Urgent health update: Consequences of war on Gaza and West Bank/East Jerusalem-August 25, 2024

Please use this information to organize and pressure elected officials and medical organizations that have been silent in the face of immense catastrophe.

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First hand report

Making tents out of aid parachutes, waiting days for a tin of beans, re-digging graves to bury more martyrs: here's what Palestinians have to overcome.
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8/19,  World Humanitarian Day, 413 NGOs sent a letter to the UN General Assembly decrying the 2023 death toll of 280 aid workers killed in 33 countries--more than ½ in Gaza, where 289 have been killed since October. “The normalization of violence against aid workers & the lack of accountability are unacceptable, unconscionable & enormously harmful for aid operations everywhere.,,Today, we reiterate our demand that people in power act to end violations against civilians & the impunity with which these heinous attacks are committed." For ongoing information, see Aid Worker Security Database.

Numbers are cumulative

GAZA STRIP

Israeli air, land, & sea bombardment continues across Gaza, causing further civilian casualties, displacement, & destruction of houses & other civilian infrastructure. Ground incursions, heavy fighting & impossible to keep up with evacuation orders continue, especially in Khan Younis & Deir al Balah. Food shortages, crumbling infrastructure, a failing medical system, flowing sewage, waste buildup, & summer heat have turned the humanitarian crisis in Gaza into a serious epidemiological threat. While all eyes in Israel are on a potential new regional war, there's another crisis going on – a pan-Palestinian water & sewage situation with dire health, social & political consequences. Israel, the main instigator of the crisis, seems to believe it won't be affected.

·       Killed: 40,265 (260 this week), ~2% of the population

·       Injured: 93,144 (743 this week)

·       Israeli soldiers killed: 332 (5 this week)

·       Israeli soldiers injured: 2,232

·       Hostages: 109

·      ~10,000 people are missing, presumed dead under the rubble. There is little heavy equipment or fuel to dig through steel & concrete ruins looking for them. 

·      ~1,760 fatalities are untraceable due to weapons that make finding a body impossible 

·      ~2,210 cadavers have been taken from graves to unknown locations by Israeli forces

Palestinian Central Bureau of Statistics (PCBS) stated that 24% of fatalities in Gaza were young adults (aged 18-29), significantly impacting Palestine’s future. UN highlighted the unprecedented hardship facing youth, including the death toll among students & academic staff & destruction & closure of all higher education institutions depriving 88,000 students access to higher education. The International Labor Organization noted an overall unemployment rate of 75%, which rises to 95% for youth.

Attacks

• 8/15, 7 killed in Jabalya Refugee Camp.

•  8/16, 5 killed & 8 injured in Gaza City.

• 8/16, 8 killed & others injured while attempting to obtain aid in Rafah.

• 8/16, 7 killed (3 children) & others injured in IDP tent in Al Mawasi.

• 8/17-18, 22 killed (15 children, including a mother & her 6 children) & others injured in Deir al Balah.

• 8/17, 7 killed in An Nuseirat Refugee Camp, Deir al Balah.

• 8/19, 9 killed & others injured in Ash Shati' Refugee Camp, Gaza City.

• 8/20, 5 killed (1 child) & others injured in Al Bureij Refugee Camp, Deir al Balah. 

• 8/20, 12 killed & others injured when a school sheltering IDPs was hit in Gaza City. Israeli military: it struck a Hamas militant base embedded inside the school. Hamas denies Israeli allegations that it uses schools & hospitals for military purposes.

• 8/20, 9 killed & 14 injured in Al Baraka market, Deir al Balah, most of the dead are children 

• 8/21, 5 fishermen killed & 1 injured in 2 attacks near Deir al Balah & Rafah. 

• 8/21, 7 killed (2 children) in IDP tent near Khan Younis. 

• 8/22, a journalist, his wife, & their 3 children killed in Al Maghazi Refugee Camp, Deir al Balah. 

• 8/22, 11 killed & others injured in Beit Lahiya. 

·       Extended families, hospital staff & volunteers are stepping in to care for Gaza’s many newly orphaned children, some of whom are injured, traumatized & haunted by memories of their parents. UNICEF estimates 19,000 unaccompanied children.

Evacuations

·       Successive Israeli evacuation orders in Gaza, including 12 just in August, have displaced 90% of its 2.1 million residents, the UN said. "Humanitarian safe" areas in Gaza Strip have been reduced from 230 sq km to 35 sq km.

• 8/17 & 8/21-22 Israeli military issued evacuation orders for Deir al Balah & Khan Younis, including entire Al Maghazi Refugee Camp. Mapping indicates the order affected 22 neighborhoods housing 42,000 people in 164 IDP sites & 14 WASH facilities, 5 schools, & 10 health facilities (2 PHCs, 5 medical points). Israeli military: "due to the exploitation of the area for terrorist activities & firing at Israel, remaining in these areas has become dangerous."

• During August, 13 evacuation orders displaced 250,000 people across Khan Younis, Deir al Balah, & northern Gaza. 86% of the Gaza Strip has been placed under evacuation orders, concentrating the population into the designated Al Mawasi “safe zone,” which now has a density of 30-34,000 people/sq. km. (compared to 1,200 people per sq.km. before October). This overcrowding, insecurity, inadequate & overstretched infrastructure, hostilities, & limited service exacerbates the dire humanitarian situation for the hundreds of thousands of people forced into Al Mawasi.

• 8/22, Muhannad Hadi, Humanitarian Coordinator for the OPT, stated: “Civilians are exhausted & terrified, fleeing from one devastated place to another, with no end in sight. This cannot continue… If evacuation orders are meant to protect civilians, the reality is that they are achieving the exact opposite.”  

·       Israeli military has been increasing its pressure on the civilian population in the Gaza Strip to evacuate from several residential areas in its north & south. Many Gazans claim the evacuations are another form of pressure on the civilian population amid hostage/cease-fire deal negotiations in Doha.

Polio

• 8/16, Palestinian Minister of Health announced 1st confirmed active case of poliomyelitis, a 10-month-old from Deir al Balah. UN Secretary-General: “Hundreds of thousands of children in Gaza [are] at risk,” UN stands ready to launch “a vital polio vaccine campaign” for >640,000 children, scheduled to begin on 8/31. WHO approved the release of 1.6 million doses of vaccine, UNICEF will coordinate delivery with cold storage units, UNRWA’s medical teams will administer the vaccines. For the campaign to be successful, transport of vaccines & required equipment would need to be facilitated as well as the entry of polio experts, fuel, cash, reliable communications, & ensuring people’s safety to reach health facilities. Guterres: while the “ultimate vaccine for polio is peace & an immediate humanitarian ceasefire,” at the very minimum, a “polio pause is a must.” 

• Total of 3 cases of children with acute flaccid paralysis, a common symptom of polio, now documented

Hospitals & Health Care 

• Severe shortages of fuel & medical supplies continue to limit the functionality of remaining hospitals & primary healthcare centers, particularly in northern Gaza. 8/19, Al Awda Hospital postponed all surgeries & appealed for urgent delivery of fuel. At Kamal Adwan Hospital, fuel & supply shortages threaten operations. Red Crescent warned that their northern Gaza ambulances, emergency medical clinics & relief services are on the verge of shutdown due to lack of fuel. Only 2 of 8 ambulances are functional.

• Despite challenges, 35 Health Cluster partners reached 337,000 people in August. 16 Emergency Medical Teams support the local healthcare workforce; they delivered needed fuel & assessed progress in the rehabilitation of the ER at Al Shifa Hospital.

Food & Nutrition

• In July, the number of children diagnosed with acute malnutrition in northern Gaza was 4 times higher than in May, whereas in the south it more than doubled. Only 1% of children in northern Gaza & 6% in the south were able to receive the recommended dietary diversity.

• The amount of humanitarian food assistance that entered southern Gaza in July was the lowest recorded since October. Fighting, damaged roads, a breakdown of law & order, & access challenges between the Kerem Shalom Crossing & Khan Younis & Deir al Balah have led to critical food shortages. >one million people in southern & central Gaza may receive no food rations in August. Repeated evacuation orders & displacement, coupled with dire shortages of cooking gas, have disrupted the kitchens & bakeries. 13 of 19 bakeries are operational. Kitchens have experienced decline since July (200 kitchens provided 700,000 meals; now 160 kitchens provide 500 meals).

• In northern Gaza, food insecurity & malnutrition are even more alarming. No commercial supplies have reached the area for >3 months, leading to a lack of protein in the local market & only a few locally grown vegetables available at exorbitant prices.  

• Since May, children suffering acute malnutrition increased by >300% in the north & by 156% in the south. Of 239,580 children screened since January, 14,750 children aged 6-59 months have been diagnosed with acute malnutrition. Nutrition Cluster reports 9 to 10% of pregnant & breastfeeding women were acutely malnourished, hampering their ability to breastfeed amidst rising numbers of preterm & low-birth-weight infants. A July UNICEF assessment found only 1% of children in the north & 6% in the south received a diverse diet, with meat, fruits & vegetables, dairy products & eggs being almost inaccessible.

Water & Sanitation

• According to the WASH Cluster, core Water, Sanitation & Hygiene activities are impeded by import & access restrictions on humanitarian aid supplies, including chlorine for disinfecting drinking water & the extension of a dedicated power line to supply electricity to the Southern Gaza seawater desalination plant. Storage & transport challenges, particularly lack of fuel, hinder the supply distribution that harms health & sanitation for vulnerable populations. 

• Trucks now distribute a significant amount of water. 22 cluster partners now deliver >7,000 cubic meters of water daily to 775 locations.

Humanitarian Aid

• Israel has divided Gaza into 3 sections, cutting off north, central and southern regions, separating families and making aid deliveries even more challenging, increasing risk of famine to central Gaza.

• In July, humanitarian access  was severely disrupted by military activities, the closure of crossings, & volatile security. Although the number of humanitarian missions coordinated with Israeli authorities increased from 414 in June to 543 in July, the percentage of missions denied by Israel doubled from 7% to 15%.  

• There are only 2 check points (of which only 1 is open at a time) through which all humanitarian missions between northern and southern Gaza must pass while awaiting Israeli military approval. Aid convoys often face long delays, exposing staff to active fighting & robbery. In July, 2 UN convoys were fired on & sustained damage. 

• 8/1-22, of 147 planned humanitarian assistance missions coordinated with the Israeli authorities to northern Gaza, 43% were facilitated, 19% were impeded, 31% were denied, & 6% were cancelled. In southern Gaza, of 278 coordinated missions, 48% were facilitated, 13% were impeded, 28% were denied, & 10% were cancelled. 

WEST BANK

·       This past week, Israeli forces killed 12 Palestinians (2 children), including 8 in airstrikes, & injured 61 (10 children). A settler also killed a Palestinian.

·       Killed: 607 Palestinians, including 589 by Israeli forces, 11 by settlers, 7 unclear. 

·       Israelis killed: 15, including 9 soldiers, 5 settlers, were killed by Palestinians in the West Bank/ East Jerusalem. West Bank Palestinians have killed 10 Israelis in Israel.

·       Compared with preceding 10 months, Israeli military use of live ammunition has almost tripled the number of Palestinian children killed (115 compared to 39) & more than doubled the number injured (1,411 compared to 615) since October.

Attacks

• 8/13-19, 45 Palestinians, including 28 children were displaced due to Israeli settler violence & harassment, & takeover of Palestinian property.

• 8/13, Israeli sniper shot, killed & then withheld the body of a 16-year-old in Anata, Jerusalem.

• 8/13, Israeli forces shot & killed a Palestinian & injured 9 others during the punitive demolition of 2 homes in Ramallah. Hundreds of soldiers & many military vehicles entered the city & were met with stone throwing. They responded with live ammunition, sound grenades, & tear gas, shooting one man in the back who died & injuring 3 others. The demolitions displaced 7 Palestinians (2 elderly), damaged 16 other residences, & temporarily displaced 12 households (49 people, 4 children).

• 8/14, Israeli drone strike killed 4 in Tammun, Tubas Governorate, then took & withheld their bodies. 2 others (1 child) were injured.

• 8/14, Israeli airstrike killed 2 & injured 7 (1 child) in Balata Refugee Camp, near Nablus. The Red Crescent transported 5 to a nearby hospital. UNRWA: airstrike damaged doors & windows of at least 5 camp residences.

• 8/14, Israeli forces shot & killed a Palestinian in Tubas after encircling his house. At least 2 shoulder-fired projectiles were launched at the house, the damage displacing 10 people (6 children). Israeli forces withheld the man's body. 

• 8/17,  Israeli military killed 2 in an airstrike on a vehicle in Jenin. Red Crescent reported transporting the 2 fatalities & a man injured from shrapnel.

• 8/17 Tamer Saker, a 21-year-old volunteer medic in a Palestinian refugee camp was killed by an Israeli bullet even though he wore the orange vest identifying him as medical staff. He died on the day planned for his sister’s wedding.

• 8/19, Israeli military shot & killed a man & injured a child in Dura, south of Hebron. Palestinians were throwing stones & the Israeli forces responded with gunfire.

Settler attacks

• Israeli settlers carried out 27 attacks against Palestinians, killing 1, injuring 7, damaging property, & displacing 9 households (45 people, 28 children). Since October, OCHA recorded ~1,270 attacks by settlers against Palestinians, of which ~120 caused Palestinian fatalities & injuries, ~1,020 led to property damage, & ~130 caused both. Since October, settlers have displaced 259 households (1,547 people, 753 children).

• 8/13, thousands of settlers, civilians, & several Israeli ministers protected by military, marched through the Old City & entered the Al Aqsa compound to commemorate the Jewish holiday Tish’a B’Av. Marchers harassed & assaulted Palestinians while destroying property & chanting racist slogans. Marchers assaulted Palestinian worshippers after the dawn prayers while Israeli forces stood by. They ransacked several shops, attacked shop owners with pepper spray, & punctured tires of 3 Palestinian-owned motorcycles. 

• 8/15, >100 settlers from Gilad Farm armed with guns, Molotov cocktails, sticks, & stones attacked properties in Jit, east of Qalqiliya & burned an uninhabited house, 3 yards, & 4 vehicles. As residents tried to repel the settlers, they opened fire, killing a Palestinian. Israeli forces erected a checkpoint at the village entrance during the attack, but only intervened after ~50 minutes by firing bullets in the air. Settlers left within 10 minutes. Red Crescent treated 3 injured Palestinians.

• 8/16, armed settlers from an outpost near Pdu'el & military assaulted & injured 2 shepherds in Kafr ad Dik, west of Salfit. According to the mayor & the affected men, they were herding on their lands when settlers arrived & threatened to kill them if they stayed. 5 Palestinians were arrested & 2 were injured while in Israeli military custody. They reported that Israeli forces blindfolded, handcuffed, and assaulted them for 2 days. 5 others were assaulted but did not require hospitalization.

• 8/16, settlers assaulted & injured a Palestinian whose family had been evicted from their home in Silwan, East Jerusalem, the previous day. The settlers threw debris & rubbish at his house & when he attempted to stop them, he was threatened with a gun, pepper-sprayed, assaulted & pushed off an embankment.

• 8/15, armed settlers of the Ateret Cohanim settler organization, protected by Israeli forces, evicted 4 households (18 people, 11 children) from a 3-story building in Silwan where they had been living for decades. Military sealed the neighborhood as the settlers took over the building. After years of legal proceedings, District Court of Jerusalem ruled for the settlers in 2022, & on 4/11, the Israeli Supreme Court rejected the family’s final appeal. Protestors were met with sound grenades & teargas. 

• 8/16, settlers harassed & displaced 5 households (27 people, 17 children) from Bedouin community, Ein al Hilwa – Um al Jmal, Tubas Governorate. A settlement outpost, established this month 500 meters from the community, subjected them to daily intimidation & harassment, prevented them from accessing grazing areas, & attempted to steal their livestock. 

• 8/24, A Palestinian woman was lightly wounded in an attack by Jewish settlers in village of Susya, near Hebron. A resident said 8 settlers wearing face coverings entered the village with a few teenagers, went into homes, beat the woman & wounded a man. The resident also reported acts of vandalism.

Home demolitions

This week, Israeli authorities demolished 34 Palestinian-owned structures: 2 as punishment, 1 during a military operation, 31 for the lack of impossible-to-obtain Israeli-issued building permits. 31 of the structures were in Area C & East Jerusalem, 3 were in Area A. 54 Palestinians (26 children) were displaced & ~163 (72 children) were affected. Since October, Israeli authorities demolished 1,416 Palestinian structures across the West Bank, displacing more than 3,200 (1,400 children), >double the number of the previous year (1,299 displaced, 606 children). Demolitions since October include more than: 500 inhabited structures, 300 agricultural structures, 100 WASH structures, 200 livelihood structures. 28 incidents, mostly in Tulkarm & Jenin, account for the majority of destruction & people affected. 

• 8/14, Israeli Civil Administration & Israeli military demolished 15 structures & their contents in At Tur, for lack of building permits, displacing 2 households (9 people, 5 children). 8 other households (44 people, 21 children) were affected. 

• 8/14, Israeli Civil Administration & Israeli military demolished 2 inhabited caravans & 2 tents in Umm al Kheir, Area C, Hebron governorate, for lacking building permits. 2 households (11 people, 4 children) were displaced while another family (7 people, 4 children) were also affected. Tents & 2 caravans were provided as a response to previous demolitions, most recently on 6/26. Israeli Civil Administration delivered no written orders prior to the demolition.

• 8/19, Israeli Civil Administration & Israeli military demolished a 4-story commercial building under construction for lacking an Israeli-issued building permit in Area C in Al Ram, Jerusalem, affecting 5 households (26 people, 17 children). Family filed & lost 2 appeals, including one to the Israeli Supreme Court but received no final order or notice prior to the demolition.

Other

·       Israeli government is advancing plans to construct Jewish-only settlements on land belonging to the Palestinian village of Battir, designated in 2014 as a UNESCO World Heritage Site. UNESCO’s designation aimed to protect Battir’s unique, ancient agricultural landscape & culture from Israel’s plans to build its separation wall through it.

ISRAEL

·       5 Israeli army reservists suspected of abusing and committing sodomy against a Hamas member at the Sde Teiman detention center will be released to 10 days of house arrest, following agreements reached between the military prosecution & the defense.

·       Netanyahu has added new conditions to Israel’s demands, additions that his own negotiators fear have created extra obstacles to a deal. Israel relayed a list of new stipulations in late July to American, Egyptian & Qatari mediators adding less flexible conditions to a set of principles it had made in late May.

·       Netanyahu is "once again sabotaging the talks" for a cease-fire/hostage deal with Hamas, a source involved in the negotiations told Haaretz. US & Israeli officials reportedly believe that truce talks are “on the brink of collapsing.”

·       The practice that Haaretz exposed of military units forcing civilian residents of Gaza to serve as human shields – searching tunnels & buildings before the forces enter, while wearing army uniforms & sometimes also protective vests to give them the appearance of IDF soldiers – is a war crime. 

·       “They’re ashamed and hurting, but they’re leaving”: doctors are moving away from Israel on an unprecedented scale. “It’s a new phenomenon, of the past few months, I’m concerned that it will only intensify,” warns a senior administrator at one of Israel’s largest hospitals.”

·       Shin Bet chief Ronen Bar noted the perpetrators of Jewish terror have lost all fear of administrative detention "due to the conditions they get in prison & the funds they receive after their release from Knesset members as well as legitimacy & praise, alongside a delegitimization campaign against the defense officials." 

US

·       US approved the sale of a landmark $20 billion weapons package to Israel, including the hotly contested & long anticipated sale of F-15 fighter jets for over $18 billion.

·       US Defense Secretary Lloyd Austin spoke with his Israeli counterpart ahead of the Hezbollah attack, reaffirming Washington's commitment to defend Israel.

·       As humanitarians opposed to US government's support for Israel's assault on Gaza continued to protest during the Democratic National Convention, American doctors who recently volunteered in Gaza enclave implored Kamala Harris—based on the carnage and heartache they have witnessed—to embrace an arms embargo on Israel & an immediate cease-fire.

·       In light of the convention’s refusal to have a Palestinian American speaker, the group Muslim Women for Harris made the decision to disband & withdraw support for Harris. “The family of the Israeli hostage that was on the stage tonight, has shown more empathy towards Palestinian Americans & Palestinians, than our candidate or the DNC has.”

INTERNATIONAL

·       Israeli military & Hezbollah traded cross-border strikes leaving at least 1 person dead deep inside eastern Lebanon, as the conflict on Israel’s northern border continued to fuel concerns about a wider regional conflagration.

·       Israeli military: it had destroyed rocket launchers aimed at Israel. Hezbollah, the Lebanese armed group: it had fired hundreds of rockets, but both sides appeared to signal they did not intend to escalate further.

·       Hamas representatives were heading to Cairo to meet with mediators before a new round of Gaza cease-fire talks, as US, Qatar & Egypt push to reach an agreement they hope can stave off the growing threat of regional war. 

·       Prosecutor of the International Criminal Court stressed the court had jurisdiction to investigate Israeli nationals & asked judges to urgently decide on arrest warrants for Netanyahu and his defense minister Yoav Gallant. In court filings, prosecutor Karim Khan urged judges weighing the arrest warrants sought against Israeli officials & Hamas leaders to not delay.

SOURCES

OCHAOPT, Portside, Haaretz, +972, The Guardian, Electronic Intifada, New York Times, The Guardian, Quds Press News Agency, Reuters, Middle East Eye, The National