Gaza humanitarian crisis (2023–present)

Residents inspect the ruins of an apartment destroyed by Israeli airstrikes

The Gaza Strip is experiencing an ongoing humanitarian crisis as a result of the 2023 Israel–Hamas war. At the start of the war, Israel implemented a complete blockade on the Gaza Strip, which has resulted in significant shortages of fuel, food, medication, water, and essential medical supplies. This siege resulted in a 90% drop in electricity availability, impacting hospital power supplies, sewage plants, and shutting down the desalination plants that provide drinking water. Widespread disease outbreaks have spread across Gaza.

Heavy bombardment by Israeli airstrikes caused catastrophic damage to Gaza’s infrastructure, further deepening the crisis. The Gaza Ministry of Health reported over 4,000 children killed in the war's first month. UN Secretary General António Guterres stated Gaza had "become a graveyard for children."

Organizations such as Doctors Without Borders, the Red Cross, and a joint statement by UNICEF, the World Health Organization, the UN Development Programme, United Nations Population Fund, and World Food Programme have warned of a dire humanitarian collapse. On November 8, UN Human Rights chief Volker Turk described the Rafah Crossing as "gates to a living nightmare."

Food and water

Food

External videos
Emily "Cali" Callahan, an American nurse who worked in Gaza for Doctors Without Borders until early November, describes the humanitarian situation in Gaza to CNN's Anderson Cooper

On 18 October, Alia Zaki, a spokesperson for the World Food Programme stated that "people are at the risk of starvation". On the same day, an Israeli airstrike destroyed a bakery in the Nuseirat Camp, killing four bakers. On X, journalist Refaat Alareer wrote the bakery was one of the last in the central and southern Gaza Strip. On 19 October, several bakeries were reportedly hit by Israeli airstrikes, making it even harder for residents to find food. On 21 October, the UN released a statement saying food stocks were "nearly exhausted". Cindy McCain, executive director of the UN World Food Programme, stated people were "literally starving to death as we speak".

By 24 October, many bakeries had reportedly closed down, while those still open had hours-long lines. On 27 October, a spokesperson for the World Food Programme stated food and other basic supplies were "running out". By 28 October Israeli airstrikes had destroyed a fifth of the bakeries operating in the Strip. On 1 November, Israel bombed one of the last remaining bakeries in Gaza City. On 2 November, UNOCHA stated more than half of all bakeries in Gaza had been destroyed. On 3 November, UN officials stated the average Gazan diet consisted of only two pieces of bread per day. On 8 November, UNOCHA stated northern Gaza no longer had any functioning bakeries. ActionAid stated more than half a million Gazans faced death by starvation. On 11 November, Corinne Fleischer, Middle East regional director of the World Food Programme, stated, "hundreds of people are queueing for hours every day to get bread rations at bakeries," as people were being pushed "closer to starvation."

Cindy McCain stated on 17 November that civilians faced the immediate possibility of starvation. Ten days later, McCain stated Gaza was on the brink of famine. Begging for food became the "new norm."

Water supply

See also: Water supply and sanitation in the State of Palestine

Before the war Gaza purchased a small share of its water from Israel (6% in 2021). Israel's blockade of water pipelines exacerbated water supply issues in the Gaza Strip, which already had a near lack of fit-to-drink aquifers. On 12 October, the United Nations said that Israeli actions had caused water shortages affecting 650,000 people. On 14 October, UNRWA announced Gaza no longer had clean drinking water, and two million people were at risk of death.

On 15 October, Israel agreed to resume water supply, but only in southern Gaza. Because Gaza's water pumps require electricity, the agreement did not ensure renewed water access. On 16 October, Minister of Energy Israel Katz said that water was available near southern Khan Younis, but the Gaza Interior Ministry denied this. By the same time, residents were drinking seawater and brackish water from farm wells, raising fears of waterborne diseases. Doctors and hospital staff drank IV solution.

By 17 October, the UN stated Gaza's last seawater desalination plant had shut down. The Guardian stated fears were growing people had begun to die from dehydration. On 18 October, Israel announced it would not allow fuel to enter Gaza. The UNRWA stated fuel was needed to resume water pump operations. Some Gazans purchased water from private vendors who purified water with solar panels. On 19 October, the UN reported Gazans were surviving on a daily average of three liters of water each. The World Health Organization recommends a minimum of 50 to 100 liters per day. On 22 October, the UN stated Gazans had resorted to drinking dirty water. On 25 October, Oxfam announced Gaza had "virtually run out" of water. On 29 October, Palestinian Water Authority chair Mazen Ghoneim stated the water shortage would be alleviated, as Israel reopened a second water pipeline.

On 3 November, the UN stated many still relied on "brackish or saline ground water," if they were drinking any water at all. On 6 November, OCHA stated continued water shortages were raising fears of dehydration. UNRWA announced on 15 November that due to the lack of fuel, 70 percent of Gaza would no longer have access to clean water. On 17 November, Oxfam stated Gaza's water supply was at seventeen percent of its pre-siege capacity. On 27 November, residents in northern Gaza received their first aid delivery of clean water since the war began.

Disease

Physical health and disease

World Health Organization Twitter @WHO

As deaths and injuries in Gaza continue to rise due to intensified hostilities, intense overcrowding and disrupted health, water, and sanitation systems pose an added danger: the rapid spread of infectious diseases.

November 8, 2023

Public health experts warned of the outbreak and spread of disease in Gaza. According to Oxfam and the United Nations, Gaza's lack of clean water and sanitation would trigger a rise in cholera and other deadly infectious diseases. Oxfam stated Gaza's sewage pumping stations and wastewater treatment facilities had ceased operations, so the buildup of solid waste and unburied bodies were likely vectors of disease. Due to the lack of clean drinking water, Gaza residents were drinking water contaminated with sewage, seawater, and farm water, another major source of disease. Richard Brennan, regional emergency director at WHO, stated, "The conditions are ripe for the spread of a number of diarrhoeal and skin disease".

Doctors also warned of overcrowded conditions at schools and hospitals. Dr. Nahed Abu Taaema stated overcrowded shelters were "a prime breeding ground for disease to spread". Abu Taaema reported a rise in rashes, lung infections, and stomach issues. On 24 October, the Gaza Health Ministry recorded 3,150 cases of disease from drinking contaminated water, mostly among children. The lack of medical supplies was another reported issue, as the World Health Organization reported a sanitation crisis in hospitals, with some struggling to sanitize surgical equipment. Dr. Iyad Issa Abu Zaher stated, "The outbreak of disease is inevitable". UNRWA schools, where an estimated 600,000 Gazans were sheltering, reported outbreaks of scabies and chicken pox, as well as a lack of basic hygiene for women menstruating. On 27 October, Action Against Hunger warned people were developing kidney failure due to the consumption of salt water and dehydration.

On 6 November, OCHA stated individuals with disabilities were suffering disproportionately due to the lack of accommodations in most shelters. UNRWA announced cases of respiratory infections, diarrhoea and chicken pox had been reported at its shelters. On 10 November, WHO stated infectious diseases, including diarrhea and chickenpox, were soaring across the Gaza Strip. OCHA stated accumulated waste in the streets risked the spread of airborne diseases and infestations of insects and rats. Doctors reported that due to a lack of fresh water and iodine, patients wounds were often infested with maggots.

Raw sewage overflowed in the streets, creating a health and environmental disaster. On 8 November, the World Health Organization stated that since the start of the conflict, 33,551 cases of diarrhea had been reported, 8,944 cases of scabies and lice, 1,005 cases of chickenpox, 12,635 cases of skin rash and 54,866 cases of upper respiratory infections. On 17 November, WHO updated these numbers, stating there were 70,000 cases of acute respiratory infections and over 44,000 cases of diarrhea, which were significantly higher than expected. UNICEF warned the worsening sanitation situation threatened a mass disease outbreak.

On 28 November, WHO stated more Palestinians risked dying from disease than bombings. UNRWA chief Philippe Lazzarini warned of an impending humanitarian "tsunami" as people succumbed to disease and the deprivation of sanitation and clean water. A Hepatitis A outbreak was reported by the United Nations on 3 December.

Psychological health

See also: Mental health in Palestine

Weeks of continuous air strikes and explosions have contributed to the psychological destruction of children in Gaza. Following 16 days of bombardment, children developed severe trauma, with symptoms including convulsion, aggression, bed-wetting, and nervousness. 90% of children in pediatric hospitals in Gaza exhibited or reported symptoms of anxiety, the majority exhibited post-traumatic stress symptoms, and 82% reported fears of imminent death. On 6 November, UNICEF spokesman Toby Fricker warned of the psychological impacts and "massive stress" experienced by children in Gaza. On 17 November, WHO chief Tedros Adhanom Ghebreyesus stated 20,000 people were in need of specialized mental health services.

Healthcare

Further information: Attacks on health facilities during the 2023 Israel–Hamas war and Al-Shifa Hospital siege

See also: Health in the State of Palestine

Doctor with wounded child, Al-Shifa.

The healthcare system of Gaza faced several humanitarian crises as a result of the conflict. Due to Israel's siege, hospitals faced a lack of fuel and relied on backup generators for the first two weeks of the war. By 23 October, Gaza hospitals began shutting down as they ran out of fuel, starting with the Indonesia Hospital. When hospitals lost power completely, multiple premature babies in NICUs died. Numerous medical staffers were killed by Israeli airstrikes, and ambulances, health institutions, medical headquarters, and multiple hospitals were destroyed. The Medecins Sans Frontieres said scores of ambulances and medical facilities were damaged or destroyed. By late-October, the Gaza Health Ministry stated the healthcare system had "totally collapsed".

11–17 October

Following the shutdown of the Gaza Strip power station on 11 October, it was reported that hospitals in Gaza would soon run out of available fuel to power generators. On 14 October, the Diagnostic Cancer Treatment Centre of the Al-Ahli Arab Hospital was partially destroyed by Israeli rocket fire. In a statement on 15 October, the World Health Organization stated four hospitals were no longer functioning after being targeted by Israeli airstrikes. On 15 October, healthcare professionals warned if hospital facilities' generators stopped, patients would die when the power was lost.

On 14 October, Israel ordered the evacuation of 22 hospitals in northern Gaza. The WHO described the order as a "death sentence" for the sick and wounded. Doctors across northern Gaza stated they were unable to follow Israel's evacuation order, since their patients, including newborns in the ICU, would die. On 16 October, Doctors Without Borders president Christos Christou wrote that the situation in Gaza was "horrific and catastrophic. … No electricity, no medical supplies. Surgeons in Al-Shifa hospital are now operating without painkillers." On 17 October, a widely condemned explosion in the al-Ahli courtyard resulted in significant fatalities.

18–24 October

Medic carrying wounded Palestinian child in Gaza

On 18 October, Doctors Without Borders stated severely wounded patients would die as the health system collapsed. On 19 October, the Ministry of Health asked for donations of liters of fuels to continue powering hospital generators, and Gaza's only cancer hospital announced it had "perilously low" levels of remaining fuel. Doctors stated pediatric patients had developed gastroenteritis infections due to the lack of clean water. Airstrikes hit the area around al-Quds Hospital. The Red Cross stated Gaza's entire health system was "on its knees". On 20 October, Doctors Without Borders stated thousands of people were at risk of dying "within hours" because it was "impossible" to give them medical attention. Doctors at al-Quds Hospital and the Palestine Red Crescent reported they received a call from the Israeli army to evacuate the hospital or "bear the consequences".

Medical Aid for Palestinians and UNICEF issued an "urgent warning" that 130 premature babies would die if fuel did not reach Gaza hospitals soon. According to the UN Population Fund, there are 50,000 pregnant women in Gaza. A UN statement signed by five major branches stated deaths could soon "skyrocket" from disease and "lack of healthcare". On 23 October, the Indonesia Hospital ran out of fuel and completely lost power. On 24 October, a Health Ministry spokesman announced the healthcare system had "totally collapsed", with 65 medics killed, 25 ambulances destroyed, and many hospitals soon shutting down due to lack of fuel. The World Health Organization warned 46 of Gaza's 72 healthcare facilities had stopped functioning. The Al-Aqsa Martyrs Hospital faced a dialysis crisis, with hundreds sharing only 24 dialysis machines.

25–31 October

On 25 October, Dr. Ashraf al-Qudra, of the Health Ministry, stated the health system was "completely out of service". The Health Ministry stated a total of 7,000 sick and wounded hospital patients were facing death. On 27 October, a Red Cross medical team arrived in Gaza, bringing medical supplies, a war surgery team, and a weapons contamination specialist. The same day, the Al Nasser Hospital in Khan Younis received a delivery of medical supplies, including antiseptic, injections, and medical mattresses, raising hopes more could be received "in the coming days".

On 28 October, a communications blackout meant wounded civilians could not dial emergency services. Ambulances were then evenly geographically distributed to provide "faster access to the injured." On 29 October, the Palestinian Red Crescent reported that it had received warnings from Israeli authorities to immediately evacuate al-Quds hospital as it was “going to be bombarded”. That day, an Israeli airstrike struck 20 metres (65 feet) from the hospital. Dr. Ghassan Abu Sitta wrote on X that he was increasingly treating patients with "distinctive phosphorus burns." On 30 October, the Turkish-Palestinian Friendship Hospital was severely damaged by an Israeli airstrike. WHO announced it could no longer resupply al-Shifa and al-Quds hospitals due to the high levels of risk. On 31 October, the Health Ministry announced the generators at two key Gaza hospitals were hours from shutting down.

1–8 November

On 1 November, the director of the Turkish-Palestinian Friendship Hospital stated Gaza's only cancer hospital was "completely out of service" after it ran out of fuel to power its generator. The Gaza Health Ministry stated the maternity ward at the Al-Helou International Hospital was hit by an Israeli bombardment. On 2 November, the Indonesia Hospital announced its main generator was no longer operational. On 3 November, the Health Ministry stated 12 cancer patients had died after the Turkish Hospital shut down. The Ministry stated 800 critically wounded patients needed to leave Gaza to receive care, stating many critically wounded patients had died in the past several days due to the collapsed healthcare system. A medical convoy in front of al-Shifa hospital was destroyed by an Israeli drone missile. Al-Quds and Indonesia Hospital were both also hit by strikes. On 4 November, the generators at Kamal Adwan Hospital shut down. The entrance of the al-Nasser Children's Hospital was hit by an Israeli strike.

As of 5 November, the Gaza health system was failing as a result of the Israeli blockade; nearly half of all hospitals were out of service due to shortages of fuel and power, and amputations and C-sections were performed without anesthetic due to shortages of medical supplies. On 6 November, Israel bombed al-Shifa hospital's solar panels. On 8 November, Italy announced it was sending a hospital ship to the coast of Gaza. Al-Quds hospital stated Israel had destroyed all roads leading to the hospital. The same day, Al-Quds completely ran out of fuel and shut down most services.

On 8 November, the Ministry of Defence of Italy announced it was sending a hospital ship to the coast of Gaza, in order to guarantee Palestinian civilians access to health services, essential goods and medical drugs. The ship initially had 170 staff members on board, 30 of whom trained for medical emergencies; 28 more members between physicians, nurses and biologists were set to join the expedition in a later phase. The Italian Joint Operations Command also announced a plan to build an Armed Forces-owned field hospital within the Gaza Strip, although the designation of the specific site was subject to the assurance of basic safety conditions in the chosen area. The Ministry of Defence authorized medical staff from foreign countries and international organizations to join the personnel of both the hospital ship and the field hospital.

9–16 November

Further information: Al-Shifa Hospital siege

Doctors Without Borders Twitter @MSF_canada

"We're on the fourth floor, there's a sniper who attacked four patients inside the hospital. One of them has a gunshot wound directly in his neck, and he is a quadriplegic [patient], and the other one [was shot] in the abdomen."

November 11, 2023

On 9 November, the Gaza government media office stated Israel had bombed eight hospitals in the past three days. The same day, Health Minister Fahrettin Koca announced Turkey was prepared to receive Gaza's pediatric cancer patients.

On 10 November, the International Red Cross stated Gaza's healthcare system had "reached a point of no return." Israeli tanks surrounded four hospitals, al-Rantisi Hospital, al-Nasr Hospital, and the eye and mental health hospitals, from all directions. The Nasser Rantissi paediatric cancer hospital caught on fire after being hit by an Israeli airstrike and began evacuations. At least three hospitals were hit by Israeli airstrikes, leading the director of the Al-Shifa hospital to state, "Israel is now launching a war on Gaza City hospitals." The strikes resulted in multiple casualties. The Interior Ministry stated Al-Shifa Hospital was bombed five times in 24 hours. The Palestinian Red Crescent claimed Israeli snipers opened fire on children at al-Quds hospital, killing one and wounding 28. The Ministry of Health stated Israel cut off Indonesia Hospital's electricity, water, and communication.

On 11 November, Ghassan Abu-Sittah, a British doctor in Gaza, stated the injured were no longer able to receive treatment for their wounds, as doctors were only able to stabilize patients. Doctors Without Borders reported a "dramatic intensification" of Israeli attacks on Al-Shifa hospital. Al-Shifa lost power, staff were killed by snipers, and the hospital was shelled and caught fire. Families who tried to leave the hospital complex were shot and killed. Ashraf al-Qudra, a doctor at al-Shifa, stated the hospital was completely out of service, as the Israeli army shot "everything that moves." Physicians for Human Rights stated two premature babies had died at al-Shifa due to the lack of electricity. IDF spokesman Daniel Hagari stated the army would help evacuate babies from al-Shifa Hospital, but a Gaza Health Ministry spokesman stated Israel had not provided "any mechanism to get the babies out to a safer hospital." Robert Mardini, director general of the Red Cross, described the situation at al-Shifa as "unbearably desperate." The Palestinian Red Crescent reported intense shooting and dehydrated babies at al-Quds.

On 12 November, the director general of al-Shifa stated the lives of 650 patients were in danger at al-Shifa Hospital due to the "catastrophic situation." The deputy health minister in Gaza stated Israel had destroyed al-Shifa's cardiac ward. Mai al-Kaila, the Palestinian Minister of Health, stated the Israeli army was not evacuating patients, but rather "forcibly evicting the wounded and patients onto the streets, leaving them to face inevitable death." A surgeon at Al-Ahli hospital stated they had run out of blood for transfusions. The Red Crescent stated al-Quds was completely out of service. The director of the Nasr Hospital stated it had been evacuated under threat of Israeli weapons and tanks. Two of Gaza's main hospitals, Al-Shifa and Al-Quds, closed down. The same day, the IDF released a video recording of soldiers leaving 300 liters of fuel outside Al-Shifa. The director of al-Shifa stated 300 liters would not power the hospital for even 30 minutes.

On 13 November, Kamal Adwan Hospital ran out of fuel. Doctors Without Borders released a statement describing the situation at Al-Shifa Hospital, stating they had no food, water, or electricity, and that there was a sniper attacking patients. The statement stated, "The situation is very bad, it is inhuman." The al-Amal Hospital's only generator shut down. Tom Potokar, chief surgeon with the Red Cross, described the situation in southern Gaza as "just relentless."

On 14 November, Israeli tanks surrounded Al Helou Hospital in Gaza City, with the hospital director stating it was a "maternity hospital only.” Israel launched a raid on al-Shifa Hospital, where thousands, including three dozen premature babies, were still sheltering. Doctors reported 40 patients at al-Shifa died. Fighting near Al-Quds Hospital halted evacuation efforts.

On 15 November, Israel raided the al-Shifa hospital. A journalist on the scene stated, it was "a nightmare that cannot be imagined," and that Israel had targeted the hospitals generators and communications unit, severing contact with the outside world. According to John Kirby, spokesperson for the US National Security Council, Hamas and Palestinian Islamic Jihad had "stored weapons" in the hospital. These claims were disputed. According to an al-Shifa employee interviewed by Al Jazeera, Israel had not brought any aid or supplies, but had "detained and brutally assaulted" men who were sheltering at the hospital. Another contact within the hospital interviewed by BBC said that Israeli soldiers had supplied water to elderly patients. According to The Wall Street Journal, an Israeli military official stated that aid was left at the hospital's front gate and that the hospital's staff was informed of its availability. Rik Peeperkorn, a World Health Organization representative, stated the hospital had no oxygen, power, or water. The hospital director stated bodies were actively decomposing, patients' wounds were full of maggots, and "The smell of death is everywhere."

On 16 November, the Indonesia Hospital completely shut down, leaving 45 patients in need of surgery.

17–24 November

On 17 November, the Palestinian Red Crescent stated its emergency medical teams were trapped at Al-Ahli Hospital. Staff at Al-Shifa stated 50 patients, including infants, had died due to power and oxygen shortages. The director of Al-Shifa stated Israel's claim to provide incubators to premature babies was false.

On 18 November, an evacuation of al-Shifa began. Ismail al-Thawabta, a spokesperson for the Palestinian media office, stated patients moved to other facilities were going to die. ActionAid called it a death sentence. The hospital stated six doctors would remain behind with 120 patients too sick to be transferred. The same day, the IDF released images of military trucks unloading supplies outside Al-Shifa hospital. According to the military, supplies included 6,000 liters of water and 2,300 kg of food. A humanitarian team from the World Health Organization visited al-Shifa and found a lack of food, water, or medicine, with signs of gunfire and a mass grave. The director of al-Shifa said people were only given one hour to evacuate, stating, "we were forced to leave at gunpoint." WHO stated 25 health workers and 291 patients, including 32 babies remained at al-Shifa.

On 19 November, the premature babies at al-Shifa were evacuated to southern Gaza, where they were planned to be moved to Egypt the following day. The World Health Organization stated it was planning missions to transport the remaining al-Shifa patients to Nasser Medical Complex and European Gaza Hospital in the next 2-3 days.

On 20 November, Israel launched an offensive on Indonesia Hospital with an airstrike that reportedly killed 12 people. Following the strike, Israeli tanks surrounded the hospital. Staff at the hospital reported Israeli soldiers shooting inside the hospital indiscriminately. Many sheltered at the hospital, as it was the last functioning one in northern Gaza. The Gaza Ministry of Health stated 200 patients were evacuated from the hospital, while an estimated 500 patients remained.

On 21 November, the World Health Organization stated three hospitals in northern Gaza would be evacuated, meaning there would be no functioning hospitals left in northern Gaza. Four doctors were reported killed after Israel bombed al-Awda Hospital. The Government of Jordan reported Israel had ordered their field hospital to be evacuated and stated they would not comply.

On 22 November, the Palestinian Red Crescent stated fourteen ambulances had arrived at al-Shifa to evacuate the hospital's remaining patients. The Kamal Adwan hospital stated Israeli bombings increased around the hospital.

On 23 November, four patients died in the transfer from northern Gaza to the Turkish-Palestinian Friendship Hospital. The Red Cross reported its staff were shot at while providing humanitarian support. The Gaza Health Ministry announced it would cease coordination with the WHO on patient evacuations following the Israeli arrest of Palestinian doctors. Staff at the Indonesia Hospital were reportedly ordered by the IDF to evacuate. The head of the Medical Emergency Rescue Committee stated patients and staff at the Indonesia Hospital were evacuated to the European Hospital in Khan Younis.

On 24 November, medical workers reported dogs were eating the corpses of unburied people in the streets. Hospitals in northern Gaza, including al-Ahli Arab Hospital, were evacuated by the World Health Organization and the Red Cross.

25–30 November

On 25 November, the director general of the Ministry of Health stated the Israeli military shot at medical teams during the temporary ceasefire in effect. UNOCHA stated only four small hospitals in northern Gaza and eight health facilities in southern Gaza were still functioning. On 26 November, the conditions for remaining patients at al-Shifa were reportedly dire. On 27 November, the Ministry of Health reported a volunteer effort at al-Shifa hospital sought to restart the dialysis department. By 28 November, the dialysis unit was reportedly reopened and receiving patients. A French warship was dispatched as a temporary hospital. On 30 November, WHO chief Tedros Adhanom Ghebreyesus stated the health needs of Gaza had increased dramatically, though only one-third of its health facilities were functioning. The Health Ministry stated hundreds needed to be evacuated from Gaza to receive medical care. Italy and the United Arab Emirates stated they were considering establishing a field hospital in Gaza.

Since 1 December

Hospitals reported overcrowding, with doctors forced to treat patients on the floor. A spokesman for the Gaza crossing authority stated the Rafah crossing remained opened for the evacuation of the sick and wounded. Doctors Without Borders stated al-Awda hospital had been damaged in an Israeli bombing. On 2 December, Saudi Arabia donated six ambulances to the Palestinian Red Crescent. On 3 December, James Elder, a spokesman for UNICEF described Nasser Hospital in Khan Younis as a "death zone." The same day, the IDF bombed the Kamal Adwan hospital, killing at least four people. Two Red Crescent paramedics were wounded by gunfire from the Israeli military.

Airstrikes

Main article: List of engagements during the 2023 Israel–Hamas war § Airstrikes

Further information: Refugee camp airstrikes in the 2023 Israel–Hamas war and School airstrikes in the 2023 Israel–Hamas war

See also: Dahiya doctrine and Roof knocking

October

El-Remal in Gaza City following an Israeli airstrike, 10 October 2023

In just one week, Israel dropped more than 6,000 bombs on Gaza. Israel's airstrikes were described as a carpet bombing and "indiscriminate". By 16 October, airstrikes had killed 2,750 people, including more than 700 children, and wounded nearly 10,000. An additional 1,000 people were missing beneath rubble. On 16 October, Israeli airstrikes destroyed a UNRWA humanitarian aid supply depot. The same day, airstrikes destroyed the headquarters of the Palestinian Civil Defence, the agency responsible for emergency response services, including firefighting and search and rescue.

On 17 October, Israel conducted intensive airstrikes in southern Gaza, in areas it told residents to seek refuge. An airstrike at a UNRWA school killed at least six people. On 18 October, the Ahmed Abdel Aziz School in Khan Yunis was hit. On the same day, the death toll in Gaza had risen to 3,478. On 19 October, an Israeli airstrike hit the Church of Saint Porphyrius, where 500 people were sheltering. Israel "pounded" areas in south Gaza it had declared as "safe zones", raising fears amongst residents that nowhere was safe. On 19 October, U.S. officials reported alarm at Israeli comments about the "inevitability of civilian casualties", after it used the atomic bombings of Hiroshima and Nagasaki as historical comparisons for their Gaza campaign.

On 20 October, Israeli continued to bombard south Gaza. IDF spokesman Nir Dinar said, "There are no safe zones". On 21 October, Israel intensified its airstrikes in advance of an expected ground invasion. On 22 October, Israeli airplanes bombed the areas around the Al Shifa and Al Quds hospitals on a night described as the "bloodiest" of the conflict so far. On 23 October, airstrikes killed 436 people in the al-Shati camp and southern Khan Younis in just one night. On 26 October, Israeli PM Benjamin Netanyahu stated Israel had "already eliminated thousands of terrorists – and this is only the beginning". On 27 October, WHO stated more than 1,000 unidentified people were buried under rubble.

By 28 October, the Israeli Air Force bombed residential buildings without any prior warning, killing an estimated 50 people per hour. On 29 October, the IDF bombed the area around the Al-Quds hospital. On 30 October, Israel bombed the Turkish-Palestinian Friendship Hospital. On 31 October, an airstrike on the Jabalia refugee camp was described as a "massive massacre."

November

Victim of Israeli airstrike in Jabalia.

On 3 November, the Health Ministry stated 1,200 children were buried under rubble, 136 paramedics had been killed, and 25 ambulance vehicles had been destroyed. On the same day, Israel bombed a medical convoy outside of al-Shifa hospital. The IDF claimed the ambulance was being used by Hamas, leading Queen's University professor Ardi Imseis to state Israel needed to prove its claim. The IDF also bombed the Osama Ben Zaid school. On 4 November, Israel bombed the al-Fakhoora School, killing at least fifteen people. Journalists reported Israel was targeting solar panels and personal generators. On 5 November, Israel bombed and destroyed Al-Azhar University. On 6 November, at least eight people died in airstrikes on the Nasser Medical Complex.

On 8 November, Israel bombed and destroyed the Khalid bin al-Walid Mosque. On 12 November, Israel used earthquake bombs on an apartment complex in Khan Younis, killing at least thirteen people. On 13 November, an Israeli airstrike on the Jabalia refugee camp killed thirty people, with Gaza's civil defence team unable to rescue injured people from the rubble due to a lack of equipment.

According to sources, both Israeli and Western, Hamas placed military facilities under schools, hospitals and mosques throughout Gaza (including Al-Shifa and the Indonesia Hospital), or used them as cover for its fighters. According to The Guardian, there were indications of Hamas' use of hospitals, schools and residential building as early as 2014. These claims have been disputed, however, including by organizations like Human Rights Watch, UNRWA, and the Palestinian Red Crescent. The Government of Qatar has criticized the lack of either concrete evidence or independent investigations, and both Palestinian and international medical staff have disputed them. Michael Lynk stated Israel's claims were used to prepare "public opinion for the attacks to come".

On 15 November, Gaza's last remaining flour mill was hit by an Israeli airstrike. On 17 November, dozens were reported killed after an airstrike on al-Falah School in the Zeitoun neighborhood, south of Gaza City. The following day, 26 people were killed in an airstrike of a residential building in southern Gaza. A strike on the Al-Fakhoora school reportedly killed at least 50. Deaf, blind, and intellectually handicapped individuals were at particular risk of death by airstrikes. Following Israel's evacuation orders for Palestinians to flee northern Gaza, the IDF intensified its attacks on southern Gaza. It again intensified strikes across Gaza before the temporary November ceasefire. By 26 November, Israel dropped an estimated 40,000 tons of explosives on Gaza.

December

In the first hours following the end of the temporary truce between Israel and Hamas, 109 people were killed by Israeli airstrikes. On 2 December, the IDF stated it had struck at least 400 locations in Gaza since the pause had ended, including 50 in Khan Younis in southern Gaza. On 3 December, the Palestinian Civil Defence stated the situation "beyond dire" as the organization was unable to rescue many people buried under rubble. The same day, 700 were reported killed in the preceding twenty-four hours.

Displacement

Main article: 2023 Gaza Strip evacuations

The line in black represents the IDF's boundary at Wadi Gaza for evacuation of the northern Gaza Strip

On 10 October, the United Nations said the fighting had displaced more than 423,000 Palestinians, while Israeli airstrikes had destroyed 1,000 homes and rendered 560 housing units uninhabitable. By 15 October, an estimated 1 million people in Gaza had been displaced, many of them fleeing northern Gaza following Israel's mandated evacuation. Due to continued heavy Israeli bombing in south Gaza, some northern Gazan refugees moved back to Gaza City. On 19 October, the UN Office for Humanitarian Affairs stated 98,000 houses, or 1 in every 4 homes in Gaza, had been destroyed by Israeli bombardments. On 21 October, the UNRWA stated 500,000 people were sheltering in UN facilities, and conditions had grown "untenable". By the end of October this had grown to over 670,000 people. Many others sheltered in hospitals.

By 22 October, the UN Office for Humanitarian Affairs stated 42% of homes in Gaza had been destroyed. By 23 October, an estimated 1.4 million people in Gaza had been left homeless. On 30 October, the Red Cross stated it would take years to rebuild destroyed homes and infrastructure. On 2 November, UNRWA stated 50 of its buildings and assets had been affected by Israeli strikes, including four shelters. On 6 November, Al Jazeera journalist Hani Mahmoud described southern Gaza as a large concentration camp. As the fighting in Gaza City intensified, the IDF announced a daily four-hour window for residents to move south, leading to thousands fleeing the city. On 10 November, an Israeli spokesman stated 100,000 people had fled northern Gaza in the prior two days. On 11 November, UNICEF stated thousands of children remained in northern Gaza, whose lives were "hanging on by a thread."

On 12 November, CARE International stated, "The journey to the south is incredibly dangerous and hard. Many of those who have made it out have experienced and witnessed terrible suffering." On 14 November, Human Rights Watch stated, "There is no reliably safe route to evacuate. Satellite imagery confirms fires, military operations, and roadblocks on every conceivable route." By 20 November, satellite imagery showed half of northern Gaza had been destroyed by Israeli airstrikes. The Financial Times described northern Gaza as a "bombed-out wasteland." Palestinians feared northern Gaza was becoming uninhabitable. By 28 November, the UN estimated 60 percent of all housing in Gaza had been destroyed.

On 1 December, Israel labelled Khan Younis a "dangerous combat zone." It issued a map of numbered zones, dividing the Gaza Strip into hundreds of different districts. It also issued an evacuation order in southern Gaza for residents to move to Rafah. At the same time it issued the evacuation, Israel bombed Rafah.

Communications

See also: Communications in the State of Palestine

On 27 October, Gaza underwent a near total communications blackout after Paltel's communication towers were destroyed in an Israeli attack. This cut off Gaza from any phone or internet service. As a result, humanitarian groups, including UNICEF, WHO, the Palestine Red Crescent Society, Doctors Without Borders, American Friends Service Committee, Medical Aid for Palestinians, and ActionAid lost all contact with their staff. The Palestinian Red Crescent Society stated wounded people would no longer be able to dial Gaza's emergency number for an ambulance. The Red Crescent stated it was "deeply concerned" about the ability of medics to provide care, stating it had lost all contact with operations room and staff in Gaza. On 28 October, Elon Musk offered to provide humanitarian groups with Starlink access, but Shlomo Karhi stated Israel would fight it with every "means at its disposal."

The UN Assistant Secretary-General and Humanitarian Coordinator in the Occupied Palestinian Territory, Lynn Hastings, stated that hospitals and aid operations could not operate without phone lines or internet. The Committee to Protect Journalists warned the world was "losing a window into the reality" of the situation in Gaza. Michael Lynk, a former UN rapporteur, stated one purpose of the internet blackout was to keep "the world blinded on what's happening." The WHO secretary-general Tedros Ghebreyesus stated he was "gravely concerned" by the blackout for the "immediate health risks" it posed to patients and for the safety of WHO staff. In a post on X, ActionAid wrote the blackout would make it "nearly impossible" for people to seek help, and stated they were "gravely concerned" for "all the people of Gaza."

Marwa Fatafta, policy manager of Access Now, stated that "taking Gaza completely off the grid while launching an unprecedented bombardment campaign only means something atrocious is about to happen." On 28 October, Netblocks stated Gaza's telephone and internet communications were gradually returning. On 31 October, Fatafta stated the blackout had been used by Israel to cover up potential war crimes as they began their ground invasion and called it a "warfare tactic to induce more pain on the population." Paltel announced Gaza had again been cut off from telecommunications and internet service. On 5 November, internet and telecoms were cut for a third time. Some residents used eSIMs to stay connected to mobile networks. On 16 November, communications in Gaza were cut off for a fourth time. The following day, communications were restored after a limited quantity of fuel was allowed to enter the Gaza Strip. On 27 November, Shlomo Karhi stated Musk had agreed not to operate Starlink in Gaza without Israeli approval.

Humanitarian aid

Main article: 2023 Israeli blockade of the Gaza Strip

Initial block on aid

The amount of aid coming in is a drop in the bucket of Gaza’s humanitarian needs. Before this conflict, about 100 trucks of aid alone entered Gaza [a day]. So imagine now, with all the hostilities going on, if only this number is coming in.

— Mey al Sayegh, (Red Cross)

On 9 October, Israel implemented a complete blockade on Gaza, preventing the entry of any humanitarian aid. Egypt closed its border to prevent civilians fleeing, but said that it would allow aid to be delivered through the Rafah crossing. A week later, despite international calls for deliveries, hundreds of tons of aid were stuck on Egypt's side of the border, as Israel bombarded the crossing amid fears of weapons deliveries, and declined to assure Egyptian authorities it would pause airstrikes for civilian aid convoys. In Israel, aid to Gaza was reportedly prevented by far-right politicians allied with Netanyahu. On 17 October, the UNRWA stated that there was currently "no water or electricity in Gaza. Soon there will be no food or medicine either".

Deliveries to southern Gaza

On 18 October, Israel announced it would allow food, water, and medicine to be delivered to a "safe zone" in west Khan Younis in southern Gaza, distributed by the United Nations. Later the same day, US president Joe Biden announced Egypt agreed to allow 20 trucks with aid to enter Gaza by 20 October. More than 100 trucks of aid were waiting at the Rafah crossing to enter into Gaza. In a statement, Human Rights Watch stated that without electricity or fuel, however, the provided aid would fail "meeting the needs of Gaza's population". On 19 October, US Special Envoy David M. Satterfield stated the US wanted "sustained" aid into Gaza. The same day, a spokesman for Oxfam stated aid distribution in Gaza would be a "big challenge", and the UN reported at least 100 trucks a day of aid were needed. On 21 October 20 trucks of aid entered Gaza. António Guterres stated it was not enough to prevent an "humanitarian catastrophe". Martin Griffiths said the UN was working to develop an "at-scale operation". On 22 October, following the second delivery of trucks, Biden and Netanyahu stated aid would continue to be allowed into Gaza.

Issues with delivery

On 27 October, Lynn Hastings, the UN's humanitarian coordinator for Palestine, stated Israel opposed the delivery of humanitarian aid to northern Gaza. As a result, UN staff would need to risk their own lives if it was determined such aid would be "lifesaving" to people in need. Philippe Lazzarini stated "soon many more will die" from Israel's blockade.

When asked about Hamas's responsibility for the safety of civilians, Hamas leader Mousa Abu Marzook allegedly replied that "it is the responsibility of the United Nations to protect them... [and] it is the responsibility of the occupation to provide them with... services". On 28 October, The New York Times reported that Hamas had stockpiled food, water, medicine and sanitary products in underground caches, in amounts that would allow it to continue fighting for several months without resupply. On 12 November, Kan 11 aired a video taken by a Gazan civilian, that appeared to show Hamas policemen beating civilians approaching a truck carrying humanitarian aid for food, before allegedly taking the supplies for themselves.

Egyptian Foreign Minister Sameh Shoukry stated "Israeli obstacles" were impeding the delivery of humanitarian aid. The United Nations announced the communications blackout had brought aid delivery to a "complete halt." On 29 October, a humanitarian zone was announced in the Khan Younis area, along with a claim that aid trucks would increase "significantly." On 30 October, OCHA director Lisa Doughten pressured the UN Security Council for the use of extra entry points to Gaza, suggesting the Kerem Shalom border crossing as the only entry equipped for rapidly processing a sufficiently large number of trucks. On 13 November, the United Nations announced it no longer had enough fuel to deliver humanitarian aid in Gaza, leading Canadian Foreign Minister Melanie Joly to say, "This is not acceptable." On 17 November, the UN suspended aid delivery again due to the shortage of fuel and the cutoff of communications.

Delivery during temporary ceasefire

The amount of aid entering Gaza increased during the temporary November ceasefire. On 26 November, the largest shipment of humanitarian aid reached northern Gaza since the start of the conflict nearly two months before. Philippe Lazzarini stated the aid entering Gaza was still inadequate. Samer AbdelJaber, a World Food Programme head, stated people were hungry and desperate. On 28 November, the White House reported that over 2,000 trucks of aid had entered Gaza since 21 October.

Resumption of hostilities

Following the resumption of hostilities on 1 December, aid deliveries into Gaza ceased. The IDF informed the Palestinian Red Crescent that the entry of trucks was "prohibited, starting from today" until further notice. Later the same day, the United States announced they had requested a reversal of the decision, and Israel stated it was prepared to allow aid at pre-pause levels.

Impact on children

Further information: Children in the Israeli–Palestinian conflict § Effects on children

Children were disproportionately impacted by Israel's attack on Gaza. On 13 November, UNICEF stated more than 700,000 children in Gaza were displaced. The Palestine Red Crescent Society stated displaced children were suffering, due to power outages, lack of basic essentials, and "scenes of pain and fear." Catherine M. Russell, the executive director of UNICEF, toured Gaza on 15 November, stating many children were buried under rubble and lacking medical care. Dr. Ahmed al-Fara, the head of pediatrics at Nasser Medical Complex in Khan Younis, stated due to the lack of clean water, he was witnessing the "most serious epidemic of gastroenteritis" among children he had ever seen. UNICEF spokesperson Toby Fricker stated, "There is no safe place for children anywhere across the strip right now." Save the Children reported serious signs of mental health issues among children in Gaza.

On 22 November, UNICEF reported unaccompanied children had been identified evacuating from northern to southern Gaza by themselves. On 28 November, James Elder, a UNICEF spokesperson, stated wounded children were sheltering outdoors in car parks and gardens. Elder called the conflict in Gaza a "war on children." Doctors warned children who survived Israeli airstrikes were left with permanent disabilities and trauma. Aid workers coined the term WCNSF, meaning Wounded Child No Surviving Family. The bodies of some children buried under rubble remained unrecovered. By 3 December, an estimated 6,150 children had been killed in the conflict.

An estimated 150 babies were born in Gaza per day since the start of the conflict. Newborn babies receiving specialized care in the West Bank were separated from their mothers who were trapped in Gaza.

Premature babies

Premature babies at Al-Shifa.

The plight of Gaza's premature babies gained global attention. Starting on 21 October, Medical Aid for Palestinians and UNICEF issued an "urgent warning" that 130 premature babies would die if fuel did not reach Gaza hospitals soon. On 23 October, officials in Gaza confirmed that that due to the Israeli siege on fuel, when hospitals lost electricity, premature babies in NICUs were at risk of death. On 11 November, IDF spokesman Daniel Hagari stated the army would help evacuate babies from al-Shifa Hospital, but a Gaza Health Ministry spokesman stated Israel had not provided "any mechanism to get the babies out to a safer hospital." The same day, Physicians for Human Rights stated two premature babies had died due to the loss of electricity. Two additional babies died soon after.

On 15 November, Israel launched a raid on al-Shifa Hospital, where three dozen premature babies were still sheltering. The director of Al-Shifa stated Israel's claim to provide incubators to premature babies was false. On 19 November, 31 premature babies at al-Shifa were evacuated by the Palestinian Red Crescent, WHO, and UNOCHA to southern Gaza. They were planned to be moved to Egypt with their families the following day. On 20 November, 28 of the babies were evacuated to Egypt. Only eight were accompanied by their parents, as the others were orphans, or their parents were unable to leave Gaza.

On 10 November, Doctors Without Borders reported that evacuating medical workers at Al-Nasr Children’s Hospital had to leave babies in incubators after the IDF bombed the pediatric hospital. On 29 November, video footage from Al-Nasr showed the aftermath of the hospital's evacuation, with the five premature babies dead still in their incubators. These were in addition to the five babies total who died at al-Shifa. The Euro-Mediterranean Human Rights Monitor confirmed the Al-Nasr infants' deaths. They stated the IDF had indicated to hospital staff they would evacuate the babies, though the IDF denied any involvement. In a recording of a phone call between COGAT and a medical official, the IDF official confirmed ambulances would retrieve patients from al-Nasr. The Red Cross stated they were "devastated" by the footage and denied they were responsible for their abandonment.

Reactions

UNRWA commissioner Philippe Lazzarini described the situation as "bone-chilling," and the World Health Organization stated that it was "spiraling out of control." On October 26, the World Organization declared that Gaza's humanitarian and health crisis had "reached catastrophic proportions." Martin Griffiths, the United Nations head of Humanitarian Affairs, stated the humanitarian crisis in Gaza was the worst he had ever seen in his life, stating, "I don’t say that lightly. I mean, I started off in my 20s dealing with the Khmer Rouge, and you remember how bad that was, the killing fields." A Doctors Without Borders video shared by Amnesty International head Agnès Callamard stated, "This brutal annihilation of an entire populations health system stretches beyond what humanitarian aid can fix." On 28 November, UN chief António Guterres stated, the "humanitarian catastrophe in Gaza is getting worse by the day." On 3 December, WHO secretary-general Tedros Adhanom Ghebreyesus visited Nasser Medical Complex, stating, "Patients were receiving care on the floor, screaming in pain... I cannot find words strong enough to express our concern over what we’re witnessing."

Support

Israeli Major General (ret.) Giora Eiland compared Israel's situation to that of the United States after Pearl Harbor. He argued that if Israel wanted to disarm Hamas, it had "no choice" but to make Gaza a place "that is temporarily or permanently impossible to live in". This, he stated, was not a "program for revenge," but a way to get the hostages back. In an op-ed in Yedioth Ahronoth on 19 November, Eiland wrote Israel should not adopt a US narrative that "allows" Israel to only fight against militants. Writing for Haaretz, Zvi Bar'el argued the humanitarian crisis was an Israeli military weapon that could be used as a bargaining chip.

The United States UN representative Linda Thomas-Greenfield vetoed a UN Security Council resolution that would have urged humanitarian aid to Gaza. In a Wall Street Journal op-ed, conservative American commentator Daniel Henninger speculated Hamas wanted to create a humanitarian crisis for publicity purposes.

Resolution efforts

In a call on 20 November, Chinese President Xi Jinping and French President Emmanuel Macron discussed measures to avoid the humanitarian crisis from getting worse. In Riyadh, Saudi Arabia on November 11, 2023, the Organisation of Islamic Cooperation and the Arab League held an emergency meeting on the Gaza humanitarian crisis created by the war.

Refugees

At the beginning of the war, Egypt announced it was closing the Rafah Crossing to Gaza, one of only three exit points along the Gaza border. Egypt cited fears about permanent displacement and a possible refugee crisis, particularly if Israel refused to allow the refugees back into Gaza after the war. Israeli PM Benjamin Netanyahu sought to convince Egypt to accept Gazan refugees.

Jordan also expressed reluctance to receive Palestinian refugees. King Abdullah II of Jordan warned Israel against pushing Palestinians into Jordan, emphasizing the need to address the humanitarian situation within both Gaza and the West Bank.

In Europe, Humza Yousaf, the First Minister of Scotland, urged the international community to establish a refugee program for Gaza. Yousaf stated Scotland was ready to offer sanctuary to refugees, and called on the UK to create a resettlement scheme. Foreign Minister Hanke Bruins Slot stated the Netherlands was discussing the possibility of accepting sick and wounded Palestinian children into the country.

In the United States, left-wing politicians, including Representatives Alexandria Ocasio-Cortez and Jamaal Bowman, emphasized the US's historical role accepting refugees and called for the acceptance of Gazan refugees. Right-wing politicians, such as former-President Donald Trump and Governor Ron DeSantis, both argued for barring admittance of any refugees from Gaza. President Joe Biden did not announce any plans to admit refugees, but stated $100 million in aid would be given to Gaza.

See also

• 2023 Israeli blockade of the Gaza Strip
• Casualties of the 2023 Israel–Hamas war
• International aid to Palestinians
• Refugee camp airstrikes in the 2023 Israel–Hamas war
• War crimes in the 2023 Israel–Hamas war

External links

• Media related to Humanitarian crises of the 2023 Israel–Hamas war at Wikimedia Commons
• "Gaza: Unlawful Israeli Hospital Strikes Worsen Health Crisis", per Human Rights Watch (11 November 2023)
• "Analysis: How bad is the humanitarian crisis in Gaza amid the Israel-Hamas war?", per PBS (19 November 2023)
• UN relief chief: 'Intolerable' humanitarian situation in Gaza cannot continue, per UNOCHA (17 November 2023)