Gaza Humanitarian Crisis (2023–present)

The Gaza Strip is experiencing a humanitarian crisis as a result of the Israel–Hamas war. The crisis includes both a famine and a healthcare collapse. 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. By mid-November, Israel had dropped the equivalent of two nuclear bombs on Gaza. The Gaza Health Ministry 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

Famine

The situation in the Gaza Strip reached dire levels of starvation and food insecurity by late 2023 and early 2024. Reports from various sources including the World Food Programme and United Nations officials highlighted a devastating situation where food stocks were nearly exhausted, bakeries were being destroyed by Israeli airstrikes, and access to basic food supplies became increasingly scarce. By November, queues of hundreds of people for bread became common, signaling a deepening crisis.

As the conflict persisted, the Gaza Strip witnessed a worsening famine, with reports indicating that begging for food became commonplace and hunger became pervasive among the population. By December, international aid organizations and relief workers sounded alarms of mass starvation, with the majority of households facing inadequate food consumption and a significant portion resorting to extreme measures to survive. Human Rights Watch accused Israel of using starvation as a method of warfare in the occupied territory, further exacerbating the humanitarian catastrophe.

By early 2024, the Gaza Strip faced one of the worst instances of man-made starvation in a century. The chief economist at the World Food Programme noted that the vast majority of people experiencing famine or catastrophic hunger worldwide were concentrated in Gaza, emphasizing the severity of the crisis. Food prices rose in Gaza as food stock ran out. With limited aid entering the region and skyrocketing food prices, the population continued to suffer, with children particularly vulnerable to malnutrition and dehydration. The international community expressed grave concerns, acknowledging the pervasive shadow of starvation looming over the people of Gaza and underscoring the urgent need for immediate humanitarian intervention to avert further tragedy.

Water supply

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. The FT notes, "Israel said on Sunday it had reopened some water lines into Gaza, but the supplies cannot be pumped without fuel, which is running out after Israel blocked supplies into the strip". 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. Doctors Without Borders stated on 18 December the water system in Gaza had collapsed. UNICEF reported children in southern Gaza were receiving 1.5 liters of water a day, while the minimum amount for survival is 3 liters per day.

As of December 6, the sole water desalination facility in northern Gaza was inoperative, while the pipeline that delivers water from Israel to the north remained shut, thereby heightening the likelihood of dehydration and waterborne illnesses due to the consumption of unsafe water sources. The impact on hospitals has been severe, as only one out of the 24 hospitals in northern Gaza is operational and capable of accepting new patients, albeit with limited services, as of December 14.

On 13 December, Israel began pumping seawater into tunnels reportedly used by Hamas. Experts warned this would irreversibly damage Gaza's water aquifers and clearwater supply. The IDF acknowledged it was flooding the tunnels on 30 January. In January 2024, the Israeli army destroyed Gaza City’s main reservoirs, Al-Balad and Al-Rimal. The director of ambulance and emergency centres for Gaza stated on 20 January that the "struggle for water is a daily torment". The UNOCHA director for Gaza stated, "We can only meet a third of the population’s need for clean drinking water."

In February 2024, Palestinians in Gaza City were killed by an Israeli airstrike while collecting water. On 11 February 2024, the municipality of Gaza reported 700 million liters of wastewater had leaked into the streets of Gaza City, threatening underground water reserves. On 28 February, the UN reported that up to one-fourth of Gaza's water wells had been destroyed. The Food and Agriculture Organization stated water was at 7 percent of pre-October levels.

Disease

Physical health and disease

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 diseases".

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. The UN reported disease outbreaks in southern Gaza shelters. Volker Türk warned of unsanitary conditions amidst mass displacement in southern Gaza. On 7 December, the World Health Organization reported increases in acute respiratory infections, scabies, jaundice, and diarrhea. On 13 December, 360,000 cases of infectious diseases were reported in shelters. On 20 December, WHO reported Gaza was experiencing "soaring rates of infectious disease outbreaks".

On 29 December, WHO chief Tedros Adhanom Ghebreyesus reported 180,000 cases of upper respiratory infections, 136,400 cases of diarrhoea, 55,400 cases of lice and scabies, 5,330 cases of chickenpox, 42,700 cases of skin rash, and 4,722 cases of impetigo. Flooding in Gaza spread sewage water, raising fears of the spread of disease. On 19 January, Yahya Al-Sarraj, the mayor of Gaza City, stated more than 50,000 tons of trash had accumulated in the city, further leading to the spread of disease. Parents reported children falling sick after being exposed to raw sewage.

In his address to the UN Security Council on 31 January 2024, Martin Griffiths, the UN under-secretary general for humanitarian affairs and emergency relief coordination, provided a comprehensive overview of the challenges currently confronting numerous individuals in Gaza. According to our latest estimates, approximately 75 percent of the entire population has been displaced. The living conditions they endure are deplorable and deteriorating with each passing day. The makeshift tent camps, established by refugees and displaced people, are being inundated by heavy rains, compelling children, parents, and the elderly to seek shelter in the mud. The issue of food insecurity continues to escalate, while access to clean water remains almost entirely unattainable. Given the limited availability of public health support, preventable diseases are rampant and will persistently propagate. On 4 March, the Gaza Health Ministry stated they had recorded about one million cases of infectious diseases.

Psychological health

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. On 9 January 2024, OCHA reported 485,000 people with mental health issues were experiencing care disruption. In March 2024, a U.S. doctor stated it appeared the Israeli military "purposely bomb by night for the psychological effect on people".

Healthcare

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.
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* 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".

By 5 January 2024, the World Health Organization reported there had been 304 attacks on healthcare facilities in Gaza since 7 October, with 606 deaths. On 24 January, WHO stated seven out of 24 hospitals remained partially operational in Northern Gaza, and seven out of 12 in Southern Gaza. On 26 January, a senior OHCHR official stated, "I fear that many more civilians will die. The continued attacks on specially protected facilities, such as hospitals, will kill civilians". The same day, a Doctors Without Borders coordinator stated, "There is no longer a healthcare system in Gaza." A senior technical adviser with the International Rescue Committee stated, "There’s nothing that could have prepared me for the horrors that I saw."

Supplies shortages

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. The Al-Aqsa Martyrs Hospital faced a dialysis crisis, with hundreds sharing only 24 dialysis machines. WHO announced it could no longer resupply al-Shifa and al-Quds hospitals due to the high levels of risk. 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.

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. On 4 November, the generators at Kamal Adwan Hospital shut down. As of 5 November, 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 supplies.

On 8 November, Al-Quds completely ran out of fuel and shut down most services. The Ministry of Health stated Israel cut off Indonesia Hospital's electricity, water, and communication. On 13 November, Kamal Adwan Hospital ran out of fuel. The al-Amal Hospital's only generator shut down.

On 6 December, Doctors Without Borders stated fuel and medical supplies at al-Aqsa hospital were critically low. Doctors at Nasser Medical Complex in Khan Younis described a lack of supplies and barely any medical functionality.

From 11 October 2023 onwards, the Gaza Strip has experienced a complete lack of electricity due to the Israeli authorities discontinuing the power supply and depleting the fuel reserves for Gaza's only power plant. The United Nations has observed that this ongoing blackout, along with the shutdown of communications and industrial fuel, is greatly impeding the aid community's ability to assess and effectively address the worsening humanitarian crisis;

Attacks and destruction

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 17 October, a widely condemned explosion in the al-Ahli courtyard resulted in significant fatalities.

On 30 October, the Turkish-Palestinian Friendship Hospital was severely damaged by an Israeli airstrike. The Gaza Health Ministry stated the maternity ward at the Al-Helou International Hospital was hit by an Israeli bombardment.

Al-Quds and Indonesia Hospital were both also hit by strikes. The entrance of the al-Nasser Children's Hospital was hit by an Israeli strike. On 9 November, the Gaza government media office stated Israel had bombed eight hospitals in the past three days.

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 Palestinian Red Crescent claimed Israeli snipers opened fire on children at al-Quds hospital, killing one and wounding 28.

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. Four doctors were reported killed after Israel bombed al-Awda Hospital on 22 November. The Kamal Adwan hospital stated Israeli bombings increased around the hospital. Two Red Crescent paramedics were wounded by gunfire from the Israeli military.

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. Doctors Without Borders stated al-Awda hospital had been damaged in an Israeli bombing. On 9 December, WHO stated two health staff had been shot and killed by the IDF at Al Awda Hospital, besieged since 5 December. The director of the European Hospital stated its paramedics had been wounded in Israeli airstrikes. On 11 December, MSF stated one of its doctors inside Al Awda Hospital had been injured by an Israeli sniper.

By 18 January 2024, none of Gaza's hospitals remained fully operational. On 19 January 2024, the Jordanian government reported that the Israeli military had deliberately targeted its new field hospital in Khan Younis, using a tank to block the hospital entrance and shooting at the hospital and bunker shelters. On 24 January, the World Health Organization stated it had recorded a total of 660 Israeli attacks on healthcare facilities.

According to United Nations Secretary-General António Guterres, the hostilities in Gaza and Israel have “created appalling human suffering, physical destruction and collective trauma across Israel and the Occupied Palestinian Territory”.

Al-Shifa Hospital

In early November, Al-Shifa Hospital in Gaza experienced a surge in Israeli attacks, with the facility being bombed five times in 24 hours. An Israeli drone missile destroyed a medical convoy in front of the hospital, and on November 6, Israel targeted the hospital's solar panels. Doctors Without Borders reported a dramatic intensification of Israeli attacks on November 11, leading to power loss, sniper killings of staff, and the hospital being shelled and catching fire. Families attempting to leave the complex were reportedly shot and killed.

Physicians for Human Rights documented the deaths of two premature babies at Al-Shifa due to electricity shortages. IDF spokesperson Daniel Hagari pledged assistance in evacuating babies, but the Gaza Health Ministry asserted a lack of provided mechanisms. On November 12, the hospital's director-general stated that 650 patients at Al-Shifa were in danger due to the catastrophic situation, including the destruction of the cardiac ward.

Doctors Without Borders reported dire conditions at Al-Shifa Hospital, citing a lack of essentials like food, water, and electricity, with reports of a sniper targeting patients. Israel's raid on the hospital on 15 November was described as an unimaginable nightmare. Witnesses stated that Israel did not provide aid or supplies. The hospital faced challenges, including decomposing bodies and maggot-infested wounds, due to a lack of essential resources.

Amid deteriorating conditions, an evacuation of Al-Shifa began on November 18. Ismail al-Thawabta, a Palestinian media office spokesperson, asserted that patients moved to other facilities faced a perilous fate. ActionAid characterized the evacuation as a death sentence. Concerns were raised about the adequacy of aid. The World Health Organization and the Palestinian Red Crescent participated in evacuation plans, aiming to transfer patients to alternative medical facilities.

The hospital stated six doctors would remain behind with 120 patients too sick to be transferred. 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.

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 22 November, the Palestinian Red Crescent stated fourteen ambulances had arrived at al-Shifa to evacuate the hospital's remaining patients.

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. On 7 December, the Gaza Health Ministry stated only basic first aid was being delivered at Al-Shifa Hospital.

Kamal Adwan Hospital

On 3 December, the IDF bombed the Kamal Adwan hospital, killing at least four people. Attacks in the vicinity of Kamal Adwan hospital were reported on 5 December. The director of Kamal Adwan Hospital stated Israel had killed two mothers and their newborn babies when Israel targeted its maternity ward. The UN confirmed the killings. Israel raided the Kamal Adwan Hospital. In response, Tedros Adhanom Ghebreyesus stated WHO was extremely worried for Kamal Adwan's medical staff.

Al-Aqsa Hospital

Beginning on 6 January, doctors at Shuhada al-Aqsa Hospital reported that Israeli fire was nearing the hospital. Tens of thousands of people were reported to be sheltering at the hospital. British doctor Nick Maynard stated his medical team was forced to evacuate the hospital as Israeli troops attacked the hospital. Medical Aid for Palestinians and the International Rescue Committee both also evacuated their medical teams when the IDF dropped leaflets telling nearby residents they were in a "dangerous combat zone." Following a visit to the hospital, the World Health Organization found 70% of staff and many patients had fled. Doctors reported many patients who were physically unable to move, and that conditions were rapidly deteriorating, with one doctor stating, "A child came in alive, literally burnt to the bone, their hands were contracting. Their face was just charcoal, and they were alive and talking. And we had no morphine."

In an interview with '' NPR'' on 10 January, one American doctor described the situation at Al-Aqsa as the "stuff of nightmares". Tedros Adhanom Ghebreyesus, the World Health Organization chief, stated, "Three months into this conflict, it is inconceivable that this most essential need — the protection of health care — is not assured." Health professionals and doctors warned of the danger of Al-Aqsa's closure since it was the last remaining hospital in the entirety of central Gaza. On 13 January, the hospital ran out of fuel to power its generators, leading to a blackout that threatened patients.

Evacuation challenges

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. 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".

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. 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." The director of the Nasr Hospital stated it had been evacuated under threat of Israeli weapons and tanks. Fighting near Al-Quds Hospital halted evacuation efforts.

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. 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. Hospitals in northern Gaza, including al-Ahli Arab Hospital, were evacuated by the World Health Organization and the Red Cross.

The Health Ministry stated hundreds needed to be evacuated from Gaza to receive medical care. A spokesman for the Gaza crossing authority stated the Rafah crossing remained opened for the evacuation of the sick and wounded. On 7 December, the Palestinian Red Crescent stated 60 percent of the wounded in Gaza required urgent medical treatment abroad. Doctors Without Borders stated on 10 December stated that the Israeli army had forced them to evacuate the Martyrs and Beni Shueila clinics, and that healthcare had completely collapsed.

International aid

The Red Cross stated Gaza's entire health system was "on its knees". Medical Aid for Palestinians and UNICEF issued an "urgent warning" that 130 premature babies would die if fuel did not reach Gaza hospitals soon. 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. The World Health Organization warned 46 of Gaza's 72 healthcare facilities had stopped functioning.

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, named ''Vulcano'' ("Volcano"), 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. By early-December, the medical staff started performing emergency surgical operations for injured Palestinian patients who were either at risk of amputation, or waiting to be moved to the Children Hospital in Doha. On 5 February 2024, it was announced that the ''Vulcano'' had returned to Italy and arrived at the seaport of La Spezia, carrying 60 Palestinian people, 14 of which were children in need of specialized healthcare, although none of them suffered from life-threatening conditions or injuries. All of the children were set to be transferred to various hospitals in Genoa, Rome, Florence, Bologna and Milan.

On 9 November, 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." The Government of Jordan reported Israel had ordered their field hospital to be evacuated and stated they would not comply. Italy and the United Arab Emirates stated they were considering establishing a field hospital in Gaza. A French warship was dispatched as a temporary hospital. On 2 December, Saudi Arabia donated six ambulances to the Palestinian Red Crescent. On 3 December, a UNICEF spokesman described Nasser Hospital as a "death zone."

WHO chief Tedros Adhanom Ghebreyesus stated fighting in southern Gaza was making it increasingly difficult to run health operations. On 10 December, WHO adopted a resolution to protect healthcare in Gaza, which director-general Tedros Adhanom Ghebreyesus described as "almost impossible in the current circumstances." On 12 December, WHO pleaded with the Israeli army not to destroy hospitals in southern Gaza. Doctors Without Borders said healthcare conditions in Gaza were akin to conditions during World War I.

Additional challenges

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." A surgeon at Al-Ahli hospital stated on 18 November they had run out of blood for transfusions.

Doctors in south Gaza reported a lack of beds and supplies. By 8 December, an estimated 286 health workers in Gaza had been killed by Israel. On 4 December, Doctors Without Borders stated hospitals in southern Gaza were overflowing with wounded patients. The Ministry of Health stated 50,000 people had been wounded since the start of the conflict.

The Red Crescent stated al-Quds was completely out of service on 12 November, as Al-Shifa also stopped receiving patients. On 16 November, the Indonesia Hospital completely shut down, leaving 45 patients in need of surgery. UNOCHA stated only four small hospitals in northern Gaza and eight health facilities in southern Gaza were still functioning. 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.

On 9 January, Rik Peeperkorn, the WHO representative for Israel and Palestine, stated, "I’ve never seen so many amputees in my life, including among children. This will have such a long-term impact for everything." On 18 January, the United Nations reported patients were dying even while hospitalized because Gaza's remaining hospitals were overwhelmed with tens of thousands of wounded people.

Airstrikes

October

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

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.*
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* 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.
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* 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.
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* 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 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. Some individuals were rescued by aid workers after reportedly surviving several days buried underneath rubble. Robert Pape stated, "Gaza will also go down as a place name denoting one of history’s heaviest conventional bombing campaigns." On 8 December, 350 people were reportedly killed in the preceding twenty-four hours. On 9 December, the Palestinian Civil Defence stated it only had one operational rescue vehicle left in the entirety of northern Gaza. On 13 December, a UNRWA school in Beit Hanoun was destroyed by an Israeli airstrike. On 14 December, a US intelligence report found half of the bombs dropped on Gaza had been unguided bombs.

A ''Sky News'' analysis found Israel was directly targeting areas that it was telling people to flee to. Experts stated the bombing campaign against Gaza had been the deadliest and most destructive in modern history, with Corey Scher of the CUNY Graduate Center stating, "Gaza is now a different color from space." ''The Wall Street Journal'' described the Israeli bombing in Gaza as the "most devastating urban warfare in the modern record". Torrential rains caused flooding, which raised fears of disease spread.

January

On 5 January 2024, evacuees fleeing Israeli attacks in central Gaza stated the situation there was "hell on Earth." One survivor of an Israeli airstrike wrote, "Even though that air strike did not kill us, it destroyed something inside us." On 12 January, the UN Secretary-General for Human Rights stated that at least 319 internally displaced persons were killed and 1,135 injured by Israeli airstrikes while sheltering in UN shelters.

As of January 2024, Israel’s offensive has either damaged or destroyed 70–80% of all buildings in northern Gaza. Numerous casualties were reported in an airstrike on a residential building near Nasser Medical Complex in Khan Younis, with hospital staff reporting having to bury 40 bodies on the hospital grounds. By 30 January, at least half of all buildings in the entirety of Gaza had been destroyed or damaged.

February

On 2 February 2024, UNOSAT, the UN's satellite centre, found that 69,147 structures, or approximately 30 percent of Gaza's total buildings, had been damaged or destroyed by Israeli airstrikes, shelling, and demolitions. The ''New York Times'' estimated that at least half of Gaza's buildings had been damaged or destroyed. Israeli bombing campaigns intensified in central Gaza, as displaced people in Rafah grew fearful of an impending Israeli attack on the city.

Displacement

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 in northern Gaza 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. The ''Financial Times'' estimated it would cost billions to rebuild Gaza.

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. On 4 December, a UN representative stated "another wave of displacement is underway." The UN stated at least four of its shelters in Khan Younis had received evacuation orders from the Israeli military. By 13 December, half of Gaza's population was in Rafah. On 21 December, a ''Financial Times'' analysis found Israel had left northern Gaza virtually uninhabitable. On 6 January 2024, UN humanitarian chief Martin Griffiths stated that Gaza had "simply become uninhabitable". More than 85% of Palestinians in Gaza, or around 1.9 million people, were internally displaced.

On 8 January, ''Al Jazeera'' reported Palestinians in Gaza were using websites like GoFundMe to fundraise the necessary money to enter Egypt via the Rafah Crossing. UNOCHA reported there were as many 15 people living per tent. On 13 January, the Gaza Health Ministry reported the infrastructure of Rafah was at its breaking point, unable to handle the large number of displaced people who'd fled there. Philippe Lazzarini stated on 17 January, "You have hundreds of thousands of people living now in the street, living in these plastic makeshift tents, sleeping on the concrete." On 24 January, Israel ordered a large area of Khan Younis to evacuate, affecting three hospitals, 24 United Nations shelters, and more than 500,000 people. In February 2024, Gaza's information office stated the IDF was deliberately burning homes.

Communications

Since the start of the war on 7 October, Gaza has undergone numerous communications blackouts, due to Israeli interference, the destruction of telecommunications infrastructure, and the killing of at least sixteen telecommunications technicians.

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” because Hamas will use it for terrorist activities.

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 3 November, the BBC began broadcasting an emergency radio service on mediumwave from Cyprus in attempt to retain communications with Gazan civilians and support infomation-finding such as "where to access shelter, food and water supplies". 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. On 3 December, PalTel reported another communications blackout. On 14 December, Gaza's communication companies reported the sixth communications blackout since the conflict's start.

On 20 December, Paltel, Ooredoo, and Jawwal reported a communications blackout in the Gaza Strip. Wounded people unable to call ambulances due to the blackouts reported biking and taking donkey carts to hospitals, while ambulance drivers stated they simply followed plumes of smoke or the sound of explosions. Telecoms went down on 26 December. On 12 January, the ninth communications blackout occurred, cutting off phone and internet access across the Strip. The following day, Jawwal reported an Israeli drone strike had killed two of their engineers attempting to repair the system, noting they had lost a total of 13 employees so far. The communications blackout was the longest of the war. The tenth blackout occurred on 22 January. In a statement, UNWRA stated, "Disruption of telecommunication services prevents people in Gaza from accessing life-saving information or calling for first responders, and continues to impede humanitarian response." The Ministry of Communications stated on 27 January that Israel had fired live bullets and a tank shell at its telecommunications crews. NetBlocks reported a "high impact" outage on 5 March.

Humanitarian aid

Initial block on aid

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... ndit 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

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