“What I saw today was shocking. It is unacceptable to see so many wounded people. Their lives must be spared and the security of those who care for them guaranteed.”
- Jakob Kellenberger, President of the ICRC, during a visit to the Gaza Strip on 13 January
The Israeli military operation has entered its nineteenth day. Israeli air, sea and ground forces continue to surround populated areas of the Gaza Strip, and the Gaza and North Gaza Governorates remain isolated from the rest of the territory. The humanitarian crisis is intensifying and the number of Palestinian civilian casualties is increasing. Israeli bombardment is causing extensive destruction to homes and to public infrastructure throughout the Gaza Strip and is jeopardizing water, sanitation and medical services. Although movement remains extremely dangerous, Palestinians continue to flee their homes seeking refuge from the hostilities. Medical staff report large numbers of blast injuries due to high explosives, resulting in traumatic injuries and amputations.
Children, who make up 56 percent of the Gaza population, continue to bear the brunt of the violence and account for a significant proportion of the dead and severely maimed. On 13 January, the United Nations Committee on the Rights of the Child emphasized ‘that all parties must ensure the protection of children during the conflict and abide by the relevant provisions of international law in this respect.’
PROTECTION OF CIVILIANS
The Israeli military remains present in the north, east and Rafah border areas. Aerial bombardment, artillery shelling and naval firing continued into 14 January, with Israeli ground troops advancing into populated areas on the outskirts of Gaza City. Pockets of the population are trapped in their homes with aid organizations unable to access these communities.
Today, during the humanitarian “lull”, rescue workers succeeded in recovering some of the bodies which had been previously inaccessible. Palestinian Ministry of Health (MoH) figures as of 1600 hours 14 January are 1,013 Palestinians dead, of whom 322 are children and 76 are women. The number of injured stands at 4,560, of whom 1,600 are children and 678 are women. The MoH reported on 12 January that the number of children fatalities has tripled since the beginning of the ground operation on 3 January (compared to the number of child fatalities from 27 December to 3 January). The danger to medical staff and the difficulty of extracting the injured from collapsed buildings makes proper evacuation and estimation of casualties difficult, including the determination of the number of Palestinian male civilian casualties.
Nine Israeli soldiers have been killed since 27 December. Palestinian militants continue to fire rockets and mortars from the Gaza Strip into Israel. According to the Israeli Police Spokesman, Israeli civilian casualties stand at four dead and 58 injured as of 12 January. (OCHA’s casualty figures do not include the number of Palestinians or Israelis treated for shock.)
The total number of displaced people in Gaza remains unknown, because the majority of them have sought refuge in the homes of relatives and friends, including an estimated 20,000 people who reportedly left their homes in Rafah on 8 January. As of 13 January, UNRWA was operating 41 shelters with 37,937 people (an increase of more than 3,000 from 13 January). Following heavy bombardment during the night of 13 January in northern Gaza, there are reports that many people fled on foot to shelters in Jabalia (3km) and Gaza (5km).
UNRWA has supplied all shelters with bread, tinned food, and drinking water, with the exception of the Khalil Uweida shelter north of Jabalia which UNRWA did not obtain approval to access on 13 January. UNRWA shelters continue to have insufficient quantities of non-food items (NFIs), with a current shortage of more than 21,000 mattresses and 19,000 blankets. (See map for updated locations of shelters.)
Several organisations, including Islamic Relief, MAP-UK and CARE have distributed NFIs to families hosting displaced persons.
SAFETY OF MEDICAL PERSONNEL
Security for medical personnel and access to medical facilities continues to be of major concern. Attacks on medical personnel and ambulances have hampered the ability to assist the injured. According to the Ministry of Health (MoH), since 27 December 2008, 13 medical personnel have been killed and 22 medical personnel have been injured while on duty; 15 ambulances have been damaged and seven ambulances have been destroyed; and twelve health facilities have been damaged through direct or indirect shelling.
On 13 January, an ambulance from Nasser Hospital, attempting to reach a wounded woman in Khuza’a village east of Khan Yunis, was fired at. The paramedic was forced to take refuge in a nearby house until the evening when the Israeli army withdrew. By the time the ambulance succeeded in evacuating the woman to the hospital, she had died.
WHO reports that the Dorah Pediatric Hospital, on the outskirts of Gaza City, was shelled for the second time on 13 January. Dorah Hospital has been closed since 8 January except for emergency services due to its proximity to fighting and damage sustained to its infrastructure. Israeli shelling and air strikes resulted in damage to an ambulance in Rafah as well as damage to the UNRWA Al Amal Health Centre and the Al Amal Co-ed School in Khan Yunis.
Hospitals remain overloaded, notably intensive care units, due to the large influx of injured persons. In addition to the issue of access of medical personnel to war injured, WHO remains concerned about the provision of health care services for the entire population. As of 13 January, 35 out of the 58 MoH primary health care (PHC) centres are functioning, though with major interruptions due to recurring power cuts and 30 percent staff attendance, according to WHO. In the two northern governorates, the majority of health centres are closed due to the fighting; the majority of centres are open in Rafah, Khan Younis and the Middle Area. The ten PHC centres that have been converted into emergency centres continue to function. All but three UNRWA health centres were open on 13 January.
Although a large quantity of medicines has been supplied by various donors and organizations, the main challenge remains the organization and distribution of these items to hospitals. Currently, it is not clear what medicines and equipment are needed.
All health care facilities are now receiving eight to twelve hours of electricity supply. MoH hospitals and the central drug store have on average 40-50 percent of their storage capacity of fuel. UNRWA and WHO are working to ensure that hospitals are receiving enough fuel supplies.
According to WHO, approximately 250 patients have been evacuated through Rafah crossing since 27 December, the majority being war injuries in addition to some chronic cases. Evacuation of the wounded and the referral of chronic patients is still a high priority.
WATER AND SANITATION
The CMWU, Gaza’s water utility, has not received approval for safe passage to repair damage to the water and waste water networks. Approximately 500,000 Palestinians in the Gaza Strip still do not have access to running water and sewage continues to flow in the streets in Beit Hanoun and Beit Lahiya. On 13 January, CMWU received four truckloads of spare parts from the Palestinian Water Authority in the West Bank.
A key challenge for the Gaza population is accessing food items due to the security situation, both for farmers to access their fields and for the population to access shops. The lack of banknotes means the population is unable to pay for the limited food stocks on the markets. On 13 January, UNRWA provided food parcels to 2,156 families. 2,276 staff received flour at the specialised distribution centres. WFP distributed 61 metric tonnes of food to about 1,000 families in Gaza City through its partner CHF.
ELECTRICITY / FUEL
Although power supply has increased as a result of repairs and the partial operation of the Gaza Power Plant, most households still do not have electricity due to damage in the electricity networks (e.g. local power lines).
On 13 January, UNRWA provided 6,000 litres of diesel to the Naser Pediatric and Psychiatric hospitals; 70,000 litres of diesel to Jawwal (mobile phone company) to maintain the network; 12,530 litres to the Gaza and Jabalia municipalities to support solid waste collection and rubble clearing operations; and 10,000 litres to ICRC for their operations.
There are currently restrictions on the regular transfer of currency between the Palestinian banks in the West Bank and their counterparts in Gaza. These restrictions have prevented the Palestinian Authority in the West Bank from paying critical salaries and benefits to PA civil servants, and the banks from operating. Further, it has prevented UNRWA from paying salaries to its staff in Gaza as well as to continue implementation of its cash assistance programme for the most destitute in Gaza (94,000 beneficiaries).
ACCESS WITHIN THE GAZA STRIP
Access between northern Gaza and the rest of Gaza remains possible only via the coastal road west of the former Israeli settlement of Netzarim and is restricted to humanitarian relief assistance (including ambulances) following coordination with the Israeli authorities.
On 14 January, the humanitarian “lull” was activated between 1300 and 1600 hours.
Only Kerem Shalom and Rafah crossings were open on 14 January.
On 13 January, the Kerem Shalom and Rafah crossings were open. A total of 94 truckloads including 46 for aid agencies were allowed entry to Gaza through Kerem Shalom crossing during the day. Also, nearly 200,000 litres of industrial gas were allowed into Gaza through Kerem Shalom. At Rafah crossing, 21 medical cases were allowed to cross out. Ten truckloads of medical and relief supplies, 17 doctors, seven ambulances and six Palestinians were allowed to cross in.
In December 2005, prior to PLC elections, an average of 631 trucks was entering Gaza on a daily basis. In May 2007, prior to the Hamas takeover of Gaza, the figure dropped to 475 trucks daily and further still in November 2008 to 23 trucks daily. Since 27 December 2008, Kerem Shalom has a daily average of 73 trucks entering Gaza.
For the Initial Response Plan and list of immediate funding needs, visit:
Protection of civilians: Civilians, notably children who form 56 percent of Gaza’s population, are bearing the brunt of the violence. As one of the most densely populated places in the world, more civilians risk being killed or injured if the conflict continues. The parties to conflict must respect the norms of International Humanitarian Law (IHL), in particular the principles of distinction and proportionality.
Access for ambulance and rescue teams: An unknown number of dead, injured and trapped people remain in houses which have been shelled and in areas where hostilities are ongoing. Due to attacks on ambulances, medical staff are fearful of reaching these places. The evacuation of wounded and safe passage of ambulances and health workers are fundamental tenants of IHL, and should be facilitated at all times. This includes the safe passage for evacuation of injured through Rafah crossing.
Opening of crossings: The number of trucks allowed into the Gaza Strip needs to be increased. Additional crossings must be opened urgently, including Karni for the provision of bulk grain.
Mains electricity is vital for the operation of services within the Gaza Strip notably health, water and sanitation services. Back-up generators are not meant to function more than 8 hours per day, and are not reliable following repeated and prolonged use. Although efforts have been made to repair damaged electricity lines, bring in needed transformers, and allow fixing of other transformers, much more needs to be done.
Supply of fuel: Industrial fuel is needed to power the Gaza Power Plant, which had been shut since 30 December but partially re-opened on 10 January. Nahal Oz crossing must remain open as it is the only crossing which can facilitate the transfer of sufficient amounts of fuel to restart and maintain operations of the power plant, and restock other types of fuel needed in the Strip. Delivery of fuel to its intended destination must be facilitated.
Cash/liquidity: The issue of cash remains of high priority. Cash has still not entered the Gaza Strip and is urgently needed. A system must be established that ensures the regular and predictable monthly transfer of the necessary cash - not only for the international organisations to be able to deliver much needed humanitarian assistance, but also in order to pay the salaries of PA personnel. Without a functioning bank system in Gaza, recovery efforts will be vastly undermined.