Urgent health update: Consequences of war on Gaza and West Bank/East Jerusalem- September 20, 2024
Israeli air, land, & sea bombardment continues across Gaza, causing further civilian casualties, displacement, & destruction of houses & other civilian infrastructure. Ground incursions and heavy fighting continue, especially in Khan Younis, Deir al Balah, Gaza City & Rafah. The extension of the war to the West Bank and Lebanon is extremely alarming.
GAZA
Numbers are cumulative
· Killed: 41,272 (154 this week) Statistics show Israeli attacks kill 2 babies daily.
· Injured: 95,551 (426 this week)
· Israeli soldiers killed: 346 (4 this week)
· Israeli soldiers injured: 2,284
· Hostages: 101
Israeli Attacks
On 9/12 & 16, 15 killed (3 children) and others injured when houses were hit in An Nuseirat, Deir al Balah.
On 9/12, 4 killed and others injured near the European Hospital in Khan Younis.
On 9/13, 5 killed (2 children) in a house in Al Mawasi area, western Rafah.
On 9/14, 15 killed (3 children) and others injured in a house in At Tuffah and a fueling facility in An Nasr, near Gaza City.
On 9/15,11 killed (2 children) and others injured in 2 attacks on Gaza City.
On 9/16, 6 killed (2 children) and others injured when an IDP tent next to a bakery was hit in As Sumoud Camp, Al Mawasi area, Khan Younis.
On 9/17, 5 killed when houses were hit in Al Bureij Camp, Deir al Balah. Palestinian Civil Defense (PCD) received distress calls from people trapped and injured but were forced to withdraw after being fired upon, injuring a crew member. The next day, PCD pulled 12 corpses from the rubble of the houses.
On 9/18, 7 killed (3 children) and others injured in Qizan An Najjar, near Khan Younis.
On 9/18, 8 IDPs killed (4 children) sheltering in Ibn Haytham School in Gaza City.
On 9/19, 5 killed and others injured when a building was hit in Jabalya.
Health Care & Hospitals
On 9/19, UNICEF Deputy Executive Director Ted Chaiban urged the entry of more “medical supplies and medical consumable like antibiotics for skin diseases, equipment for neonatal units, syringes and bandages for surgery rooms” and appealed for the urgent medical evacuation of critically ill and injured children, including many suffering from leukemia and other cancers, “whose lives can be saved only with medical treatment abroad.” The MoH in Gaza reported that 70% of medications and 83% of health supplies have been exhausted from its stockpiles, with this severe deficit forcing hospitals and health-care facilities to suspend services and vital procedures such as heart surgeries, cardiac catheterization, and joint replacements.
25% of all injuries reported by 23 July require rehabilitation services “now and for years to come,” reports WHO. They estimate between 3-4,000 limb amputations have occurred, ~2,000 spinal cord and traumatic brain injuries, 2,000 severe burns. “Acute rehabilitation services are severely disrupted and specialized care for complex injuries is not available, placing patients’ lives at risk,” warned WHO. Gaza’s only limb reconstruction and rehabilitation center, in the Nasser Medical Complex in Khan Younis, became non-functional in Dec.2023, and was further damaged in Feb.2024. 39 physiotherapists have been killed. No in-patient rehab and prosthetic services remain, and even the most essential assistive devices, like wheelchairs and crutches, are lacking due to Israeli restrictions on aid.
Women and girls are disproportionately affected by the deteriorating health crisis. Over 5,000 female cancer patients are unable to access treatment; 25% of women reported skin infections (2x that of men); and they account for most hepatitis A and gastrointestinal diseases. An estimated 155,000 pregnant and breastfeeding women face major obstacles in accessing pre- and post-natal care, rising complications during pregnancy & birth, and a shortage of essential medications for newborns. Of pregnant women: 92% report UTIs, 76% anemia, 28% pre-term labor, 44% hypertension, 16% hemorrhage, and 12% stillbirth.
The MoH reported that Dr. Ziad Mohammed al-Dalou, abducted by Israeli forces during its March raid on Al-Shifa Hospital, died in an Israeli jail, the 3rd doctor to die in Israeli custody since October.
Evacuations
On 9/14, the Israeli military ordered the evacuation of 3 neighborhoods in Beit Lahia, affecting 850 people in 3 IDP sites. As of 9/16, more than 55 evacuation orders remain in force, covering 86% of Gaza.
Aid Access
In August, the UN and NGO partners conducted 598 coordinated humanitarian movements across the Gaza Strip: 395 in the south and 203 in the north. Of these, only 250 were facilitated, 99 impeded and 176 denied. 46% were either denied or impeded, making August the most challenging month for humanitarian access since January 2024.
Of the 9 health sector movements planned to transport over 200,000 liters of fuel to hospitals, only 1 was facilitated while 4 were impeded and 4 denied.
Access through the only 2 remaining checkpoints between north and south Gaza has been increasingly unpredictable and restrictive since 8/16, resulting in significant delays and limiting the time humanitarian teams have to complete their activities. For instance, an 8/24 broken gate prevented a mission from delivering 10,000 vaccines, 58 pallets of medicine, including cold chain items, and life-saving medical supplies for pregnant women, as well as 24,000 liters of fuel.
Convoys are frequently required by Israeli forces to wait for hours at holding points before approaching checkpoints, exposing them to violence and looting. There have been multiple incidents of shots being fired towards, near, or around humanitarian convoys as they approach checkpoints, despite the vehicles being clearly marked and coordinated with Israeli forces, most recently on 8/27.
NGO facilities have been attacked by Israeli forces and affected by evacuation orders, severely limiting the ability to respond the urgent needs of the people in Gaza.
Humanitarian Aid
Repeated forced displacement has resulted in family separations, eroding social protection systems, especially for women and children. According to UNFPA, this and the lack of law enforcement exposes women and girls to more violence, including gender-based violence (GBV). Overcrowding, abysmal water and sanitation conditions, and scarcity of soap and hygiene products deprive women and girls of privacy and dignity, and make them more vulnerable to infection and disease. Multiple evacuation orders have forced closure GBV-response service delivery points and made survivors difficult to trace and serve. They are further harmed by the shortage of tents, facilities and safe spaces, and unstable internet and electricity.
The upcoming rainy season promises flooding and water and sanitation access problems for the majority of displaced people living in unsafe shelters. The Shelter Cluster has reports 1.13 million people need rainproofing kits and 1.34 million people need bedding. The Israeli stranglehold on aid must be broken before the significant rainfall and lower temperatures arrive in November.
On 9/13, the WASH and Health Clusters published an urgent call on the lack of access to soap, shampoo, and detergent to combat diarrhea and skin infections in Gaza. Ongoing constraints by the Israeli authorities on the entry of essential supplies are particularly harmful for children, pregnant women, and people with compromised immune systems and are increasing stress and anxiety in overcrowded shelters.
· Despite a meticulous process in place to ensure aid worker safety in Gaza, the leading cause of death in the humanitarian sector over the last 11 months has been Israeli airstrikes. Of the 378 aid workers killed worldwide since October 7, more than 75 percent have been killed in Gaza or the West Bank, according to the Aid Worker Security Database. The number of humanitarians killed in Palestinian territory in the last three months of 2023 was more than the deadliest full year ever recorded for aid workers. There were 14 incidents where humanitarians were attacked despite giving the IDF their coordinates and being clearly identified as civilians.
Water & Sanitation
As the rainy season approaches, IDPs have been forced to shelter along the coast. Families across Gaza are faced with two choices: either sink in overflowing sewage in destroyed cities or get flooded by rising tides on Gaza’s beach encampments.
The Khan Younis municipality called on people present within rainwater collection ponds and temporary sewage treatment basins in Al Muhararat area, and all low-lying areas to leave and seek safer places due to the danger of overflows. They noted that the ongoing conflict damaged 70% of the transmission lines and rainwater drainage networks, 80% of the sewage transmission lines, pumps and stations, and destroyed 1,800 of 2,200 rainwater filters. The Deir al Balah emergency committee has warned residents to evacuate before it starts raining, as has the municipality of Gaza.
The WASH Cluster reported it received only 31% of the fuel it needed to operate critical WASH facilities. On 9/16, the Palestinian Water Authority (PWA) delivered fuel to 41 facilities, including 37 wells and 4 sewage pumping stations, north of Wadi Gaza, the 1st fuel supply by PWA since 8/13.
Water production remains at ¼ of the levels prior to October 2023. Persistent challenges include leaks, network damage, and spillage during trucking. The WASH Cluster estimates that 70% of network water is leaked due to damages sustained during fighting, with repairs impeded by a combination of insecurity, lack of access and Israeli rejection of imports of spare parts.
Food & Nutrition
38,214 children <5 and 15,603 pregnant and breastfeeding women (PBW) received a 30-day supply of supplements from the World Food Program, representing a 46% increase compared to the 2nd half of August.
Of all children screened for malnutrition, 19,352 have been diagnosed with acute malnutrition, including 15,175 with moderate acute malnutrition (MAM) and 4,177 with severe acute malnutrition (SAM); of those with SAM, 145 had medical complications. Treatment was provided in 4 stabilization centers and 102 outpatient sites. Coordinating nutrition support for newly displaced people arriving at shelters is increasingly complex.
As of 9/16, 14 bakeries were operational: 1 in Khan Younis, 7 in Deir al Balah, 4 in Gaza City and 2 in Jabalya. 5 bakeries in the north were temporarily closed for lack of fuel. 5 bakeries in Rafah remain closed due to ongoing hostilities. Bread from the 14 bakeries is delivered to kitchens for free distribution along with cooked meals but does not meet the high demand.
In early September, >500,000 cooked meals prepared in 155 kitchens were provided daily to families, compared with 450,000 daily meals provided in 130 kitchens in late August.
Due to supply shortages, partners provide only 1 food parcel per family in September in central and southern Gaza, compared with 2 parcels per family in the north.
In support of the polio vaccination campaign, partners provided cooked meals and bottled water to hundreds of campaign workers across the Strip. Many food distribution points were also used as vaccination sites to maximize coverage.
Education
Approximately 40 new Temporary Learning Spaces (TLSs) have been established, benefiting around 6,500 students with access to education focused on developing core skills in literacy and numeracy as well as recreation, mental health and psychosocial support.
The Ministry of Education (MoE) in Ramallah has updated its portal to facilitate remote access to education for some 20,000 of the more than 650,000 school-aged children in Gaza. This is the sole option available to continue formal education. The Education Cluster is circulating the online links to students and working with the Emergency Telecommunications Cluster to improve access to the MoE portal.
West Bank, including East Jerusalem
Killed: 689 Palestinians, including 671 by Israeli forces, 11 by settlers, 7 unclear.
· This week, Israeli forces killed 11 Palestinians (1 child) and injured 50 (6 children).
· Israelis killed: 1 soldier and 1 settler.
East Jerusalem faces a severe water shortage. A month ago, the Israeli government pledged to address the water shortage in East Jerusalem's Kufr Aqab, under Jerusalem's municipal jurisdiction, but has taken no action. In response to a High Court petition, Israel now claims the responsibility lies with the Palestinian Authority.
Eyewitnesses recount the killing of US-Turkish citizen Aysenur Ezgi Eygi at a protest in Beita: “She came here out of love.” Palestinians and allies honor the activist slain by the Israeli army.
Israeli Attacks
On 9/10-12, Israeli forces carried out ground and air attacks in Tubas and Tulkarm, killing 5 in Tulkarm and 6 in Tubas. Significant damage to infrastructure, displacement, and prolonged electricity and water disruptions resulted.
Israeli forces closed Tulkarm city and the Tulkarm and Nur Shams refugee camps. They surrounded the 2 main hospitals, obstructing ambulances and medical teams. A drone attack on a car killed 3. At least 24 people, including 4 students, were stuck for 5 hours in an UNRWA school and clinic in Tulkarm refugee camp as Israeli military operated in the area. A paramedic evacuating a fatality was shot and injured and 5 other paramedics were arrested. The Palestine Red Crescent (PRCS) condemned the attacks on its premises and crews.
Israeli bulldozers damaged water and electric infrastructure and over 600 housing units in and around the 2 camps, with 58 rendered uninhabitable, displacing 82 households (360 people, 161 children).
Israeli forces imposed a curfew In Tubas city and Al Far’a refugee camp, closing city entrances and killing 5 in an airstrike. They surrounded the Turkish Hospital, obstructing ambulance street access. On 9/12, Israeli forces killed an off-duty UNRWA sanitation worker and injured 7 others in Al Far’a camp. 6 Palestinians, including a child, were shot during the operation.
Settler Violence
This week, settlers perpetrated 23 attacks against Palestinians, resulting in 11 injuries, and damage to property. Palestinians perpetrated 3 attacks against settlers in this period, injuring 1 and damaging 2 vehicles. October 2023-September 2024, OCHA recorded 1,360 attacks by Israeli settlers against Palestinians, of which over 130 led to Palestinian fatalities and injuries, 1,088 led to damage to Palestinian property, and 143 led to both casualties and property damage. Settler violence displaced 277 households (1628 people, 794 children) since October.
Nine Palestinians, including five women, two teachers and one foreign activist, were injured by Israeli settlers governorate; On 9/16, Israeli settlers, accompanied by Israeli forces, broke into an animal shelter in Al Mu'arrajat East Bedouin community (Jericho) and its school, where they injured 7 people, attacking a woman with sticks and breaking her hand, and attempted to steal sheep, ransacked homes and damaged property.
In another two separate incidents in the Hebron governorate, Israeli settlers physically assaulted and injured two Palestinians, including one child; On 9/11, armed Israeli settlers injured a 69-year-old man herding sheep near Umm at Tiran (Hebron). They also stole his money and 16 sheep.
On 9/16, settlers dressed in military-style uniforms injured a child traveling with his father on their tractor on Road 317 near At Tawani (Hebron).
In 5 incidents, settlers vandalized over 490 Palestinian-owned trees and saplings and other agricultural property in villages in Nablus, Jenin and Salfit governorates.
On 9/15, the last remaining Palestinian in the Ein al Hilwa – Um al Jmal community in Tubas was forced to displace due to settler violence. Since his return to protect his family property after several Palestinian households were displaced on 8/15, he has been subjected to daily harassment by Israeli settlers and military. The military detained him on 9/ 14, transferred him handcuffed to a military base, before finally being released. He then began dismantling his structures in preparation to leaving the area.
Demolitions
This week, Israeli authorities demolished 35 Palestinian-owned structures, due to the lack of Israeli-issued building permits, which are almost impossible to obtain. Since October, Israeli authorities demolished 1,697 Palestinian structures across the West Bank, displacing >4,400 Palestinians (1,850 children). The structures included over 700 inhabited structures, 300 agricultural structures, 100 water, sanitation and hygiene structures, and 200 livelihood structures. For more on demolitions and displacement, see the OCHA demolition dashboard.
On 9/11, Israeli forces demolished 18 agricultural structures and 2 residences in Biddu and Az Za’ayyem Bedouin communities in Jerusalem, displacing a family of 4 (2 children).
On 9/12, Israeli authorities demolished 2 apartments, displacing 8 (4 children), in a multi-story building in Al Walaja village, within the boundaries of Jerusalem.
On 9/11, the Israeli Supreme Court rejected an appeal by a Palestinian family against their eviction from their home, requested by the Ateret Cohanim settler organization in the Batn al Hawa area of Silwan, East Jerusalem. This puts 2 households (16 people) at imminent risk of displacement. There are 93 families (450 people, 200 children) in Batn al Hawa at risk of forced displacement due to eviction cases filed by Ateret Cohanim, and 120 other East Jerusalem households facing similar settler organization cases.
Education-related incidents
With the start of the new school year on 9/9, several West Bank schools are facing access restrictions, Israeli operations, and settler-related violence, according to the Education Cluster and the Palestinian Ministry of Education (MoE). At least 58 schools (50 in Area C and 8 in East Jerusalem) serving about 6,500 students face pending demolition or stop-work orders.
Al Mu’arrajat East Bedouin Elementary School, serving about 100 students from 2 Bedouin communities in Jericho, faces demolition orders. On 9/16, settlers and Israeli forces broke into the school during classes and assaulted and injured 2 teachers. Israeli forces arrested and tied up 2 Palestinians, including the school principal and then beat them. Israeli forces confiscated footage from the school’s surveillance cameras.
In the Israeli-controlled H2 area of Hebron, movement restrictions have hindered 13,065 students' access to schools, forcing them to move to online classrooms with only 25% attendance across 34 schools in H2 due to inadequate internet and limited remote learning resources. The Qurtuba school, serving about 110 students, resumed in-person classes, but with the main gate operated by Israeli forces, staff and students face risks, including a detour through an olive grove, often used by settlers and leaving students vulnerable to attack.
In Israel
A school defied the Haifa Labor Court’s order to reinstate a teacher reprimanded for a video stating his refusal to serve in the military in the West Bank. The school principal and supervisor have barred him from entering the classroom.
Israel's defense establishment is offering African asylum-seekers willing to participate in the Gaza war assistance in obtaining permanent residency status in Israel. To date, no asylum-seekers who contributed to the war effort have been granted official status.
· A narrow strip of scrubland and sand dunes on the Gaza side of the border with Egypt has emerged as a major obstacle in talks aimed at halting the Israel-Hamas war and freeing scores of hostages. Israeli Prime Minister Benjamin Netanyahu says Israel must maintain control over the so-called Philadelphi corridor to prevent Hamas from replenishing its arsenal through smuggling tunnels under the border. He says that’s necessary to ensure the group can never again launch an attack into Israel like the one on Oct. 7 that ignited the war. However, Israeli media have cited military officials saying any tunnels into neighboring Egypt had been sealed from the Egyptian side for years before the war, making smuggling through them unlikely.
Israel/Lebanon
At least 25 people were killed and >600 wounded when hand-held electronic devices exploded without warning. Most were walkie-talkies, but there are also reports of mobile phones, laptops, and even solar panels suddenly exploding.
Experts on international law pointed to the indiscriminate nature of the blasts in Lebanon and the prohibition on booby traps.
International
In a disturbing escalation against the Palestine solidarity movement in Britain, police arrested journalists and activists Sarah Wilkinson, Richard Medhurst, and Palestine Action co-founder Richard Barnard under the UK's Terrorism Act.
US students and faculty returning after the summer break are encountering increased repression by administrations trying to silence support for Palestinian rights. At NYU, the administration has essentially placed a gag order on anyone criticizing Zionism, a political ideology, by categorizing it as a protected identity class. At Barnard, the administration adopted its so-called institutional neutrality policy and identified the word “Zionist” as a potential “code word” that may constitute prohibited discrimination or harassment against Jewish and Israeli students, the Columbia Spectator reported. Palestine Legal reports Columbia’s school year began with NYC police violently arresting student picketers demanding divestment from genocide on the first day of classes.
· The UN Special Rapporteur on the Right to Food Michael Fakhri has said that the spread of disease and Israel’s “starvation campaign” in Gaza is “killing more people than bombs and bullets”. He added that the damage inflicted by famine “is going to be carried by Palestinians for several generations in the future”. His comments follow his new report to the UN General Assembly last week, in which he detailed how Israel has used starvation in Gaza “with the intent to destroy in whole or in part the Palestinian people”.
· People across Lebanon were hit with a second round of handheld device explosions on 9/18, wounding over 450 people as hospitals are already overwhelmed with the scores of people injured across the country in a similar attack orchestrated by Israel the day before. At least 14 people were killed by a wave of walkie talkie explosions, according to an initial count by Lebanon’s health ministry shortly after the attack. Homes and shops were set on fire by the blasts. Lebanon’s news agency also reported that solar energy systems had exploded. The attacks, which humanitarian groups noted are likely war crimes, are an escalation by Israel.
Sources: OCHAOPT, MondoWeiss.net; Haaretz; Democracy Now; DropsiteNews.com; 972mag.com; theintercept.com; electronicintifada.net; Responsible Statecraft.org, Middle East Eye, english.alarabiya.net, Palestine Legal, Truthout