health facilities are damaged or destroyed, including hospitals, clinics, and primary care centers, significantly reducing access to medical care. Due to ongoing destruction, fuel shortages, and a lack of essential supplies, 80% of primary care centers are no longer operational. Out of 36 hospitals with inpatient capacity, only 17 are partially functional, representing 53% of the pre-crisis inpatient, ICU, and maternity beds. (World Bank)

Fuel shortages have exacerbated the crisis, severely limiting electricity for critical equipment, including ICUs incubators. For instance, according to UNICEF, the number of operational neonatal incubators has dropped by 70% from 178 to just 54, with North Gaza particularly affected, where only two hospitals—Kamal Adwan and Al Awda—remain partially functional (OCHA). The Indonesian Hospital has also been rendered out of service. Without adequate fuel, many facilities struggle to maintain even basic services, including intensive care and maternity care. In terms of maternal and child health, the conflict has taken a toll on the physical and mental well-being of pregnant women, increasing the likelihood of premature births. UNICEF reports a rise in premature births, driven by stress, malnutrition, and lack of prenatal care. Neonatal care has collapsed, with only 9 incubators out of 105 functional in North Gaza, following attacks that severely damaged hospitals. Many pregnant women are unable to access safe childbirth services due to the destruction of healthcare facilities, shortages of medical personnel, and transportation challenges, resulting in a rise in maternal deaths (UNFPA).

Specialized care, including rehabilitation, is also unavailable, leaving an estimated 22,500 injured individuals without necessary services (WHO). Additionally, the displacement and deaths of healthcare workers have reduced staffing levels, further straining the already overwhelmed system. Medical supplies are critically low, with severe shortages of life-saving medications, surgical equipment, and essential consumables. The lack of functional healthcare facilities has led to overcrowding, forcing patients to seek care under dire conditions. The healthcare system's breakdown has also hindered public health responses, including vaccination campaigns, exacerbating risks of disease outbreaks.

Food insecurity and malnutrition have reached catastrophic levels, with the entire Strip classified as IPC Phase 4 (Emergency). Between September and October 2024, 1.84 million people faced Crisis or worse levels of food insecurity, including 133,000 in Catastrophe (IPC Phase 5). This means there are significant food consumption gaps, high levels of acute malnutrition, and increased mortality. Projections indicate that the situation is likely to worsen significantly. By April 2025, it is estimated that over 90% of the population, almost 2 million people, will be in IPC Phase 3 or above. More alarmingly, 345,000 people will likely be in a state of Famine (IPC Phase 5). Acute malnutrition has reached serious levels (IPC AMN Phase 3), ten times higher than pre-conflict levels. 80% of the population (1.7 million people) are not receiving their monthly food rations as of late October 2024.

Most children consume food from less than two food groups. The scarcity of nutritious food, compounded by the collapse of food systems, has led to a sharp increase in malnutrition cases, particularly among infants and children. This malnutrition significantly weakens their immune systems, increasing their vulnerability to life-threatening illnesses. Additionally, it is estimated that 16,500 pregnant and breastfeeding women will require treatment for acute malnutrition (UN). Damage to agricultural production is severe, with 68% of cropland destroyed, leaving Gaza increasingly reliant on external aid. This destruction has contributed to the reliance on external aid and imported goods, as local production can no longer meet the needs of the population (FAO).

The Water, Sanitation, and Hygiene (WASH) sector is also facing many challenges (UN OCHA). Approximately 1.4 million people are consuming less than the recommended six liters per person per day for drinking and cooking. Additionally, nearly half of the population lacks access to the minimum 15 liters per person per day necessary for drinking, cooking, and maintaining basic hygiene. (OCHA). The destruction of water and sanitation infrastructure has led to widespread contamination of water supplies. This has significantly increased the risk of disease outbreaks, with reports indicating a sharp rise in acute respiratory infections, diarrhea, and skin conditions, particularly among children and vulnerable populations. (UNICEF). Additionally, only 12% of the required daily fuel for critical services is available, severely limiting the operation of water pumps and sewage treatment facilities. The lack of electricity has disrupted the functionality of critical equipment, leading to untreated sewage flooding streets and increasing the risk of waterborne diseases (WASHCLUSTER).

Aid volumes entering Gaza have decreased by 75% compared to pre-conflict levels, due to insufficient border crossings being open and challenges in bringing aid in. In October 2024, an average of only 37 humanitarian trucks per day entered Gaza, compared to the pre-conflict average of 500 trucks daily (ReliefWeb). The significant drop in the average daily truck entries into Gaza to 58 in October 2024 marks the lowest level since November 2023 (Reliefweb).

Inside Gaza, the distribution of aid faces significant hurdles due to insecurity, ongoing military operations, and severe movement restrictions. These challenges are compounded by critical fuel shortages, extensive infrastructure damage, and incidents of looting, further hindering the timely delivery of essential goods. Humanitarian workers operate under extreme risks, navigating a volatile and often hostile environment to reach affected communities.

WEST BANK

In the West Bank, including East Jerusalem, violence continues to escalate, with 736 Palestinian deaths reported as of November 2024. Since October 7, 2023, over 1,800 structures have been destroyed, confiscated, or demolished, resulting in the displacement of 4,630 people, including 1,950 children. Movement restrictions have intensified, with the number of checkpoints exceeding 700, including 150 new ones established since October 2023, severely limiting access to land and essential goods (OCHA).

Since October 1, 2024, Israeli settlers have vandalized approximately 600 olive trees and saplings across 15 communities in the West Bank (OCHA). This has contributed to the displacement of over 4,630 Palestinians, including around 1,950 children, due to the destruction, confiscation, or demolition of approximately 1,800 Palestinian structures (UNRWA). These movement constraints have disrupted daily life and hindered humanitarian aid delivery.

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