Guidance

Country policy and information note: humanitarian situation in Gaza, Palestine, November 2024 (accessible)

Updated 2 October 2025

Executive summary

Gaza is a small, densely populated, enclave of Palestine, inhabited by around 2.1 million mostly Palestinian Arabs.

The current conflict in Gaza has been ongoing since October 2023 and has caused Gaza’s already-fragile economy, and its high unemployment levels, to worsen. Most Gazans now live in poverty, more than 62% of residential property has been damaged or destroyed, food and water availability is severely diminished, and the healthcare system is overwhelmed and on the verge of collapse.

Almost every Gazan – between 97% and 100% - is currently in need of humanitarian aid across the entire Gaza Strip. At least 95% of Gazans are experiencing acute food insecurity, at crisis level or worse, with the severity increasing the more northerly the governorate in the Gaza Strip.

Aid arriving in Gaza is insufficient to meet the level of needs and numerous obstacles prevent or delay the aid from being distributed across parts of the Gaza Strip. Furthermore, Hamas, the armed group which took control of the Gaza Strip in 2007, sees humanitarian aid and public service being unfairly distributed, to serve the interests of Hamas over the needs of ordinary civilians.

The general humanitarian situation in Gaza is so severe that there are substantial grounds for believing that there is a real risk of serious harm because conditions amount to torture or inhuman or degrading treatment as defined in paragraphs 339C and 339CA(iii) of the Immigration Rules/Article 3 of the European Convention on Human Rights (ECHR).

Internal relocation is unlikely to be reasonable due to the overall shortfall of the arrival and distribution of humanitarian aid in Gaza, and the unpredictable and fast-moving nature of the conflict.

Where a claim is refused, it is unlikely to be certifiable as ‘clearly unfounded’ under section 94 of the Nationality, Immigration and Asylum Act 2002.

Assessment

Updated 5 September 2024.

About the assessment

This section considers the evidence relevant to this note – that is the country information, refugee/human rights laws and policies, and applicable caselaw – and provides an assessment of whether, in general:

• the humanitarian situation is so severe that there are substantial grounds for believing that there is a real risk of serious harm because conditions amount to inhuman or degrading treatment as within paragraphs 339C and 339CA(iii) of the Immigration Rules/Article 3 of the European Convention on Human Rights (ECHR)
• internal relocation is possible to avoid serious harm
• if a claim is refused, it is likely to be certified as ‘clearly unfounded’ under section 94 of the Nationality, Immigration and Asylum Act 2002.

Decision makers must, however, consider all claims on an individual basis, taking into account each case’s specific facts.

Points to note

Some COI sources cited in this note refer to Gaza as an Occupied Palestinian Territory (OPT). It should be noted, however, that on 21 September 2025, the UK made an announcement of its recognition of Palestine as a state. While all CPIT references in this note have been changed from ‘Occupied Palestinian Territories’ to ‘Palestine’, COI references remain as published. It should also be noted that Palestine is not universally recognised as a state and, as such, some COI sources may continue to refer to Palestine as an OPT.  

Palestinian refugees in Gaza who were receiving protection and/or assistance from the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) are excluded from the protection of the Refugee Convention under Article 1D unless such protection has ceased for any reason.

Exclusion under Article 1D of the Refugee Convention does not automatically exclude a person from humanitarian protection. Whether a person is entitled to humanitarian protection will depend on the facts of the case. For general guidance, see the Asylum Instruction on Humanitarian Protection.

This note must be considered alongside the Asylum Instruction on Article 1D of the Refugee Convention: Palestinian refugees assisted by the United Nations Relief and Works Agency (UNRWA), which provides details on how to consider asylum claims made by Palestinians whose habitual place of residence is Palestine, Jordan, Lebanon, or Syria (see also, Exclusion).

It should also be noted that the sources cited within this document use a variety of terms to refer to the Gaza Strip in its entirety, including ‘Gaza’ and ‘the Strip’. The term ‘Gaza’ is also used by some sources to refer specifically to Gaza City, or the Gaza governorate. Such terms should therefore be read and considered within their wider context.

1. Material facts, credibility and other checks/referrals

1.1 Credibility

1.1.1 For information on assessing credibility, see the instruction on Assessing Credibility and Refugee Status.

1.1.2 Decision makers must also check if there has been a previous application for a UK visa or another form of leave. Asylum applications matched to visas should be investigated prior to the asylum interview (see the Asylum Instruction on Visa Matches, Asylum Claims from UK Visa Applicants).

1.1.3 Decision makers must also consider making an international biometric data-sharing check (see Biometric data-sharing process (Migration 5 biometric data-sharing process)).

1.1.4 In cases where there are doubts surrounding a person’s claimed place of origin, decision makers should also consider language analysis testing, where available (see the Asylum Instruction on Language Analysis).

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1.2 Exclusion

1.2.1 Decision makers must consider whether there are serious reasons for considering whether one (or more) of the exclusion clauses is applicable. Each case must be considered on its individual facts and merits.

a. Applicability of Article 1D of the Refugee Convention

1.2.2 Article 1D of the Refugee Convention is one of the exclusion clauses in the Refugee Convention. It excludes persons receiving protection or assistance from organs or agencies of the United Nations (other than the United Nations High Commissioner for Refugees (UNHCR)) from the Refugee Convention. However, its overall purpose is to ensure the continuing protection of Palestinian refugees until their position is settled in accordance with relevant United Nations General Assembly resolutions.

1.2.3 Palestinian refugees in the Gaza Strip who were previously assisted by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and continue to be eligible for such assistance but who seek asylum outside the area of UNRWA operation are excluded from the scope of the Refugee Convention unless they can show that UNRWA assistance or protection has ceased for any reason. This includes where a person ceases to receive protection or assistance beyond their control or independent of their volition.

1.2.4 A Palestinian eligible for UNRWA protection or assistance and previously registered with UNRWA, or (though not registered) in receipt of UNRWA protection or assistance, is not entitled to Refugee Convention refugee status simply by leaving the UNRWA areas of operation and claiming asylum elsewhere.

1.2.5 Situations where UNRWA protection or assistance may cease beyond the person’s control, or not of their own volition, may include the following circumstances:

• where there is a threat to life, physical integrity or security or freedom, or other serious protection related reasons
• situations such as armed conflict or other situations of serious violence, unrest and insecurity, or events seriously disturbing public order
• more individualised threats or protection risks such as sexual and/or gender-based violence, human trafficking and exploitation, torture, inhuman or degrading treatment or punishment, severe discrimination
• arbitrary arrest or detention

1.2.6 Additionally, practical legal and/or safety barriers to accessing UNRWA assistance may mean that UNRWA assistance is in practice no longer available and may include:

• being unable to access UNRWA assistance because of long-term border closures, roadblocks or closed transport routes
• absence of documentation to travel to, or transit, or to re-enter and reside, or where the authorities in the receiving country refuse their re-admission or the renewal of their travel documents
• serious dangers such as minefields, factional fighting, shifting war fronts, banditry or a real risk of other forms of violence or exploitation

1.2.7 In the non-binding case of SN and LN v Zamestnik-predsedatel na Darzhavna agentsia za bezhantsite (Directive 2011/95/EU – Person registered with UNRWA), heard on 11 January 2024 and promulgated on 13 June 2024, the Court of Justice of the European Union (CJEU) considered whether, within the meaning of EU Directive 2011/95, UNRWA protection or assistance has ceased when UNRWA finds itself unable to ensure dignified living conditions for the person registered with, or eligible for assistance from, UNRWA, for whatever reason, including by reason of the general situation prevailing in an UNRWA area of operation.

1.2.8 The CJEU held in SN and LN that UNRWA assistance must be considered to have ceased in an UNRWA area of operation when:

‘… (i) that body [UNRWA] finds itself unable, for whatever reason, including by reason of the general situation in the sector of that body’s area of operations, in which that stateless person had his or her habitual residence, to ensure to that stateless person, taking into account, where applicable, his or her state of vulnerability, dignified living conditions, consistent with its mission, without him or her being required to demonstrate that he or she is specifically targeted by that general situation by reason of elements specific to his or her personal situation, and

‘(ii) that stateless person of Palestinian origin would find himself or herself, if he or she were to return to that sector, in a state of serious insecurity, taking into account, where applicable, his or her state of vulnerability, since the administrative and judicial authorities are required to carry out an individual assessment of each application for international protection based on that provision, within the framework of which the age of the person concerned may be relevant.’ (Closing paragraph 2)

1.2.9 In summary, the CJEU held in SN and LN that UNRWA’s assistance or protection must be considered to have ceased to a person registered with UNRWA, or eligible for UNRWA assistance, when UNRWA is no longer able to provide, within its relevant area of operation:

• dignified living conditions, and
• minimum security conditions

1.2.10 The CJEU also held in SN and LN that the assessment of whether UNRWA’s protection or assistance has ceased in the relevant UNRWA area of operation should take into consideration the period of time from which the person left the UNRWA area of operation until the time of the protection determination.

1.2.11 While the UK is not bound by the CJEU determination in SN and LN, the judgement provides helpful guidance on factors to be taken into consideration within an assessment of whether UNRWA protection or assistance has ceased for any reason within the meaning of Article 1D of the Refugee Convention. As such, decision makers should take the CJEU judgement of SN and LN into account when making this assessment.

1.2.12 Palestinian ‘refugees’ resident in Gaza who were not receiving or eligible to receive protection or assistance from UNRWA are not excluded under Article 1D. These cases should be considered on their merits under the Refugee Convention unless there are serious reasons for considering whether one (or more) of the other exclusion clauses is applicable. Each case must be considered on its individual facts and merits.

1.2.13 Further guidance on handling Palestinians assisted by UNRWA is set out in the Asylum Instruction on Article 1D of the Refugee Convention: Palestinian refugees assisted by the United Nations Relief and Works Agency (UNRWA) (see also Points to note).

b. Exclusion under Article 1F of the Refugee Convention

1.2.14 There are a number of armed groups operating in Gaza, including (but not limited to) the military wings of Palestinian groups such as Hamas (Harakat al-Muqawama al-Islamiya, “Islamic Resistance Movement”) and the Palestinian Islamic Jihad (PIJ). Some of these groups may be involved in terrorist activities (several are proscribed under the UK Terrorism Act 2000, see Proscribed terrorist groups or organisations) or are responsible for serious human rights abuses in Gaza as well as neighbouring countries such as Israel and other areas of Palestine.

1.2.15 If there are serious reasons for considering that the person has been involved with these groups, then decision makers must consider whether any of the exclusion clauses under Article 1F are applicable.

1.2.16 If the person is excluded from the Refugee Convention under Article 1F, they will also be excluded from a grant of humanitarian protection (which has a wider range of exclusions than refugee status).

1.2.17 For guidance on exclusion and restricted leave, see the Asylum Instruction on Exclusion under Articles 1F and 33(2) of the Refugee Convention, Humanitarian Protection and the instruction on Restricted Leave.

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2. Convention reason(s)

2.1.1 A severe humanitarian situation does not in itself give rise to a well-founded fear of persecution for a Refugee Convention reason.

2.1.2 In the absence of a link to one of the 5 Refugee Convention grounds necessary to be recognised as a refugee, the question to address is whether the person will face a real risk of serious harm to qualify for Humanitarian Protection (HP).

2.1.3 However, before considering whether a person requires protection because of the general humanitarian and/or security situation, decision makers must consider if the person faces persecution for a Refugee Convention reason. Where the person qualifies for protection under the Refugee Convention, decision makers do not need to consider if there are substantial grounds for believing the person faces a real risk of serious harm meriting a grant of HP.

2.1.4 For further guidance on the 5 Refugee Convention grounds see the Asylum Instruction, Assessing Credibility and Refugee Status. For guidance on HP see the Asylum Instruction, Humanitarian Protection.

3. Risk

3.1.1 The general humanitarian situation in Gaza is so severe that there are substantial grounds for believing that there is a real risk of serious harm because conditions amount to torture or inhuman or degrading treatment as defined in paragraphs 339C and 339CA(iii) of the Immigration Rules/Article 3 ECHR. However, decision makers must consider each case on its facts.

3.1.2 An enclave of Palestine, the Gaza Strip is a small strip of land around 25 miles long by 7 miles wide, that comprises 5 governorates and sits between the Mediterranean Sea, Israel, and Egypt. With a population of around 2.1 million, the Gaza Strip has a high population density that is comparable overall with Greater London. Prior to the conflict which began in October 2023, sources estimated the median age in Gaza to be 19.5 years, with a little under half of the population being comprised of children. A proscribed terrorist armed group known as Hamas took over control of the Gaza Strip in 2007 (see Geography and demography, Children, Exclusion under Article 1F of the Refugee Convention, Economy, and relevant section of the CPIN, Palestine: Security situation in Gaza).

3.1.3 Gaza’s already-fragile economy and high levels of unemployment have worsened due to the current conflict which began in October 2023. The economy has contracted by more than 80% and unemployment has risen from around 45% prior to the start of the conflict to around 79% as of June 2024. The number of Gazans living in poverty has increased from between around 54% and 63%, to almost the entire population. Sources also state the proportion of the population in need of humanitarian assistance rose from around 80% prior to the start of the conflict, to between 97% and 100% within the first six months of the conflict (see Socio-economic situation, People in need (PIN) and Poverty).

3.1.4 By the end of January 2024, an estimated 62% of Gaza’s residential units were either damaged or destroyed. In absolute numbers, the EU, UN and The World Bank interim damage assessment stated that almost 291,000 housing units were damaged or destroyed by the end of January 2024. By mid-April 2024, the UN Economic and Social Commission for Western Asia (ESCWA) and the UN Development Programme (UNDP) said that figure had risen to around 370,000, with around 291,000 of those (~79%) damaged, and 79,000 (~21%) destroyed (see Shelter and non-food items (NFI)).

3.1.5 Gazans sheltering in schools and makeshift tented camps have inadequate living space, ventilation, privacy and safety, protection from the elements, and access to water, sanitation and hygiene (WASH) facilities. Sources indicate that since the start of the conflict, between 220 and 4,130 people have been required to share one toilet, a ratio approximately 10 to 200 times worse than the established practice minimum as outlined by the Sphere Humanitarian Charter and Minimum Standards in Humanitarian Response. Similarly, around 4,500 people have been sharing one shower, around 90 times the Sphere standard, and shelters have provided around 1 to 1.5 square metres of living space per person, significantly less than the Sphere standard of 3.5 square metres per person. The lack of clean water and sanitation disproportionately affects women and girls (see Shelter and non-food items (NFI) and Water, Sanitation and hygiene (WASH)).

3.1.6 Food production capabilities are significantly limited in Gaza due to the ongoing hostilities and damage sustained by the agricultural sector and to commercial infrastructure. Food availability is severely diminished and significant price increases for the food that is available for purchase has made it unattainable for most Gazans. In late November 2023 and during a humanitarian pause in the conflict, 83% of households surveyed by the UN World Food Programme in Gaza’s southern governorates, and 97% of those surveyed in its northern governorates were found to have inadequate food consumption (see Food security).

3.1.7 Between 1 May and 15 June 2024, the Integrated Food Security Phase Classification (IPC) found 95% of Gazans to be experiencing acute food insecurity, at crisis, emergency, or catastrophic levels, of which 15% were at the catastrophic level. With a further 5% experiencing stressed levels of food insecurity, only 0.4% of Gazans were experiencing minimal levels of food insecurity. The IPC also found that the northern governorates experienced the most severe level of acute food insecurity, followed by the middle governorates. Gaza’s Ministry of Health said that between 28 February and 2 April 2024, 28 people, mostly children, died from complications of dehydration and severe acute malnutrition (SAM). Oxfam reported that between January and April 2024, people in the northern Gaza governorates were forced to survive on around 10% to 15% of the 2,100 kilocalories needed per person per day, and that only 41% of the daily kilocalorie needs for the whole population entered the Gaza Strip between October 2023 and early April 2024 (see Food security).

3.1.8 Sources indicate that between December 2023 and February 2024, around 81% to 95% of households were without access to safe drinking water. As of late March 2024, around 57% of assessed WASH infrastructure had sustained damage or been destroyed, and a lack of fuel to run those desalination plants that can still operate is exacerbating the situation. In April 2024, the UN Environment Programme estimated that the available water supply was between 2 and 8 litres per person per day. Households, humanitarian shelters and IDP shelters reported that they were forced to resort to rationing water supplies, forgoing personal hygiene and sanitation needs and having to use alternative water sources including agricultural wells containing brackish water, risking exposure to pesticides and other chemicals. According to the World Health Organization, the WASH situation has contributed to the spread of diseases such as diarrhoea, cholera, and Hepatitis A (see Water, sanitation and hygiene (WASH)).

3.1.9 Around 17,000 of Gaza’s children were separated from their families as of February 2024 and between 15,200 and 19,000 children were orphaned by late Spring 2024, according to UN agencies. Sources report that the physical and mental health of children continues to be severely impacted by the ongoing conflict. Instances of diarrhoea in under 5s rose by 2000% in the first 2 months of the conflict and instances of global acute malnutrition (GAM) and severe acute malnutrition (SAM) in the same age group are estimated to have increased almost 4.5-fold and 7-fold, respectively, 4 months into the conflict. The Norwegian Refugee Council noted that the majority of children are now working to help support their families, leaving them vulnerable to violence and exploitation (see Children).

3.1.10 Education in Gaza ceased with the onset of the conflict, leaving all of its approximately 625,000 students out of school and many school buildings being used as IDP shelters. The UN’s Office for the Coordination of Humanitarian Affairs (OCHA) said that 88% of school buildings had sustained some level of damage 7 months into the conflict. While the Education Cluster has opened Temporary Learning Sites, serving over 17,000 children as of 21 June 2024, this represents fewer than 3% of all children out of school (see Education).

3.1.11 Damage to Gaza’s healthcare infrastructure and the impact of the ongoing conflict on medical staff, combined with large increases in injuries, new disabilities and communicable diseases, are resulting in a healthcare system that is overwhelmed and close to collapse. In December 2023, the number of health personnel available across the Gaza Strip was reportedly one third of those available pre-conflict. Sources indicate that health staff capacity continues to be reduced due to exhaustion and mental ill-health. In April 2024, only 10 of Gaza’s 36 hospitals (~28%) were reportedly partially functional, though by early June 2024 an additional 7 hospitals (therefore a total of 17 hospitals (~47% of Gaza’s hospitals)) had regained partial functionality. A further 5 of 9 field hospitals (~55%) were either fully or partially functional as of early June 2024 (see Health and healthcare).

3.1.12 Cases of diarrhoea have occurred at 25 times pre-conflict levels, while the healthcare system has also received an influx of Hepatitis A cases, respiratory illnesses and mental illnesses. In late June 2024, Médecins Sans Frontières teams reported that they were experiencing critical shortages of medicines and equipment and had been unable to receive medical supplies into Gaza for almost two months. Gazans with non-communicable diseases, such as cancer and dialysis patients no longer have access to required healthcare. According to the UN and the WHO, almost 4,900 patients were medically evacuated from Gaza to Egypt via the Rafah border crossing between 1 November 2023 and early May 2024 before the crossing closed again. This represents 38% of evacuation requests made up to early June 2024 (see Health and healthcare).

3.1.13 The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) remains the largest provider of humanitarian assistance in Gaza. Despite funding difficulties and several announcements by UNRWA that it was no longer able to provide humanitarian assistance, it has continued to provide emergency aid in the form of shelter, healthcare, psychosocial support, and food parcels. Other UN agencies, several Arab states, and 24 international NGOs have also been supporting aid programmes but there have been fewer than 10 international NGOs carrying out direct operations on the ground between October 2023 and March 2024. While almost 1,000 local NGOs were registered in Gaza at the start of the conflict, the majority have ceased operations, leaving vulnerable persons including women, children, and people with disabilities most impacted and with increased needs (see United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and Other aid agencies).

3.1.14 Sources state that the aid effort falls significantly short of meeting needs in Gaza. There has been insufficient aid entering Gaza via the few border crossings that are only open intermittently as well as barriers to the distribution of aid including fuel shortages, road damage and debris, the looting of aid trucks and ongoing hostilities which have caused unprecedented loss of life to aid workers. There are also difficulties with tracking where distribution is most needed due to the repeated displacement of people. The distribution of aid to vulnerable persons, such as those with disabilities, is particularly challenging. Sources also indicate that Hamas operations result in the unfair distribution of humanitarian aid and public services, to serve the interests of Hamas over the needs of ordinary civilians (see Humanitarian aid).

3.1.15 In the country guidance case of HS (Palestinian – return to Gaza) Palestinian Territories CG [2011] UKUT 124 (IAC), heard on the 15 and 16 December 2009, 22 and 23 February 2010, and 10 June 2010, and promulgated 11 April 2011, the Upper Tribunal (UT) considered, amongst other matters, whether the general situation in Gaza amounted to a breach of Article 3 of the ECHR. The UT looked at a wide range of evidence primarily covering events in 2008 and 2009 after the Israeli blockade had begun and large-scale conflict occurred during ‘Operation Cast Lead’. The hostilities led to thousands of casualties as well as substantial damage to infrastructure, economic activity and public services (see paras 186 to 214).

3.1.16 On the basis of the evidence before it, the UT held in HS that:

‘Our assessment of the background evidence is that it clearly shows a harsh state of affairs in Gaza which reflects a deterioration beyond the situation prior to the Operation Cast Lead hostilities. The infrastructure of Gaza is significantly depleted, and there are problems of access to electricity and clean water and there are limits on the amount of products that are brought into the territory. We do not seek to undervalue the level of difficulty that the appellants in this case, and indeed other residents of Gaza, face in the territory. But we consider that the tests set out in the Refugee Convention as applied in the case law and under Article 3 are set at a level of risk which is higher than that which would be experienced by the appellant and her family in this case on return…

‘As regards the general socio-economic and humanitarian situation in Gaza, there is on the whole common ground in the evidence provided by both sides, although some of the evidence on the part of the Secretary of State indicates some small level of improvement in various respects. There has to be shown to be a severe deprivation with denial of shelter, food and the most basic necessities of life for the appeal to succeed. It is relevant to note… that to succeed in a claim for protection based on poor socio-economic or dire humanitarian living conditions under… Article 15 of the Qualification Directive or Article 3, the circumstances would have to be extremely unusual… The appellant and her family have relatives in Gaza, and, even if they are unable to accommodate them, they have friends also, and there is a good deal of humanitarian aid… It is necessary to bear in mind the reduced levels of violence, and the fact that basic goods are, to a limited extent, being imported into Gaza whether with Israeli assistance or as a consequence of being brought in through the tunnels, and though the situation is a serious one, we do not consider that it crosses the Article 3 or Refugee Convention threshold…

‘The conditions in Gaza are not such as to amount to persecution or breach of the human rights of returnees or place them in need of international protection’ (paragraphs 222, 224 and 225(6)).

3.1.17 However, a subsequent determination by the Court of Appeal (EWCA) in the case of MI (Palestine) v Secretary of State for the Home Department [2018] EWCA Civ 1782, heard on 19 July 2018, promulgated on 31 July 2018, considering arguments about the Article 3 threshold following the European Court of Human Rights case of Sufi and Elmi v. The United Kingdom - 8319/07 [2011] ECHR 1045 (28 June 2011) held that it is:

‘… sufficiently arguable that the conditions in Gaza are and were attributable to the direct and indirect actions of the parties to the conflict within the meaning of [282] of Sufi & Elmi and that there was an element of intentionality if that is a necessary ingredient before the approach in that case will be adopted …. Whether the case is one to which the Sufi & Elmi approach should apply will be a matter for that [UT] to decide.

‘Finally, our attention was drawn to the fact that the Country Guidance in HS not only pre-dates the decision in Sufi & Elmi but is also dealing with the position as it was up to 2010, some years before the 2014 military operation with its serious impact on the population and the infrastructure. Counsel suggested that perhaps a new Country Guidance case on Gaza should be considered. Ultimately that is a matter for the Upper Tribunal, not this Court, although I can see the sense of the suggestion given that, on any view the Country Guidance in HS is somewhat out of date.’ (paras 32 to 34)

3.1.18 At the time of writing, there has not been a CG case on Gaza since HS. However, humanitarian conditions in Gaza have significantly and durably deteriorated since HS was promulgated and are generally extremely poor. The country information in this note indicates that there are ‘very strong grounds supported by cogent evidence’ to depart from these findings.

3.1.19 For further guidance on assessing risk, see the Asylum Instruction on Assessing Credibility and Refugee Status.

4. Protection

4.1.1 The state is not able to provide protection against a breach of Article 3 because of general humanitarian conditions if this occurs in individual cases.

4.1.2 For further guidance on assessing state protection, see the Asylum Instruction on Assessing Credibility and Refugee Status.

5. Internal relocation

5.1.1 While the level of need and access to humanitarian aid have varied geographically across Gaza throughout the conflict, internal relocation is unlikely to be reasonable due to the overall shortfall of the arrival and distribution of humanitarian aid and the unpredictable and fast-moving nature of the conflict.

5.1.2 For further guidance on considering internal relocation and factors to be taken into account see the Asylum Instruction on Assessing Credibility and Refugee Status.

6. Certification

6.1.1 Where a claim is refused, it is unlikely to be certifiable as ‘clearly unfounded’ under section 94 of the Nationality, Immigration and Asylum Act 2002.

6.1.2 For further guidance on certification, see Certification of Protection and Human Rights claims under section 94 of the Nationality, Immigration and Asylum Act 2002 (clearly unfounded claims).

Country information

This section contains publicly available or disclosable country of origin information (COI) which has been gathered, collated and analysed in line with the research methodology. It provides the evidence base for the assessment.

The structure and content follow a terms of reference which sets out the general and specific topics relevant to the scope of this note.

This document is intended to be comprehensive but not exhaustive. If a particular event, person or organisation is not mentioned this does not mean that the event did or did not take place or that the person or organisation does or does not exist.

The COI included was published or made publicly available on or before 3 July 2024. Any event taking place, or report published after this date, will not be included. Please note that the country information included in this CPIN is the most recent information available at the time of writing. However, it should be noted that some of the information and statistics pre-dates the current conflict in Gaza and should be viewed with this in mind.

Decision makers must use relevant COI as the evidential basis for decisions.

7. Geography and demography

7.1 Geography

7.1.1 On 24 October 2023, Cable News Network (CNN), the US-based multinational news organisation^{[footnote 1]}, published an article entitled ‘Gaza explained: What to know about the enclave’, citing various sources, which stated: ‘Gaza is a narrow strip of land, only about 25 miles long and seven miles wide… To its west lies the Mediterranean Sea, to its north and east is Israel, and Egypt is to its south. It is one of two Palestinian territories, the other being the larger Israeli-occupied West Bank, which borders Jordan.’^{[footnote 2]}

7.1.2 The CIA World Factbook stated on its undated ‘Gaza Strip’ webpage, which was last updated on 3 July 2024, that the Gaza Strip comprises a total of 360 square kilometres, made up of entirely land area (i.e. no water area).^{[footnote 3]} By comparison, the total land area of the United Kingdom, at 241,930 square kilometres^{[footnote 4]}, is approximately 672 times the size of the Gaza Strip. The Gaza Strip has 72 kilometres of land borders, 13 with Egypt and 59 with Israel, plus 40 kilometres of coastline, along the Mediterranean Sea.^{[footnote 5]}

7.1.3 On 7 August 2022 Al Jazeera published an article entitled ‘The Gaza Strip explained in maps’, updated on 9 October 2023, which stated: ‘At only 41km (25 miles) long, it can take less than an hour to drive from Rafah in the south to Beit Hanoon in the north.’^{[footnote 6]}

7.2 Maps

7.2.1 Mapsland published the following undated map of the Gaza Strip prior to the start of the conflict in October 2023, which shows its roads and cities, built-up areas, refugee camps, and border crossing points.^{[footnote 7]}

(Note: this map does not reflect HMG’s view of any boundaries and is used for illustrative purposes only):

7.2.2 OnTheWorldMap.com published the following 2021 map of the Gaza Strip showing its 5 governorates, their capitals, and its other main cities and towns.^{[footnote 8]} It should be noted that Yasser Arafat International Airport has not been operational since 2001.^{[footnote 9]}

(Note: this map does not reflect HMG’s view of any boundaries and is used for illustrative purposes only):

7.3 Population density and demography

7.3.1 The CIA World Factbook estimated the Gaza Strip’s population to be 2,098,389 people in 2023^{[footnote 10]} and 2,141,643 in 2024.^{[footnote 11]} It is unclear whether the 2024 estimate has taken into account the conflict in Gaza. For general details on their methodology, see their undated webpage ‘About the World Factbook – Frequently Asked Questions (FAQs)’. The 2023 estimate from this source was used by CPIT to calculate a pre-conflict population density of 5,828 people/km² (based on 360km² land area, see Geography).

7.3.2 The same source also stated that the population of the Gaza Strip is Palestinian Arab and (in a 2012 estimate which was not updated) comprised 98 to 99% Muslims, predominantly Sunnis. It further estimated 38.8% of Gazans to be aged 0 to 14 years, 58.3% aged 15 to 64 years, and 2.9% aged 65 years or over, with a median age of 19.5 years old. The population was also stated by the source to be mainly concentrated in the major cities, particularly Gaza City in the north.^{[footnote 12]}

7.3.3 On a webpage entitled ‘Where we work’, which was last updated in August 2023, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) stated: ‘The Gaza Strip has a population of approximately 2.1 million people, including some 1.7 million Palestine Refugees… Eight recognized Palestine Refugee camps span the Gaza Strip and have some of the highest population densities in the world.’^{[footnote 13]}

7.3.4 On 16 October 2023, the Financial Times published an article entitled ‘The Gaza Strip – in charts’ which stated:

‘… Gaza [has] a population density that is similar to London. But more granular data shows that many areas are up to six times as dense. This includes the parts of northern Gaza, including Gaza City…

‘… The Gaza Strip as a whole has a population density of 5,751 per square kilometre, which is very similar to 5,601 for Greater London [Central London has a population density of 11,144 people/km²^{[footnote 14]}].

‘… But in some areas of Gaza City in the north and Khan Younis, density tops 30,000 people per sq km.

‘… 1.6mn [million], [refugees] are in Gaza. The Gazans who are not officially defined as refugees… are [typically] descendants of locals…’^{[footnote 15]}

7.3.5 On 10 October 2023, NBC News, a US-based news division^{[footnote 16]}, published an article which explained: ‘The Gaza Strip’s density is comparable to many major global cities, but whereas people in those areas have the option of leaving or expanding the suburbs, Gazans cannot.’^{[footnote 17]}

8. Socio-economic situation

8.1 Basic indicators

8.1.1 It is unclear whether the 2024 estimates by the CIA World Factbook, cited in the table below, have taken into account the conflict in Gaza. For general details on their methodology, see their undated webpage ‘About the World Factbook – Frequently Asked Questions (FAQs)’.

Population	2,098,389 (2023 est.)[footnote 18], 2,141,643 (2024 est.)[footnote 19]
Life expectancy at birth	74.8 years (2023 est.)[footnote 20], 75.5 years (2024 est.)[footnote 21]
Maternal mortality ratio (deaths per 100,000 live births)	20 (2020 est. – note: this data is for the Gaza Strip and the West Bank)[footnote 22]
Infant mortality rate (per 1,000 live births)	16 (2023 est.)[footnote 23], 15.1 (2024 est.)[footnote 24]
Poverty (population living below poverty line)	59.3% (2021 est.)[footnote 25] Poverty line set at US$5.50 [£4.29 GBP[footnote 26]] per day international poverty line (2011 Purchasing Power Parity)[footnote 27]
Literacy rate (age 15 and older)	98% (2022 est. – note: this data is for the Gaza Strip and the West Bank)[footnote 28]
Average years of schooling (primary to tertiary education)	13 (2021 est. note: this data is for the Gaza Strip and the West Bank)[footnote 29]

8.2 Economy

8.2.1 The UNRWA ‘Where we work’ webpage, updated in August 2023, stated:

‘For at least the last decade and a half, the socioeconomic situation in Gaza has been in steady decline.

‘A blockade on land, air and sea was imposed by Israel following the Hamas takeover of the Gaza Strip in 2007.

‘… The economy and its capacity to create jobs have been devastated, resulting in the impoverishment and de-development of a highly skilled and well-educated society.’^{[footnote 30]}

8.2.2 On 29 February 2024, Freedom House published its ‘Freedom in the World 2024 – Gaza Strip’ report, covering events of 2023, which described the Gaza Strip as having been in a ‘… dire economic situation…’^{[footnote 31]}

8.2.3 The same source went on to state:

‘The long-standing blockade of the Gaza Strip’s land borders and coastline has greatly reduced economic opportunity in the territory over the years. Even before the war that began in October 2023, nearly 80 percent of Gazans relied on humanitarian aid, more than half lived in poverty, and nearly 80 percent of young people were unemployed, according to the United Nations [UN].

‘… [I]ntermittent restrictions on the entry of construction materials have hampered growth and recovery from past conflicts, and Israeli patrols limited farming near the border fence as well as fishing in coastal waters. Hamas has imposed price controls that may have further dampened economic activity, and Israeli authorities accuse Hamas of diverting imported goods for military purposes, including tunnel construction.

‘Inconsistent access to fuel imports and electricity… has hindered all forms of development in the territory…

‘… The 2023 war imposed extreme new economic hardships on Gaza residents, with UN OCHA [the United Nations Office for the Coordination of Humanitarian Affairs] warning that the civilian population was at imminent risk of famine.’^{[footnote 32]}

8.2.4 On 2 April 2024, the UN published a joint report with the European Union (EU) and The World Bank, providing a preliminary estimate of the impact of the current Gaza conflict, from October 2023 to the end of January 2024 (referred to herein as the joint EU, UN, and The World Bank preliminary damage assessment). The assessment was based on data from IPSOS, a market vendor contracted by The World Bank since November 2023, and included satellite imagery (triangulated and validated by The World Bank), traditional and social media reporting, and ground partner information where possible.^{[footnote 33]} Citing various sources, the report stated: ‘The conflict has caused widespread and enduring damage, affecting virtually all economic sectors, with severe consequences on tangible assets, incomes, and human capital. The consequences of this shock are expected to exert a prolonged and substantial burden on economic activities for several years ahead.’^{[footnote 34]}

See Annex 1 of the report for information about the methodology used for, and the limitations of, the assessment.

8.2.5 On 2 May 2024, the United Nations Economic and Social Commission for Western Asia (ESCWA) and the United Nations Development Programme (UNDP) published a joint report on the expected socio-economic impacts of the Gaza War. The report, which cited various sources, stated:

‘… [A]s reported by PCBS [Palestinian Central Bureau of Statistics, the centralised producer of official statistics in the Palestinian territories^{[footnote 35]} … severe economic decline [was] observed in the fourth quarter of 2023, particularly pronounced in Gaza, where the economy contracted by 81 per cent year-on-year compared to the fourth quarter of 2022, leading to a GDP decline of 22.5 per cent for the entire 2023 year.

‘… In Gaza, all sectors experienced losses of more than 90 per cent compared to the previous quarter. The local economy has been eviscerated by the current war.’^{[footnote 36]}

8.2.6 On 23 May 2024, The World Bank published an update on the ‘Impacts of the Conflict in the Middle East on the Palestinian Economy’ which, citing various sources, stated: ‘Based on… [the joint EU, UN, and The World Bank preliminary damage assessment^{[footnote 37]}] data and assuming that reconstruction will not start before 2025, the economic contraction in Gaza is forecast to worsen significantly in 2024, exceeding 50 percent (y/y) [year on year] as the effects of fixed capital destruction linger.’^{[footnote 38]}

8.2.7 On 7 June 2024, the International Labour Organization (ILO), a specialised agency of the UN ‘devoted to promoting social justice and internationally recognized human and labour rights’^{[footnote 39]}, published their fourth joint bulletin with the PCBS, which provided an update on the impact of the ongoing conflict on the economy and labour market. Citing various sources, the bulletin stated:

‘… [T]he economic toll of the war in the OPT is immense. Real GDP has contracted… during the first eight months of the war, with an estimated 83.5 per cent contraction in the Gaza Strip…

‘… Between October 2023 and January 2024… of the private sector establishments… 100 per cent in the Gaza Strip - experienced either complete cessation or reduced production… losing 85.8 per cent of its production value during the initial four months of the conflict, amounting to an estimated loss of USD 810 million [a little under £631 million GBP^{[footnote 40]}].

‘… Construction declined by 100 per cent, while industry plummeted by 97.2 per cent, compared to the no-war baseline.

‘… These challenges are further compounded by inflationary pressures, which erode individuals’ purchasing power and their ability to meet their most basic needs, particularly amid increased job losses and reduced incomes. In April 2024, year-on-year inflation reached… a staggering 153.3 per cent in the Gaza Strip…’^{[footnote 41]}

8.2.8 On 30 June 2024, the OCHA published a Cash Working Group (CWG) guiding note which stated:

‘Starting from March 2024, access to liquidity has increasingly become problematic, due to a) the concentration of people in small areas [for example, the southernmost governorate of Rafah, with a pre-crisis population of 300,000, hosted up to 1.3 million people] that create pressure on the local financial institutions by increasing demands for cash and liquidity, b) the immense logistics, safety and security challenges in moving cash from and between banks and ATMs, and c) the irregular trends of deposits of cash from businesses and traders into banks. This has negatively impacted the economic sector…’^{[footnote 42]}

8.3 Employment

8.3.1 The UNRWA ‘Where we work’ webpage, updated in August 2023, stated: ‘With… an overall unemployment rate of 46.6 per cent (48.1 per cent for Palestine Refugees living in the camps) at the end of the third quarter of 2022 and an unemployment rate of 62.3 per cent among youth (15-29 years, refugees and non-refugees), the already fragile humanitarian situation in Gaza threatens to deteriorate further.’^{[footnote 43]}

8.3.2 The ‘Freedom in the World 2024 – Gaza Strip’ report stated:

‘… [E]xtremely high unemployment, and the dysfunctional court system… impedes enforcement of labor protections [pre-conflict].

‘… [L]abor activity in general was heavily disrupted along with the rest of civilian life during the conflict that began in October 2023.

‘… While Gaza residents were able to own property and engage in business activity prior to October 2023, their rights were seriously undermined by the effects of periodic conflicts between Hamas and Israel, among other factors… Impediments to private enterprise in Gaza included persistent Israeli bans on imports of many raw materials. These restrictions were unilaterally adjusted by Israeli authorities based on political and security criteria.

‘… Private business activity… largely ceased during the fighting and bombardment [as of December 2023].

‘… [Even pre-October 2023], PA [Palestinian Authority] officials have little ability to enforce legal protections against exploitative labor conditions in Gaza, and most private-sector wage earners receive less than the legal minimum, which is itself lower than the poverty threshold.’^{[footnote 44]}

8.3.3 On 18 March 2024, the ILO and the PCBS, published their third joint bulletin on the impacts of the Gaza War on the economy and labour market. Citing various sources, the bulletin stated:

‘Based on more updated PCBS data and some additional insights from the ILO’s survey [of West Bank employers in January 2024], it is now estimated that, as of the end January 2024, 201,000 jobs have been lost in the Gaza Strip… This new estimate… reflects an assumed reduction of private sector employment in the Gaza Strip by 90 per cent (given the continued decline in production capacity in the Gaza Strip), a reduction in public sector employment by 15 per cent and the complete loss of employment for the 20,000 Gazans previously employed in Israel. This new estimate is an upward revision to the job loss estimate in Bulletin No. 2 [estimated then to be a minimum of 66 per cent of employment had been lost in the Gaza Strip, equivalent to 192,000 jobs.^{[footnote 45]} With further Israeli military operations expected in Southern Gaza, the job losses will likely rise further.’^{[footnote 46]}

8.3.4 The joint EU, UN, and The World Bank preliminary damage assessment report stated:

‘… Unemployment rates in Gaza were alarming, reaching 45.1% in September 2023, with youth unemployment at 59.5%.

‘… Even prior to the conflict, young Palestinians in Gaza faced high unemployment, recurrent conflict, and mental health challenges, all of which had limited their prospects. The conflict has terminated any dignified, safe, and stable career/job prospects for youth, due to its punishing toll on Gaza’s economy, infrastructure, and education system affecting 80,000 higher education students.’^{[footnote 47]}

See Annex 1 of the report for information about the methodology used for, and the limitations of, the assessment.

8.3.5 The ILO and PCBS June 2024 fourth joint bulletin stated: ‘During the ongoing war period, the unemployment rate… surged… with particularly alarming figures in the Gaza Strip (79.1 per cent).’^{[footnote 48]}

9. Humanitarian situation

9.1 People in need (PIN)

9.1.1 Sphere, an association who ‘defines, promotes and applies humanitarian principles and minimum standards to ensure lifesaving, protective and accountable response to crisis^{[footnote 49]}’ published the Sphere Handbook used by ‘… international NGOs, United Nations agencies, and governmental authorities across the globe … when planning, delivering and evaluating humanitarian operations.’^{[footnote 50]} The handbook outlines minimum humanitarian standards in four areas: Water supply, sanitation and hygiene promotion (WASH), Food security and nutrition, Shelter and settlement and Health.^{[footnote 51]} The minimum humanitarian standards as outlined by Sphere are referred to by sources in the relevant sections below.

9.1.2 On 14 December 2023, the International Rescue Committee (IRC) published its ‘2024 Emergency Watchlist’ report which stated: ‘Before October 7 [2023], 80% of Gaza’s population were reliant on humanitarian assistance. The disruption and destruction of hospitals and power and water desalination plants, combined with massive displacement and disruption of livelihoods, means that nearly all 2.3 million people living in Gaza will be in need of humanitarian aid in 2024, and with even more severe needs than before.’^{[footnote 52]}

9.1.3 In January 2024, UN Women, which works towards the empowerment of women and gender equality in its Member States^{[footnote 53]} , published a report entitled ‘The Gendered Impact of the Crisis in Gaza’, which stated: ‘In Gaza… severe humanitarian needs are at unprecedented levels, in a context where needs were already dire prior to the current escalation.’^{[footnote 54]}

9.1.4 In March 2024, Humanitarian Outcomes, a London-based specialist consultant team which provides research and policy advice for humanitarian aid agencies and donor governments^{[footnote 55]} , published a report covering the first six months of the conflict in Gaza. The report was based on a mobile telephone survey of 810 people (487 men and 323 women) across all 5 governorates in Gaza conducted by GeoPoll, a global remote research service provider^{[footnote 56]}, between 4 and 17 February 2024.^{[footnote 57]} The report stated: ‘… 793 survey respondents (98%) said they were in need of aid.’^{[footnote 58]}

9.1.5 The same source also provided the survey results by governorate. It found 100% of people in the North Gaza and Khan Younis governorates to have said they were in need of aid, 99% in Deir-Al-Balah, 98% in the Gaza governorate, and 97% in Rafah.^{[footnote 59]}

9.2 Shelter and non-food items (NFI)

9.2.1 The Sphere Handbook set out a minimum standard practice in humanitarian response for shelter of 3.5 square metres of living space excluding cooking, bathing, and sanitation areas, or 4.5 to 5.5 square metres where cooking, bathing and/or sanitation areas are included.^{[footnote 60]}

9.2.2 On 8 February 2024, the Norwegian Refugee Council (NRC) published an article which stated: ‘At least 69,000 housing units in Gaza have been destroyed, while 290,000 other homes have been damaged, according to the NRC-led Shelter Cluster. The amount of debris exceeds 8,000,000 metric tonnes and will take three years to remove.’^{[footnote 61]}

9.2.3 The ‘Freedom in the World 2024 – Gaza Strip’ report stated: ‘Reconstruction of homes that were damaged or destroyed during past rounds of fighting lagged for many years, leaving thousands of people displaced or in temporary housing. … As of late December 2023, more than 60 percent of Gaza’s housing units had reportedly been destroyed or damaged in the conflict that began in October [2023].’^{[footnote 62]}

9.2.4 On 8 March 2024, the OCHA published a ‘Humanitarian Needs and Response Update’, covering 27 February to 4 March 2024, which stated:

• ‘About 1.7 million people across the Gaza Strip are… in need of shelter and NFI assistance.
• ‘Approximately 22,930,000 metric tons of debris has been generated by the destruction of properties, mainly residential units, across the Strip. Cluster partners estimate that it would take around eight years to clear the debris, given existing capacities in the Strip.
• ‘Preliminary findings from a rapid shelter assessment that has been piloted at 33 UNRWA [United Nations Relief and Works Agency for Palestine Refugees in the Near East] sites, predominantly schools, show that covered living space is as low as 1 m2 per person, significantly falling below the Sphere standard of 3.5 m2 per person.’^{[footnote 63]}

9.2.5 On 25 March 2024, the UN Human Rights Council (HRC) published an advance, unedited, version of a report of the Special Rapporteur on the situation of human rights in the Palestinian territories. The report, which was based on the data and analyses of organisations on the ground, international jurisprudence, and investigative reports and consultations with affected individuals, authorities, civil society and experts^{[footnote 64]}, stated: ‘Seventy percent of residential areas have been destroyed.’^{[footnote 65]}

9.2.6 The joint EU, UN, and The World Bank preliminary damage assessment report stated:

‘… [T]he physical and the corresponding monetary impacts caused by the conflict [estimated by the preliminary damage assessment at around US$18.5 billion (almost £14.5 billion GBP^{[footnote 66]}) in direct damages to built infrastructure in Gaza, by the end of January 2024] are dominated by damages to residential buildings (72% of the total)…

‘… The ongoing conflict has damaged or destroyed approximately 62% of all homes in Gaza, equivalent to 290,820 housing units, at an estimated value of US$13.3 billion [around £10.38 billion GBP^{[footnote 67]}]… Among the affected housing units, 76% are fully destroyed, and 24% are partly damaged. Damages to apartments constitute 82% of the total damage. Nearly 75% of the total damage cost is concentrated in Gaza City, Jabalya, Khan Younis, Beit Lahiya and Rafah Municipalities… As a result, by end-January 2023 [sic – CPIT considers this should state ‘by end-January 2024’], more than 1.08 million people will not be able to return to their homes as they have been destroyed or rendered otherwise uninhabitable.’^{[footnote 68]}

See Annex 1 of the report for information about the methodology used for, and the limitations of, the assessment.

9.2.7 The May 2024 ESCWA and UNDP joint report stated:

‘The average rate of reconstructing completely destroyed housing units after Israeli military escalations against Gaza in 2014 and 2021 was 992 housing units per year. During the current war, and as of 15 April 2024, approximately 370,000 housing units in Gaza have been damaged, 79,000 of which were completely destroyed. Even with an optimistic scenario, in which a five-fold increase of construction materials is allowed into Gaza, it would take until 2040 to reconstruct the completely destroyed housing units.’^{[footnote 69]}

9.2.8 On 27 May 2024, the OCHA published a ‘Gaza Humanitarian Response Update’, covering 20 to 26 May 2024, which stated:

• ‘There are no remaining stocks of shelter materials inside Gaza to address the large-scale displacement caused by recent evacuation orders and intensified military activities.
• ‘[There is a] Lack of safely identified locations for shelters.
• ‘Fuel shortages hamper the distribution of shelter and NFI assistance by partners.
• ‘Households’ own lack of access to transportation hinders their ability to carry shelter items with them.’^{[footnote 70]}

9.2.9 On 31 May 2024, the OCHA published a ‘Reported impact snapshot’ for day 238 of the hostilities. Citing the Shelter Cluster as the source of figures yet to be verified by the UN, it stated that IDP (internally displaced persons) shelters provided an average of 1 square metre per person, 41% of shelters lacked sufficient ventilation, and 57% of shelters were infiltrated by rain and water.^{[footnote 71]} CPIT noted that the same figures were provided by the OCHA in the 26 reported impact snapshots/reports it published since (and including) its day 175 reported impact report, published on 29 March 2024.^{[footnote 72]}

9.2.10 On 4 June 2024, Oxfam published an article which stated: ‘People are paying nearly $700 [£550 GBP^{[footnote 73]}] for the most basic tents and there is so little space left, that some have been forced to set up tents in the cemetery at Deir al-Balah.’^{[footnote 74]}

9.2.11 On 26 June 2024, the OCHA published a ‘Gaza Humanitarian Response Update’, covering 10 to 23 June 2024, which stated:

• ‘The[re is a] continued large-scale lack of shelter materials entering Gaza.
• ‘The[re is a] lack of functional markets for people to access shelter materials and NFIs.
• ‘The[re is a] continued degradation of existing shelters, especially makeshift ones, including due to repeated waves of displacement and the need to frequently disassemble and reinstall them.’^{[footnote 75]}

9.2.12 On 27 June 2024, the Norwegian Refugee Council (NRC) published ‘On-the-record update #4 on situation in Gaza, Palestine’ which, based on updates from its teams in Gaza, stated: ‘Internally displaced persons are residing in makeshift shelters that provide little protection from the heat and no privacy or safety.’^{[footnote 76]}

9.2.13 The same source, quoting its Education Officer in Gaza, stated: ‘The tents, that are meant for temporary use only, are 3x4 [metres] in size and host more than 15 people, even 20 in some cases. Then you have families who don’t even have that sheet of plastic or plank of wood to build a shelter.’^{[footnote 77]}

9.2.14 On 3 July 2024, the OCHA published a ‘Reported impact snapshot’ for day 271 of the hostilities. Citing the Shelter Cluster as the source of figures yet to be verified by the UN, it stated that IDP shelters provided an average of 1.5 square metres per person (below the minimum standard of 3.5 square metres per person), and that around 100,000 Gazan households were estimated to be in urgent need of shelter support.^{[footnote 78]} CPIT noted that the same figures were provided by the OCHA in the 6 reported impact snapshots it published since (and including) a snapshot published on 5 June 2024.^{[footnote 79]}

9.3 Water, sanitation and hygiene (WASH)

9.3.1 The Sphere Handbook set out a minimum standard practice in humanitarian response of 15 litres per person per day (pppd) for drinking and domestic hygiene (with 7.5 litres pppd potentially appropriate for a short time, such as in a drought), and a maximum of 50 people per bathing facility.^{[footnote 80]} Regarding excreta management, the Handbook set out that there should be a maximum of 20 people per toilet in the medium-term^{[footnote 81]}, that human faeces should not be present in the environment in which people live^{[footnote 82]}, and that all human excreta should be ‘… disposed of in a manner safe to public health and the environment.’^{[footnote 83]}

9.3.2 The World Health Organization’s (WHO) emergency situation update issue 6, published on 21 October 2023, reported water availability of 3 litres per person per day (pppd).^{[footnote 84]}

9.3.3 On 6 December 2023, the UN World Food Programme (WFP) published a report based on 399 telephone surveys conducted by WFP Palestine from 27 to 30 November 2023, during a humanitarian pause to the conflict. 88 respondents were located in the northern governorates of Gaza and North Gaza, and 311 were in the southern governorates of Deir Al Balah, Khan Younis, and Rafah^{[footnote 85]}. The report stated: ‘… [O]n average interviewed households are reporting having access to 1.8 liter[s] in the Northern governorates and 2 liters in the Southern governorates of safe water per person per day. Only 7 percent in the Northern governorates as well as 16 percent in Southern governorates reported having access to more than 2.5 liter[s] of safe water per person per day.’^{[footnote 86]} No analysis of whether the findings were representative of the general situation for all Gazans was included.

9.3.4 On 14 December 2023, the WFP published a ‘Food Security Update’ based on a further 151 phone interviews it conducted from 3 to 12 December 2023, after the humanitarian pause ceased. All respondents were IDPs in southern governorates (WFP stated that 233 of the November 2023 respondents fit this profile).^{[footnote 87]} The report stated: ‘Access to water remains severely constrained, with less than 2 liters per person per day…’^{[footnote 88]} While it also stated: ‘As the other population groups in Gaza such as those in north Gaza or residents represents a smaller share of the total population, the random sample was not able to capture a sufficient sample size from these groups. Therefore, this report focuses on IDPs in southern governorates in Gaza.’^{[footnote 89]}, it is not clear whether the findings were representative of the general situation for all IDPs in the southern governorates.

9.3.5 The International Rescue Committee (IRC) stated in its ‘2024 Emergency Watchlist’ that: ‘… [A] lack of fuel for water desalination has left 95% of Gaza’s population without access to safe water, increasing the risk of diseases like cholera.’^{[footnote 90]}

9.3.6 On 21 December 2023, the WHO published an article entitled ‘Lethal combination of hunger and disease to lead to more deaths in Gaza’ which stated: ‘In Gaza today, on average, there is only one shower for every 4500 people and one toilet for every 220. Clean water remains scarce and there are rising levels of outdoor defecation. These conditions make the spread of infectious diseases inevitable.’^{[footnote 91]}

9.3.7 Issues 20 and 21 of the WHO emergency situation update, published on 11 and 22 January 2024 respectively, reported that there was ‘No access to clean water in the Northern Governorates’.^{[footnote 92]}

9.3.8 On 18 February 2024, the Global Nutrition Cluster (GNC), a group of 51 partners and observers that aim to safeguard and improve the nutritional status of emergency affected populations^{[footnote 93]}, published the findings of a nutrition situation analysis carried out in Gaza from December 2023 to January 2024, covering the first 120 days of the conflict.^{[footnote 94]} The report stated: ‘81% of households lack safe and clean water, with average household access at less than one litre per person per day. This is… of particular concern for babies being fed infant formula.’^{[footnote 95]}

9.3.9 The joint EU, UN, and The World Bank preliminary damage assessment report stated:

‘Around 57% of water infrastructure and assets have been destroyed or partially damaged, including the desalination plants in the northern and middle areas, 162 water wells, and two of the three connections with Mekorot, Israel’s national water company that supplies water to Gaza… The WASH system has almost completely collapsed, and the current water production capacity is estimated at below 5% of the usual output and progressively decreasing every day. Gaza’s municipal infrastructure including 5 out of 6 solid waste management facilities bears substantial damage… with Gaza City alone accounting for 37% of this total.’^{[footnote 96]}

See Annex 1 of the report for information about the methodology used for, and the limitations of, the assessment.

9.3.10 On 28 May 2024, Save the Children published a press release which stated: ‘Many Palestinians are now surviving on less than 3% of their daily water needs as temperatures rise dangerously high and diseases like diarrhea and hepatitis rapidly spread.’^{[footnote 97]}

9.3.11 The 4 June 2024 Oxfam article stated: ‘Living conditions are so appalling that in Al-Mawasi [to where many Palestinians fled from Rafah], there are just 121 latrines for over 500,000 people – or 4,130 people having to share each toilet [Oxfam considers this a conservative figure as it is estimated that at least 550,000 people were in Al-Mawasi].’^{[footnote 98]}

9.3.12 On 6 June 2024, the WHO published issue 33 of its emergency situation update, covering the period 7 October 2023 to 6 June 2024, which stated: ‘Limited access to proper WASH facilities, compounded by overcrowding, continue to contribute to the rise in infectious diseases, including diarrhoeal illness and hepatitis A.’^{[footnote 99]} WHO reported a link between limited access to proper WASH facilities and an increase in infectious diseases in the 11 emergency situation updates it published between 3 March 2024 and 6 June 2024.^{[footnote 100]}

9.3.13 On 18 June 2024, the UN Environment Programme (UNEP) published a report on the ‘Environmental Impact of the Conflict in Gaza’, citing various sources, which stated:

‘All sources of water to Palestinians in Gaza - the Coastal Aquifer via wells, desalinated water supplied by the three Gaza desalination plants, piped water from the Israeli company Mekorot, and the small scale water suppliers - have been disrupted, as have wastewater treatment and disposal facilities.

‘… The pipelines supplying water from Israel have been partially functioning. After an initial shutdown, where the water flowing through the three connections was stopped … The Humanitarian Cluster covering WASH (the WASH Cluster) reported an average daily flow… during March 2024… [of] less than a quarter of the daily flow before the escalation.

‘… Displacement of more than a million people to the south of Gaza has put immense pressure on water and sanitation services there… Much of the untreated sewage released into the environment in the Gaza Strip is likely to be concentrated in the south, where the largest number of people have been located for much of the conflict.

‘The available water supply in April 2024 was estimated to be 2-8 litres per capita per day (lcd) compared to 85 l/c/d before October 2023: quantity varies based on the geographic location, availability of water resources, and damage to water infrastructure. Small scale (Short Term Low Volume) private operators have become one of the primary source of water supply… The cost of water from water tankers to end users has risen dramatically, from 20 NIS [Israeli New Shekels] [around £4.25 GBP^{[footnote 101]}] before 7 October [2023] to 150 NIS [around £31.89 GBP^{[footnote 102]}] in April 2024. Households, humanitarian shelters and IDP centres have reported that they have been forced to resort to rationing water supplies for drinking and cooking, with people forced to forgo personal hygiene and sanitation needs. People have been forced to use alternative water sources for drinking, such as utilizing traditional agricultural wells containing brackish water, often ingesting saline water (with a salt content exceeding 3,000 milligrams per litre), exposing themselves to pesticides and other chemicals usually present in these types of wells.

‘… The possible seepage of sewage containing pathogens and chemical pollutants into the aquifer poses a health risk to anyone extracting and using untreated water directly from wells. Further deterioration of the aquifer from sewage infiltration will compound risks to health from poor water quality, depending on how quickly it will be possible to rebuild a reliable supply of safe water (by rebuilding water treatment facilities and/or by supplementing water extracted from the aquifer with fresh water from desalination plants).’^{[footnote 103]}

9.3.14 The same source also stated: ‘The lack of clean water and sanitation disproportionately affects women and girls, impacting their ability to manage menstrual hygiene safely and with dignity.’^{[footnote 104]}

9.3.15 On 25 June 2024, the Integrated Food Security Phase Classification (IPC) Global Initiative, ‘an innovative multi-partner initiative for improving food security and nutrition analysis’^{[footnote 105]} published an acute food insecurity snapshot report which stated: ‘By the end of May [2024]… nearly 70 percent of WASH facilities across the Gaza Strip were damaged or destroyed.’^{[footnote 106]}

9.3.16 On 1 July 2024, the OCHA published ‘Humanitarian Situation Update #185’ which stated: ‘Piles of garbage and sewage continue accumulating in Gaza, rotting in the heat near displacement sites, with the stench being so pervasive as to cause nausea, reported the UNRWA Director of Planning, Sam Rose. Amid desperate sanitary conditions, the extreme heat and the lack of clean water continue to fuel the spread of infectious diseases…’^{[footnote 107]}

9.3.17 The OCHA 3 July 2024 ‘Reported impact snapshot’ stated: ‘Two out of three water pipelines coming from Israel are partially operational, as of 1 July [2024]. Two out of three water desalination plants are intermittently operational. On 30 June and 1 July [2024], the two plants temporarily ceased operations due to lack of fuel.’^{[footnote 108]}

9.4 Poverty

9.4.1 In December 2023, The World Bank published an update on the ‘Impacts of the Conflict in the Middle East on the Palestinian Economy’, which it finalised at the end of November 2023. Citing various sources, it stated:

‘Poverty was already severe in Gaza before the war. Unofficial estimates show that almost 60 percent of Gazans were already poor on the eve of the conflict, with 8 out of every 10 Gazans already dependent on aid.

‘… Massive internal displacement, destruction of homes, assets and productive capacity, along with a deep recession have pushed even more Gazans below the poverty line and deepened poverty for those already vulnerable. Multidimensional poverty^{[footnote 109]} in Gaza has also skyrocketed due to the hostilities that has seen the discontinuation of school access for children, as well as the difficulties related to accessing health and other basic services. The overwhelming majority of Gazans are estimated to be living in multidimensional poverty [the last official measure of multidimensional poverty was in 2017 when the World Bank estimated that it stood at 45%^{[footnote 110]}]’^{[footnote 111]}

9.4.2 The May 2024 ESCWA and UNDP joint report stated ‘Given [the number of job losses reported by the ILO and] that already 89 per cent of wage employees in the private sector in Gaza earned less than the State of Palestine minimum monthly wage (697 NIS [£148.65 GBP^{[footnote 112]}) in 2022 [according to the main findings of a Labour Force Survey in 2022 by the Palestinian Central Bureau of Statistics], even in the best-case scenario, a considerable share of people in Gaza will be living in extreme poverty.’^{[footnote 113]}

9.4.3 The World Bank May 2024 update on the economic impacts of the conflict stated:

‘New results from the 2023 household survey show that poverty was increasing already before the conflict. The latest nationally representative data… is from the PECS [Palestinian Expenditure and Consumption Survey] survey conducted in 2023. Before the start of the current conflict… poverty rates were around… 63.7 percent [in Gaza]…

‘… As a result of the conflict, nearly every Gazan now lives in poverty - at least over the short term…’^{[footnote 114]}

9.5 Food security

9.5.1 The Sphere Handbook set out a minimum standard practice in humanitarian response for general food security and food assistance, that acceptable food consumption should be present in at least 35% of targeted households (or more than 42% if oil and sugar are provided), and that at least 5 main food groups should be consumed regularly.^{[footnote 115]} The Handbook also noted minimum food energy requirements of 2,100 kilocalories per person per day.^{[footnote 116]}

9.5.2 The UN World Food Programme (WFP) report of 6 December 2023 set out its findings on food security from the 399 telephone surveys it conducted from 27 to 30 November 2023, during a humanitarian pause (see relevant Water, sanitation and hygiene (WASH) paragraph for details of sample size and methodology). CPIT has placed data from the report into the table below^{[footnote 117]}:

	Northern Governorates (Gaza & North Gaza)	Southern Governorates (Deir Al Balah, Khan Younis, and Rafah)
Households with inadequate (poor or borderline[footnote 118]) food consumption	97%	83%
Households adopting extreme consumption strategies to cope with food shortage	95%	82%
Suffering severe levels of hunger	48%	38%
Reporting going at least one full day and night without food (% of participants who did this for more than 10 days in prior month)	9 out of 10 (18%)	2 out of 3 (13%)
Households’ access to cooking fuel	25% burning waste as main source, rest using firewood or wood rubbish	7% no access to any sort of fuel, 11% burning waste, rest using firewood or waste wood
Households reliant on humanitarian assistance for food	1 in 3	1 in 2

9.5.3 The WFP 14 December 2023 ‘Food Security Update’ report, which focused on IDPs in the southern governorates only, presented its findings from the 151 telephone surveys it conducted between 3 and 12 December 2023, after the humanitarian pause ceased (see relevant Water, sanitation and hygiene (WASH) paragraph for details of sample size and methodology), as a direct comparison with its findings from its November surveys. CPIT has placed data from the report into the table below^{[footnote 119]}:

	27-30 November 2023 (during the humanitarian pause)	3-12 December 2023 (after the pause)
IDP households with inadequate (poor or borderline[footnote 120]) food consumption	83%	93%
IDP households with poor food consumption	39%	66%
IDP households adopting extreme consumption strategies to cope with food shortage	82%	96%
IDPs aware of individuals resorting to wild or raw food due to hunger	42%	49%
Suffering severe levels of hunger	38%	56%
IDP households’ access to cooking fuel	7% no access to any sort of fuel	15% no access to any sort of fuel, 13% burning solid waste as primary source

9.5.4 The same source stated:

‘Results indicated that nearly all of IDP households in the southern governorates are resorting to extreme consumption coping strategies (96%), to deal with the lack of food or money to purchase food [based on 5 consumption-based Coping Strategies: 1) reliance on less preferred/less expensive food; 2) borrowing food from family/friends; 3) limiting meal sizes; 4) restricting adults’ consumption so small children can eat; 5) reducing number of daily meals^{[footnote 121]}]. Almost all strategies were consistently applied for an average of around seven days. The only strategy that exhibited a significantly lower average (of 3 days) is borrowing food or relying on assistance from friends or relatives… indicating that the option of help and support from others is no longer possible. This trend was also found to be consistent when comparing results from both the pause period and after.’^{[footnote 122]}

9.5.5 On 18 March 2024, the IPC published a report of its review which stated: ‘In the first FRC [Famine Review Committee] review of the situation in Gaza, conducted in December 2023, the FRC concluded that there was Catastrophic food insecurity in all governorates in the Gaza Strip.’^{[footnote 123]}

9.5.6 The same source also stated ‘… [I]n the North Gaza and Gaza Governorates… The Famine threshold for acute food insecurity has already been far exceeded and the steeply increasing trend in malnutrition data indicates that it is highly likely that the Famine threshold for acute malnutrition has also been exceeded.’^{[footnote 124]}

9.5.7 The March 2024 IPC Gaza report also stated the following regarding food availability:

‘Food from own production as well as individual, organizational, or shops stocks can be considered nearly exhausted. Field reports have been received of people scavenging in building rubble in search of food or consuming animal feed, but these sources of food are also being exhausted. It is estimated that only a maximum of 10-15% of the food needs in terms of Kilocalories have been entering in the northern governorates in the period January – February 2024… The residual food sources coming from looting and scavenging are finite resources and it is unknown at what point even this strategy will be exhausted.’^{[footnote 125]}

9.5.8 On 2 April 2024, WHO published issue 27 of its Emergency Situation Update which stated: ‘According to MOH [Ministry of Health] reports, 28 patients have died due to complications of dehydration and SAM [severe acute malnutrition, including 25 children less than five years old.’^{[footnote 126]} It is noted that the March 2024 IPC Gaza report previously stated that the MOH count of deaths from malnutrition and dehydration, started on 28 February 2024, ‘… may not be representative, [but] they are indicative of an alarming and rapidly worsening situation.’^{[footnote 127]}

9.5.9 The joint EU, UN, and The World Bank preliminary damage assessment report stated: ‘Food prices in Gaza increased by 39%, quarter-on-quarter (q/q), in Q4 2023, driven by reduced access to food, heightened transportation costs, and lower volumes of aid.’^{[footnote 128]}

See Annex 1 of the report for information about the methodology used for, and the limitations of, the assessment.

9.5.10 On 4 April 2024, Oxfam published an article which stated:

‘People in northern Gaza have been forced to survive on an average of 245 calories a day - less than a can of beans - since January [2024]…

‘The minuscule amount of food represents less than 12 percent of the recommended daily 2,100 calorie intake needed per person…

‘… Oxfam’s analysis is based on the latest available data used in the recent Integrated Food Security Phase Classification (IPC) analysis for the Gaza Strip. Oxfam also found that the total food deliveries allowed into Gaza for the entire 2.2 million population - since last October [2023] - amounted to an average of just 41 percent of the daily calories needed per person.

‘… Oxfam also found that less than half the number of food trucks needed to reach the daily 2,100 calories intake for everyone are currently entering Gaza. Using IPC and UNRWA data, Oxfam’s analysis found that an absolute minimum of 221 trucks of food alone are needed every day, not accounting for wastage or unequal distribution. Currently just 105 trucks of food are entering Gaza daily on average [between 21 February and 27 March 2024, inclusive, excluding an average of 8 trucks a day that entered during this period and which may have included food as part of the consignment].

‘… In addition to the limited availability of food, the ability to find or buy a nutritious, varied diet is not feasible across Gaza. For the little fruit and vegetables still available, extreme price rises due to scarcity have put them out of reach for most people. Specialized nutrition products and centers to treat malnourished children are also difficult or impossible to find.’^{[footnote 129]}

9.5.11 On 22 May 2024, the World Food Programme (WFP) published an article entitled ‘Gaza updates: WFP targets soup kitchens as supplies dwindle and bakeries close in Rafah’ which stated:

• ‘… There are currently no food distributions taking place in the south of Gaza except for some limited stocks that are given to community kitchens for hot meals…
• ‘All bakeries in Rafah have shut down. However, WFP is still able to support six bakeries in Central Gaza, four in Gaza City and, since Monday (21 May [2024]), one in Jabalia…
• ‘The limited distribution of food parcels and wheat flour in central and northern Gaza is ongoing…
• ‘Four bakeries are open and operating in Gaza City, providing essential bread in the north.’^{[footnote 130]}

9.5.12 The IPC Global Initiative 25 June 2024 update stated:

‘Although with some disruptions, in March and April [2024] the amount of food deliveries and nutrition services provided to the northern governorates increased. These appear to have temporarily alleviated conditions in the northern governorates. In this context, the available evidence does not indicate that Famine is currently occurring.

‘… The latest data show that, to be able to buy food, more than half of the households had to exchange their clothes for money and one third resorted to picking up trash to sell. More than half also reported that, often, they do not have any food to eat in the house, and over 20 percent go entire days and nights without eating.

‘… By the end of May [2024], 57 percent of agricultural land had been destroyed or severely damaged, limiting the food system’s functionality.’^{[footnote 131]}

9.5.13 Noting hostilities and restricted humanitarian access as the key drivers, the same source also provided data showing which of the IPC Phases Gazans were found to meet (as a percentage of a 2.25 million analysed population) between 1 May and 15 June 2024, overall and according to 3 geographical areas of Gaza.^{[footnote 132]} CPIT has placed this information into the table below:

IPC Phase	Northern governorates (North Gaza & Gaza)	Middle governorates (Deir Al-Balah & Khan Younis)	Southern governorates (Rafah)	Overall (all of the Gaza Strip)
1 – Minimal	0%	0%	5%	0.4%
2 – Stressed	0%	5%	10%	5%
3 - Crisis	35%	55%	40%	51%
4 – Emergency	45%	25%	35%	29%
5 - Catastrophe	20%	15%	10%	15%

9.5.14 For more information about the IPC Acute Food Insecurity scale, which has become the global standard for classification, see page 2 of The IPC Famine Fact Sheet.^{[footnote 133]}

9.5.15 In terms of absolute numbers, the IPC Global Initiative June 2024 update also stated: ‘About 2.13 million people [95% of the 2.25 million population analysed by the IPC] across the Gaza Strip faced high levels of acute food insecurity classified in IPC Phase 3 or above (Crisis or worse) between 1 May and 15 June [2024], including nearly 343,000 people who experienced catastrophic food insecurity (IPC Phase 5).’^{[footnote 134]}

9.5.16 For the per kilo prices of some specific food items in October 2023 (after the start of the current conflict), see a report published by the Palestinian Central Bureau of Statistics (PCBS) on 8 November 2024.^{[footnote 135]}

9.6 Children

9.6.1 A BBC news article published on 4 December 2023 noted:

‘Medics working in the Gaza Strip are using a specific phrase to describe a particular kind of war victim.

‘”There’s an acronym that’s unique to the Gaza Strip, it’s WCNSF - wounded child, no surviving family - and it’s not used infrequently,” Dr Tanya Haj-Hassan who works with Doctors Without Borders told BBC News…

‘… Determining the precise number of orphaned children in the Gaza Strip is challenging given the “intensity of hostilities and rapidly evolving situation on the ground”, according to Ricardo Pires, the communication manager at the UN children’s fund Unicef.

‘Mr Pires adds that the organisation attempted to reach hospitals and health staff in Gaza to identify and register children, but “these efforts are proceeding very slowly due to the extremely challenging conditions”.

‘He explained not only was it “almost impossible” to identify safe, temporary care arrangements due to “chaotic and overcrowded” shelters and hospitals, but “the normal system to identify document, trace and reunite children with relatives is barely functional”.’^{[footnote 136]}

9.6.2 On 5 January 2024, UNICEF published an article which stated:

‘… [L]iving conditions for children continue to rapidly deteriorate, with increasing cases of diarrhea and rising food poverty among children, raising the risk of mounting child deaths.

‘… Cases of diarrhea in children under five years of age rose from 48,000 to 71,000 in just one week starting 17 December [2023], equivalent to 3,200 new cases of diarrhea per day. The significant increase in cases in such a short timeframe is a strong indication that child health in the Gaza Strip is fast deteriorating. Before the escalation in hostilities, an average of 2,000 cases of diarrhea in children under five were recorded per month. This recent climb represents a[n]… increase of about 2000 per cent.

‘… Evidence has shown that children with poor health and nutrition are more vulnerable to serious infections like acute diarrhea. Acute and prolonged diarrhea seriously exacerbates poor health and malnutrition in children, putting them at high risk of death.’^{[footnote 137]}

9.6.3 On 1 February 2024, ACAPS, an independent organisation that provides humanitarian data and analysis to assist with disaster response^{[footnote 138]}, published a report about the impact of the conflict on children in the Gaza Strip. The report, which cited various sources including 6 key informant interviews [KIIs] with operational responders and organisations that specialise in certain population groups with specific needs^{[footnote 139]}, stated:

‘Before the current hostilities, children comprised 47% (1.1 million) of Gaza’s population; since 7 October 2023, the conflict has affected nearly all of them. Children are exposed to death, injury, and the loss of family and homes, and they endure physical and psychological trauma. The conflict has led to the destruction of safe spaces such as schools and hospitals and the denial of humanitarian aid access, leaving children in overcrowded shelters with limited access to essential goods and services. The hostilities particularly affect children under five years old, displaced children, unaccompanied and separated children (UASC), and children with disabilities or with family members with disabilities because they often are unable to flee attacks and are at high risk of abandonment, malnutrition, and trauma.’^{[footnote 140]}

9.6.4 On 2 February 2024, UNICEF published a summary of the press briefing of the same date, given by its State of Palestine Chief of Communication, Jonathan Crickx, at the Palais des Nations [United Nations office] in Geneva:

‘“UNICEF estimates that at least 17,000 children in the Gaza Strip are unaccompanied or separated…

‘“… This corresponds to 1% of the overall displaced population - 1.7 million people.

‘“Of course, this is an estimation since it is nearly impossible to gather and verify information under the current security and humanitarian conditions.

‘… “Children’s mental health is severely impacted. They present symptoms like extremely high levels of persistent anxiety, loss of appetite, they can’t sleep, they have emotional outbursts or panic every time they hear the bombings.

‘“Before this war, UNICEF was considering that more than 500,000 children were already in need of Mental Health and Psychosocial support [MHPSS] in the Gaza Strip. Today, we estimate that almost all children are in need of MHPSS, more than 1 million children.

‘… “… The only way to have this mental health and psychosocial support delivered at scale is with a ceasefire…”’^{[footnote 141]}

9.6.5 The Global Nutrition Cluster (GNC) 18 February 2024 report stated: ‘Infant feeding practices, suboptimal before the crisis, have further deteriorated, and an increased number of infants now rely on formula milk for survival – which requires safe and clean water. The scarcity of clean drinking water in Gaza will further expose young children to an increase in the risk of infection and subsequently malnutrition.’^{[footnote 142]}

9.6.6 On 19 February 2024, a report entitled ‘Crisis in Gaza: Scenario-based Health Impact Projections’ was published by the London School of Hygiene and Tropical Medicine, the Health in Humanitarian Crises Centre, and the Johns Hopkins Center for Humanitarian Health. The report stated: ‘The ongoing war in Gaza has precipitated a nutritional emergency for children. Before the current conflict, the global acute malnutrition (GAM) and severe acute malnutrition (SAM) prevalences were low amongst children 6-59 months (3.2% and 0.4%, respectively). As of 7 Feb 2024, we project they had already risen significantly (14.1% and 2.8%, respectively), albeit with likely geographical variations.’^{[footnote 143]}

9.6.7 In April 2024, UN Women published a report within its Gender Alert series which stated: ‘UN Women estimates more than 6,000 mothers may have been killed, leaving 19,000 children orphaned.’^{[footnote 144]}

9.6.7 On 27 May 2024, the UN Human Rights Council (HRC) published an advance, unedited, version of a ‘Report of the Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel’, citing various sources, which stated:

‘Siege, hostilities and displacement have had a disproportionate impact on groups in vulnerable situations and their equal enjoyment of fundamental rights, including children and newborns… Children have experienced multifaceted effects and at least 28 have died due to acute malnutrition and dehydration. Children are also particularly vulnerable to the spread of infectious diseases.

‘… Attacks on residential buildings have resulted in significant life-altering physical, emotional and cognitive challenges for affected children, many of whom were pulled from the rubble with serious injuries… Around 1,000 children had had one or more limbs amputated by the end of November 2023, some performed without anaesthesia. Attacks also severely impacted infrastructure essential for children’s wellbeing, including hospitals, schools and basic services, resulting in an increased numbers of deaths and preventing adequate treatment for the injured. The health, educational and social effects for children will be lifelong and impact generations. The Commission is concerned by the long-term psychological impact on children who are suffering from increasing symptoms of post-traumatic stress.

‘… [T]housands of children… [have lost] one or both parents… [or have been] separated from their families in the chaos of hostilities… According to the Gaza Ministry of Health, at least 15,173 children in Gaza have lost one or both parents since 7 October [2023].’^{[footnote 145]}

9.6.9 On 29 May 2024, the OCHA published a humanitarian situation update -which stated: ‘A post-distribution monitoring survey conducted by the Nutrition Cluster shows that… in May [2024]… 95 per cent of children aged six to 23 months [were] eating two or less different food groups per day. Moreover, 85 per cent of children did not eat for a whole day at least once in the three days before the survey was conducted. Lack of dietary diversity is one of the key drivers of acute malnutrition…’^{[footnote 146]}

9.6.10 On 26 June 2024, the OCHA published a humanitarian situation update covering events between 10 and 23 June 2024 which stated:

‘Partners continue to conduct Mid-Upper Arm Circumference (MUAC) screenings in shelters and healthcare facilities across the Gaza Strip. Since mid-January [2024], 117,209 children aged 6-59 months have been screened for malnutrition, including 11,903 children screened so far in June [2024]. Of the total, 8,505 have been diagnosed with acute malnutrition and have been receiving eatment in line with the simplified protocols; these include 6,634 children diagnosed with Moderate Acute Malnutrition [MAM], and 1,874 with severe acute malnutrition (SAM).’^{[footnote 147]}

9.6.11 The Norwegian Refugee Council (NRC) 27 June 2024 Update, quoting its Education Officer in Gaza, stated: ‘“We are noticing that most children have to work to help their families. They are put at risk of violence and exploitation while trying to provide a living for the household. The pressure of what is happening wears them down. Trauma and chronic stress are recurrent…”’^{[footnote 148]} The update did not quantify or define what was meant by ‘most’.

9.7 Education

9.7.1 On 13 November 2023, the PCBS published a report based on data from the Ministry of Education and the Ministry of Higher Education and Scientific Research, which stated ‘… [A]ll schools in [the] Gaza Strip have been suspended/closed as of the beginning of the… [current conflict, starting on 7 October 2023], depriving about 608 thousand students of their right to school education.’^{[footnote 149]}

9.7.2 The ‘Freedom in the World 2024 – Gaza Strip’ report stated: ‘… [V]irtually all university facilities and over 300 public and UNRWA schools were partially or completely destroyed. UN officials reported that 69 percent of all school buildings had sustained significant damage by year’s end [2023]. Many of the buildings that survived were used as shelters by displaced civilians, or as bases and detention centers by combatants.’^{[footnote 150]}

9.7.3 The joint EU, UN, and The World Bank preliminary damage assessment report stated:

‘Damage to education infrastructure [up to the end of January 2024] amounts to US$341 million [a little over £259.5 million GBP^{[footnote 151]}, accounting for 1.8% of the total physical damage and corresponding monetary impact of the conflict^{[footnote 152]}]. The education system in Gaza has effectively collapsed, impacting all of the 625,000 students and 22,564 teachers. An estimated 56 school facilities have been destroyed, and 219 have been partially damaged. Many remaining schools are being used as shelters for IDPs. Tertiary education institutions have significantly suffered too, with an estimated 17 universities and college campuses, 63% of the assessed campuses, destroyed or partially damaged. Casualties among students and teachers continue to rise, emphasizing the profound human impact of the crisis.

‘… To date, half a year of schooling is effectively lost, leaving school-aged children missing critical instructional hours and losing foundational skills essential to achieve a better livelihood in their future… The education system will take years to operate even at pre-conflict levels. Surviving students and teachers are experiencing psychosocial trauma with varying levels of severity.’^{[footnote 153]}

See Annex 1 of the report for information about the methodology used for, and the limitations of, the assessment.

9.7.4 On 5 April 2024, the OCHA published ‘Humanitarian Needs and Response Update - 26 March - 01 April 2024’ which stated:

‘… A new Satellite-derived Damage Assessment conducted by the Education Cluster concludes that at least 67 per cent of schools in Gaza will either need full reconstruction or major rehabilitation work to be functional again. The analysis also provides evidence that complements reports, photos, and videos previously received by the Education Cluster “showing that schools are being used for military operations… In total, about 38 per cent of school buildings (212) have been “Directly Hit” since 7 October [2024], 30 per cent have been “Damaged,” 18 per cent are “Likely or Possibly Damaged,” and 12 per cent have no reported damage. The category “directly hit” excludes 35 incidents where school playgrounds but not structures were hit, which are classified under the “damaged” category. Some 84 per cent (94 out of 212) of directly hit schools are in the Gaza governorate, followed by Khan Younis, North Gaza, and Deir al Balah. Among the 122 directly hit schools, 58 per cent (112) are public schools, 29 per cent (62) are UNRWA schools, and 13 per cent (28) are private schools. The assessment additionally finds that 188 school buildings that have been used as IDP shelters have been either directly hit or damaged. In total, 53 schools are now classified as destroyed and 38 schools have lost at least half of their structures.’^{[footnote 154]}

The mentioned satellite-derived damage assessment data can be found on the Occupied Palestinian Territory (OPT) Education Cluster’s ‘Damaged Schools Dashboard – Gaza’, started in 2023 and updated periodically.^{[footnote 155]} 

9.7.5 On 16 April 2024, Save the Children published an article which stated:

‘Previously 503,500 children attended, and 18,900 teachers taught at the school buildings which have now [as of 30 March 2024] had a direct hit or sustained major or moderate damage. Out of the 16 university campuses in Gaza, 4 have been destroyed, and 10 have been severely or moderately damaged.

‘… When children are out of school for a long period, their learning does not just stop but is also likely to regress. We know from previous crises that the longer children are out of school, the greater the risk that they do not return. This risks their prospects in the longer-term, including their income, and their mental and physical health, while they may also be at greater risk from violence and abuse.’^{[footnote 156]}

9.7.6 The May 2024 ESCWA and UNDP joint report stated: ‘The halting of classes during the war and the destruction of schools in Gaza has had a significant impact on the expected years of schooling, which is assumed to [have] decreased by 0.5 years after six months of war. Each additional month of war will lower the expected years of schooling by 0.5 years, leading to the significant decline of expected years of schooling of two years if the war continues beyond nine months.’^{[footnote 157]}

9.7.7 The OCHA ‘Gaza Humanitarian Response Update’ covering 20 to 26 May 2024 stated: ‘… [A]ccording to the new satellite-derived damage assessment, 85.8 per cent of schools have sustained some level of building damage.’^{[footnote 158]}

9.7.8 On 13 June 2024, the Norwegian Refugee Council (NRC) published ‘On-the-record update #3 on situation in Gaza, Palestine’, based on updates from its teams in Gaza, which stated: ‘June usually marks the end of the school year, but for children in Gaza, it marked an entire year of learning loss, with schools closed and formal education suspended since 7 October [2023].^{[footnote 159]}

9.7.9 On 21 June 2024, the OCHA published ‘Humanitarian Situation Update #181’ which stated:

‘On 21 June [2024], the Palestinian Ministry of Education (MoE) reported that about 39,000 high-school students in Gaza have been deprived of the opportunity to take their General Secondary Examinations (also known as Tawjihi) that are scheduled to begin on 22 June [2024]… Overall, some 625,000 students have been out of school in Gaza since October 2023 due to the escalation of hostilities and, as of 11 June [2024], more than 7,000 students and 378 educational staff have been killed in Gaza according to the MoE. Within this context, and given large-scale damage to education infrastructure, Education Cluster partners continue to establish and expand Temporary Learning Sites (TLSs) for school-aged children in and around IDP shelters, which currently serve over 17,000 children in Khan Younis and Deir al Balah; according to the Cluster, these spaces are critical for offering children non-formal learning as well as opportunities to benefit from recreational and mental health and psychosocial support interventions.’^{[footnote 160]}

9.7.10 The OCHA ‘Gaza Humanitarian Response Update’ covering 10 to 23 June 2024 stated:

• ‘The [Education] Cluster continues to establish and expand Temporary Learning Sites (TLSs) for school-aged children in and around IDP shelters, including in informal sites. In addition to allowing children to engage in structured education activities, TLSs allow children to benefit from awareness-raising sessions provided by other Clusters on a range of issues, such as unexploded ordnance, gender-based violence and services for their protection.
• ‘… Safety and security concerns remain a significant factor hampering the Education response. Many parents have expressed fear about sending their children to TLSs, which limits children’s access to provided services.
• ‘Notwithstanding recent improvements, the lack of space for establishing TLSs is greatly affecting the Education emergency response. This is due to the continued use of schools as shelters and the limited availability of land in informal displacement sites to establish tents for educational activities.
• ‘The lack of fuel remains a major impediment; no requests for fuel by Education Cluster partners have been approved, preventing them from carrying out urgent activities.
• ‘Limited capacity continues to hamper the scaling up of the Education Cluster response; while many national NGOs are supporting the Cluster response, they lack the required resources, including funds and supplies, to increase the provision of recreational and psychosocial support activities. Furthermore, the lack of educational material available on the local market has caused prices to increase dramatically.
• ‘The Education Cluster response remains underfunded, with only 35 per cent of the required funds received.’^{[footnote 161]}

9.7.11 The OCHA 3 July 2024 ‘Reported impact snapshot’, citing the Education Cluster (unless otherwise noted) as the source of figures yet to be verified by the UN stated:

• ‘~625,000 students with no access to education.
• ‘7,993 students and 391 educational staff killed (source: MoE [Ministry of Education], as of 2 July [2024].
• ‘88% of all school buildings (497 out of 563) sustained some level of damage, including 54% directly hit (as of 3 May [2024]).
• ‘69% of school buildings used as IDP shelters (238 out of 345) were directly hit or damaged (as of 3 May [2024]).’^{[footnote 162]}

9.8 Health and healthcare

9.8.1 The Sphere Handbook set out a number of key indicators for minimum standard practice in humanitarian response for health systems and essential healthcare. See the Handbook for details.^{[footnote 163]}

9.8.2 On 1 November 2023, the United Nations (UN) published an article entitled ‘Israel-Palestine crisis: UN welcomes first medical evacuations from Gaza’ which stated: ‘WHO said that 81 people had managed to cross into Egypt for [medical] treatment… [T]he Rafah passenger terminal between Egypt and Gaza had been allowed to open on an exceptional basis Wednesday morning [1 November 2024] for the first time since 7 October [2023], to allow the departure from the enclave of some wounded Palestinians…’^{[footnote 164]}

9.8.3 On 14 February 2024, ACAPS published a report about the impact of the conflict on people with disabilities in the Gaza Strip. The report, which cited various sources^{[footnote 165]}, stated:

‘The closure of numerous hospitals has brought the strip’s health system to the verge of collapse. As at 7 February 2024, only 13 of the 36 hospitals in Gaza - seven in the north and six in the south - were partially operational. The partially operational hospitals face an overwhelming influx of casualties and are experiencing shortages of electricity, fuel, medicine, and basic supplies. The lack of medical staff is another obstacle to the proper functioning of the healthcare system in Gaza. Approximately 10,700 medical consultations take place in shelters daily. As at 27 December 2023, there were only 342 health personnel available in the Gaza Strip. Before 7 October [2023], the average number of medical consultations per doctor was 113, while there were 1,016 health staff.

‘… Injured people are at risk of long-term impairment. Post-trauma physical rehabilitation is crucial in preventing complications and long-term impairment. As a result of intense conflict, many people have acquired new disabilities… [S]hortages of medicine and equipment to alternatively treat injuries… combined with a lack of medical staff and capacity, have resulted in health facilities resorting to amputations to prevent further infections from wounds.

‘… The prevalence of mental and physical disabilities in the Gaza Strip can be expected to increase significantly as the conflict continues. Before 7 October [2023], mental health was already a major concern in the strip. According to a 2022 survey, over two-thirds (approximately 1.4 million) of the population in the Gaza Strip experienced depression.’^{[footnote 166]}

9.8.4 Humanitarian Outcomes’ March 2024 report, which was based on remote interviews with 21 key informants from humanitarian organisations and donor governments as well as GeoPoll telephone surveys (see relevant paragraph of People in need (PIN) for details of the surveys) stated:

‘The fact that health facilities have been able to continue to operate even as medical staff run out of basic supplies and equipment such as morphine and tourniquets, and must reuse bandage materials, is a testament to these providers [humanitarian aid workers and health staff in Gaza]. Interviewees warn though that many are nearing the limits of human endurance, are exhausted and overwhelmed, and that among all the other needs, mental health support to staff will be critical.’^{[footnote 167]}

9.8.5 The March 2024 IPC Gaza report stated:

‘There are now only four hospitals and two clinics remaining in the Gaza Governorate and two hospitals and two clinics in North Gaza Governorate. All of them operate at a very low level. The degradation of the health system has continued since December 2023… Despite this, operators manage to conduct some activities including vaccination (confirmed for north Gaza). However, there is very limited to no malnutrition treatment in the north… Overall, the health and nutrition services available in the northern governorates are extremely limited and incapable of meeting the large and growing need for healthcare in this area.’^{[footnote 168]}

9.8.6. The joint EU, UN, and The World Bank preliminary damage assessment report stated:

‘The conflict has damaged or destroyed 84% of all health facilities at a cost of U$554 million [a little under £432 million GBP^{[footnote 169]}], accounting for 3.0% of the total physical damage and corresponding monetary impact^{[footnote 170]}, though this is noted to be a conservative figure which excludes the cost of health machinery and equipment, and medication stocks] severely impacting Gaza’s health system. 649 health facilities have been affected. 29 hospitals, representing more than three quarter of the hospitals, have suffered over US$222 million [around £173 million GBP^{[footnote 171]}] in damage. Health centers, clinics, and pharmacies have also incurred significant damages, exacerbating the challenge of providing medical services. Remaining functional health facilities and hospitals continue to face the lack or shortage of electricity supply or fuel for backup electricity generators. The municipality of Gaza City bears the highest burden of the destruction with an estimated US$276 million [around £215 million GBP^{[footnote 172]}] worth of damages. In combination with the extreme levels of violent deaths and injuries, and the mass displacement, and overcrowding, this has caused extremely concerning health consequences. Destruction and continuing hostilities are gravely obstructing ambulance access to the injured and health facilities.’^{[footnote 173]}

See Annex 1 of the report for information about the methodology used for, and the limitations of, the assessment.

9.8.7 On 6 April 2024, the WHO published an article which stated:

‘A WHO-led multi-agency mission accessed Al-Shifa Hospital in north Gaza on 5 April [2024] to conduct a preliminary assessment of the extent of destruction and identify needs to guide future efforts to restore the facility.

‘… Al-Shifa Hospital - once the largest and most important referral hospital in Gaza – is now an empty shell… No patients remain at the facility. Most of thebuildings [sic] are extensively damaged or destroyed and the majority ofequipment [sic] is unusable or reduced to ashes. The WHO team said that the scale of devastation has left the facility completely non-functional, further reducing access to life-saving health care in Gaza. Restoring even minimal functionality in the short term seems implausible and will require substantial efforts to assess and clearthe [sic] grounds for unexploded ordnance to ensure safety and accessibility for partners to bring in equipment and supplies. 

‘… Six months – half a year – into the war, the destruction of Al-Shifa Hospital and Nasser Medical Complex has broken the backbone of the already ailing health system.

‘… Of the 36 main hospitals that used to serve over 2 million Gazans, only 10 remain somewhat functional, with severe limitations on the types of services they can deliver.’^{[footnote 174]}

9.8.8 On 13 May 2024, the German Federal Office for Migration and Refugees (BAMF) published ‘Briefing Notes’, citing various sources, which stated: ‘A lack of fuel has prevented the transfer of medical patients from the north to the south of the Gaza Strip. The UN have warned that hospitals and ambulances would soon be forced to suspend their services due to the lack of fuel.’^{[footnote 175]}

9.8.9 The 28 May 2024 Save the Children press release stated:

‘… [N]o hospital in northern Gaza is currently accessible. Medical workers across Gaza say patients are dying daily due to a shortage in medical supplies, as doctors, nurses, and other health workers continue to be killed or forcibly displaced.

‘… More than 81,026 Palestinians in Gaza remain critically injured and all medical evacuations out of Gaza have come to a halt since… the Rafah crossing [closed] on 7 May [2024]. An estimated 14,000 critically ill and injured patients require lifesaving treatment abroad.’^{[footnote 176]}

9.8.10 The OCHA Flash Update #172 of 29 May 2024 stated:

‘… Al Emirati Maternity Hospital is the only hospital in Rafah that remains functional, although partially, compared with three in early May [2024]. An Najjar Hospital was evacuated on 7 May [2024], and Al Kuwaiti Hospital in Rafah ceased operations on 27 May [2024]… Moreover, only 13 international Emergency Medical Teams (EMTs) coordinated by WHO are currently deployed in Gaza, reports the Health Cluster, down from 19 EMTs prior to 7 May [2024]. On 29 May [2024], the Palestine Red Crescent Society (PRCS) announced [on X, formerly Twitter] that its teams were forced to evacuate the PRCS Al Quds Field Hospital in Al Mawasi area of Rafah due to growing insecurity, including artillery and air bombardments, and evacuation of residents. PRCS is in the process of relocating its field hospital to Khan Younis. On 28 May [2024], PRCS spokesperson, Nebal Farsakh, warned [also on X]… there is no adequate surgical capacity to simultaneously treat all the injured persons…

‘… WHO stressed that Al Ahli Hospital [in Gaza City] is serving twice the number of patients it is designed for, is lacking essential surgical supplies and is unable to conduct life-saving surgeries in the evenings due to lack of specialized staff.’^{[footnote 177]}

9.8.11 Issue 33 of the World Health Organization emergency situation update provided various statistics regarding the situation for health and healthcare in the Gaza Strip as of 6 June 2024, which CPIT has summarised below:

• 17 of 36 (47%) hospitals were partially functional; of those, 14 were partially accessible (due to insecurity and road/entrance damage)
• none of the partially functional hospitals were located in Rafah, jeopardizing the right to health of around 90,000 Gazans located there
• 38 of 97 (39%) primary health care facilities, including active NGOs were functional
• 4 of 9 (44%) field hospitals were fully functional while 1 field hospital (11%) was partially functional
• medical evacuations were halted, but 4,895 patients (38% of 12,760 requests) were medically evacuated via Rafah since October 2023^{[footnote 178]}

9.8.12 The same source provided the following figures about the situation regarding communicable diseases as of 26 May 2024, though it is also noted to have stated that they should be interpreted with caution due to delayed and incomplete data reporting:

• ‘865,157 Cases of acute respiratory infections
• ‘485,315 Cases of diarrhea
• ‘93,690 Cases of scabies and lice
• ‘57,887 Cases of skin rashes
• ‘8,538 Cases of chickenpox
• ‘81,795 Cases of acute jaundice syndrome’^{[footnote 179]}

9.8.13 On 21 June 2024, Médecins Sans Frontières (MSF) (also known as Doctors Without Borders) published an article which stated:

‘Médecins Sans Frontières (MSF) teams in the Gaza Strip, Palestine, are facing critical shortages of essential medicines and equipment. Our teams have been unable to bring any medical supplies into Gaza since the end of April [2024].

‘… Despite medical needs skyrocketing across the Strip, without a significant refill of medical supplies in the coming days, MSF might have to stop or drastically reduce some of our medical activities in Gaza.

‘… In Khan Younis, we were unable to provide general medical consultations for several days in our recently opened Al-Attar healthcare centre, due to the lack of supplies and medications to run activities.’^{[footnote 180]}

9.8.14 On 24 June 2024, Insecurity Insight, an association which collects and analyses data about violence against civilians and damage to civilian infrastructure in armed conflict^{[footnote 181]}, published a report entitled ‘Critical Condition: Violence Against Healthcare in Conflict – 2023’ which stated:

‘In a few months spanning late 2023 and the first few months of 2024… Almost all hospitals and health centers across the strip have been impacted… More than two-thirds of hospitals in Gaza are not functioning – either due to lack of resources or as a result of severe damage by explosive weapons. The remainder are partly functioning and are overwhelmed with an influx of patients and a shortage of resources, staff, and food due to the ongoing blockade. Health workers have been forced to work with a severe shortage of medical supplies, fuel, food, and water. Surgeons have reported carrying out surgeries under torch light due to the lack of electricity and in some cases have been forced to carry out these surgeries without proper anesthesia. Health workers have been forced to work under very insecure and dangerous conditions…

‘Additionally, the war has massively disrupted patients’ continuity of care. Chronically ill patients, including 1,200 dialysis patients, have been “unable to receive care.” After the Turkish-Palestinian Hospital stopped operating after being severely damaged and running out of fuel, around 10,000 cancer patients were left without the necessary special care, medicines, and treatment. Additionally, since October 7, 2023 less than 50% of patients who had applied for permits to leave the Gaza Strip through Rafah for specialized health care have been given permits, of which only 80% were able to do so. Although vaccinations have entered the Gaza Strip, their administration is difficult, since most people are displaced and living in tents or temporary shelters… Across the Gaza Strip few hospitals are still able to provide maternity services, and those that do have a limited number of beds available and fewer midwives and doctors than normal. Additionally, when women give birth, there is “no pain medication, anesthesia or hygiene materials” due to a lack of resources.

‘… Health workers… are exhausted. Additionally, many health workers are also mourning the deaths of their loved ones. While many are extremely traumatized, currently no psychological support is available for them.

‘The destruction of health care infrastructure, universities, and medical institutions has left prospective and current medical students with nowhere to study or train. The killing and detention of hundreds of health care workers, including specialists, hospital directors, heads of departments, and medical students, will likely have an adverse impact on the future of the health care system in Gaza and its rapidly diminishing ability to rebuild the health system, given the extent of the destruction of medical infrastructure.’^{[footnote 182]}

9.8.15 On 1 July 2024, the OCHA published ‘Humanitarian Situation Update #185’ which stated: ‘PNGO [Palestinian NGOs Network]… [said] that about 10,000 people, half of them children, are estimated to have become disabled since October 2023…. PNGO warned that the destruction of hospitals and rehabilitation centres, restrictions on the evacuation of patients, and the limited entry of assistive devices, such as wheelchairs, crutches, hearing aids and medical mattresses, have placed the lives of PwD [people with disabilities] at risk.’^{[footnote 183]}

9.8.16 The same source also stated:

‘On 30 June [2024], the Palestine Red Crescent Society (PRCS), in collaboration with the Palestinian Agricultural Relief Committees and Atfaluna Society for Deaf Children, inaugurated the first shelter site for displaced people with disabilities (PwD) in Deir al Balah. Under the supervision of a specialized PRCS team, this site will host about 100 families and make available tailored support and services for PwD, including relief programmes, health care, rehabilitation, and psychological support.’^{[footnote 184]}

9.8.17 The OCHA Humanitarian Situation Update #185 also stated:

‘… On 30 June [2024], the Ministry of Health highlighted that hospitals are struggling with over 10,000 reported cases of Hepatitis A and 880,000 cases of respiratory illnesses, with diarrhea, skin infections and lice outbreaks also being rampant. Rates of diarrheal infections are already 25 times higher than prior to the conflict, according to WHO. As the situation worsens, growing concerns exist that cholera may become prevalent, “further deteriorating inhumane living conditions,” warned UNRWA.’^{[footnote 185]}

9.8.18 On 21 August 2024, the OCHA published a ‘Gaza Humanitarian Response Update’, covering 5 to 18 August 2024, which stated:

‘The multiple evacuation orders issued by the Israeli forces in Khan Younis and Deir al Balah between 8 and 17 August [2024] have resulted in the loss of essential health services; impacting 17 health facilities in total, including five primary healthcare centers and nine medical points. The distance of these orders is one kilometer or less from four key hospitals: Nasser Medical Complex, Al-Amal and Kuwaiti Palestine Red Crescent Society (PRCS) hospitals, and Al Aqsa Hospital; hindering people’s access to healthcare.’^{[footnote 186]}

9.8.19 See United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) for information specifically about Gaza’s UNRWA-run health services.

10. Humanitarian aid

10.1 United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)

10.1.1 On 15 October 2023, UNRWA published a statement in which its Commissioner-General, Philippe Lazzarini, stated: ‘… [A]s of today, my UNRWA colleagues in Gaza are no longer able to provide humanitarian assistance.’’^{[footnote 187]}

10.1.2 On 14 December 2023, the UN Security Council published a report of the Secretary-General which stated:

‘Today, UNRWA serves as the key lifeline for the population of Gaza amid a complete humanitarian catastrophe, as it is sheltering over a million people, running health centres and distributing life-saving aid… Despite this, UNRWA continues to suffer from chronic underfunding. For UNRWA to be able to continue to play a key stabilizing role in the region and remain the international community’s trusted partner to facilitate the humanitarian response in Gaza, it is essential that it receive strong political and financial support from Member States to find solutions for a sustainable model with predictable and sufficient income.’’^{[footnote 188]}

10.1.3 On 22 February 2024, UNRWA published a ‘Letter from the Commissioner-General to the President of the UN General Assembly’ which stated: ‘It is with profound regret that I must now inform you that the Agency has reached breaking point, with Israel’s repeated calls to dismantle UNRWA and the freezing of funding by donors at a time of unprecedented humanitarian needs in Gaza. The Agency’s ability to fulfil the mandate given through General Assembly resolution 302 [on assistance to Palestine refugees^{[footnote 189]}] is now seriously threatened.’^{[footnote 190]}

10.1.4 Humanitarian Outcomes’ March 2024 ‘Gaza Humanitarian Access Report’ stated:

‘Before the current conflict erupted, UNRWA had 13,000 staff in Gaza working in civil sector roles such as education and health services. Around 3,000 emergency operations staff are still actively working, making UNRWA by far the largest employer of aid workers, with a workforce larger than that of all the other humanitarian missions combined. It also maintains the logistical backbone for operations with its health centres, and its schools and other facilities serving as shelters and aid distribution hubs.

‘The decision by the US government and some other humanitarian donors [to cease funding UNRWA] thereby threatens to undermine the greater part of aid operations – already inadequate – that are taking place in Gaza. Recognising this, 19 international NGOs supporting programmes in Gaza issued a joint statement urging the restoration of funding, insisting, “The work of UNRWA cannot be replaced by other agencies.” Regional-level donor representatives also recognise the indispensability of UNRWA at the current time and were said to be discussing potential options between them for filling the gap.’^{[footnote 191]}

10.1.5 On 4 March 2024, UNRWA published a ‘Statement of the Commissioner-General of UNRWA to the General Assembly’ in which he stated:

‘I am here today because UNRWA, the United Nations Agency for Palestine Refugees, is at a breaking point.

‘… 16 countries have paused their funding, totaling 450 million dollars.

‘UNRWA has no capacity to absorb financial shocks. Especially while a war rages in Gaza.

‘I am deeply grateful to the Member States and donors that have maintained or even increased their funding.

‘Thanks to them, the Agency, which is the backbone of humanitarian assistance in Gaza, can continue operating and remains a lifeline for Palestine Refugees across the region.

‘But for how long?

‘It is hard to say. We are functioning hand-to-mouth.

‘… In most conflict situations, humanitarian needs can be addressed by a number of specialized entities.

‘In Gaza, however, UNRWA is so prominent that all partners will continue to rely on our seasoned staff.

‘… Only UNRWA has the footprint and the capacity to deliver services, including education and primary healthcare at scale, in the absence of a full-fledged state authority.

‘… [E]ven as its operational context has worsened and resources have dwindled, the Agency has continued to deliver on its mandate.’^{[footnote 192]}

10.1.6 On 23 March 2024, the United Nations (UN) published an unofficial transcript of the ‘Secretary-General’s press encounter in Al Arish, Egypt’ in which the Secretary-General is reported to have stated:

‘3,000 UNRWA members of staff are the centre of the distribution of aid in Gaza.

‘169 have been killed, and they are going with enormous courage, resilience and determination, supporting the people in Gaza.

‘… I asked Catherine Colonna [former French foreign minister], and the group of Nordic Institutes to look into how UNRWA can be strengthened in order to be able to avoid any Hamas infiltration for any purpose and to guarantee its neutrality in the conflict.

‘We are working hard to make it happen…’^{[footnote 193]}

10.1.7 On 2 April 2024, UNRWA published ‘UNRWA Situation Report #98 on the Situation in the Gaza Strip and the West Bank, including East Jerusalem’ noting all information contained therein was valid as of 22:30 on 1 April 2024, and which stated:

‘UNRWA is disproportionately impacted… [by denial of] access to the north to deliver emergency food assistance and other basic supplies.

‘… [I]n the month of March [2024] over half of all UN supplies delivered via Rafah and Kerem Shalom were UNRWA supplies.  The UN Emergency Humanitarian Relief Coordinator Martin Griffiths said, “UNRWA is the backbone of the humanitarian operation in Gaza. Any effort to distribute aid without them is simply doomed to fail.”’^{[footnote 194]}

10.1.8 On 7 May 2024, the International Crisis Group (ICG), an organisation that provides independent analysis and advice on how to prevent, resolve or manage conflict^{[footnote 195]}, published an article which stated: ‘… UNRWA… [has had] one in every 100 of its staff killed – the highest staff death toll in UN history.’^{[footnote 196]}

10.1.9 On 3 July 2024, UNRWA published ‘UNRWA Situation Report #117 on the Situation in the Gaza Strip and the West Bank, including East Jerusalem’ noting all information contained therein was valid as of 22:30 on 1 July 2024, which stated:

• ‘As of 1 July [2024], the total number of UNRWA colleagues killed since 7 October [2023] is 193.
• ‘UNRWA is working to verify the details of incidents reportedly affecting UNRWA premises…
• ‘… 450 incidents impacting UNRWA premises and the people inside them have been reported since the beginning of the war (some with multiple incidents impacting the same location), including at least 72 incidents of military use and/or interference at UNRWA premises. 188 different UNRWA installations have been impacted [this figure represents more than half of more than half UNRWA’s 350 installations across the Gaza Strip^{[footnote 197]}].
• ‘UNRWA estimates that in total at least 520 IDPs sheltering in UNRWA shelters have been killed and at least a further 1,596 injured since the start of the war. UNRWA is still verifying the number of casualties caused by incidents that impacted its installations, and notes that these figures do not include some reported casualties where the number of injuries could not be determined.’^{[footnote 198]}

10.1.10 With regard to UNRWA-run health services, the same source stated:

• ‘As of 24 June [2024], 91 medical points and eight (out of 26) UNRWA health centres were operational. These health centres provide primary health care, including outpatient services, non-communicable disease care, medications, vaccination, antenatal and postnatal health care and dressing for the injured.
• ‘According to the Health Cluster, UNRWA remains one of the largest health actors operating inside the Gaza Strip, contributing to over half of the people reached with health services. Between 7 October [2023] – 23 June [2024], UNRWA has provided over 4.3 million medical consultations in health centres and medical points across the Gaza Strip. In addition to medical consultations, UNRWA continues to provide vaccines with over 120,000 children vaccinated. Following the uptick in malnutrition rates, pregnant and lactating women were also provided with nutritional support including health education and promotion about nutrition and infant breast feeding, with 99,302 women reached.
• ‘… With the support of more than 300 counsellors, UNRWA continues to provide lifesaving psychosocial support (PSS) services in Gaza, including psychosocial first aid, individual and group counselling, fatigue management sessions, recreational activities, Explosive Ordnance Risk Education (EORE) and protection cash assistance, reaching children, youth and adults.
• ‘Since the onset of the conflict, it is estimated that 680,000 IDPs, including 430,000 children, have benefited from a total of 228,042 PSS sessions/activities. From 15 – 22 June 2024, a total of 51,033 IDPs, including 21,253 children, benefited from these services. Specifically, counsellors addressed 1,864 individual consultations and provided 906 group awareness sessions. Additionally, they conducted 1,090 recreational activities engaging 20,768 children. Counsellors also provided 329 EORE sessions to 6,709 adults and 391 sessions to 7,259 children.’^{[footnote 199]}

10.1.11 With regard to its work on food aid, the UNRWA situation report #117 stated:

• ‘… As of 20 June [2024], UNRWA continued to distribute flour in the southern governorates. To date, a total of 380,225 families (nearly 1.9 million people) have been reached, of whom 367,768 families have received two rounds of flour and another 300,978 families have received three rounds.
• ‘As part of its emergency response, UNRWA distributes food parcels in the southern governorates. UNRWA food parcels consist of flour, rice, chickpeas, lentils, cheese, hummus and fish [though the composition of the food parcel may change based on food item availability] and are designed to cover approximately 90 per cent of calorific needs. To date, approximately 210,920 families (nearly 1.15 million people) have been reached, of whom 34,839 families (nearly 215,000 people) have received two rounds of food parcels.
• ‘In addition to distribution of its own food parcels, UNRWA has distributed other in-kind food parcels on behalf of other UN organizations, reaching approximately 1.4 million people.’^{[footnote 200]}

10.2 Other aid agencies

10.2.1 The ‘Freedom in the World 2024 – Gaza Strip’ report stated:

‘During the conflict in late 2023, the offices of many Palestinian NGOs were destroyed, and staff members were killed or displaced. The active combat, heavy Israeli air strikes, and tight restrictions on border crossings made it extremely difficult for international humanitarian organizations to deliver vital assistance to the population… Multiple foreign donor governments and international aid agencies also suspended or withdrew funding from Palestinian NGOs… citing the need for reviews to ensure that they were not inadvertently supporting terrorist activities.’^{[footnote 201]}

10.2.2 Humanitarian Outcomes’ March 2024 report (see relevant paragraphs of People in need (PIN) and Health and healthcare for methodology), stated:

‘Since the beginning of the current conflict, the international aid presence in Gaza has been very small. While 24 international NGOs are supporting programme activities inside Gaza, fewer than half of them have a ground presence themselves [fewer than 10 have managed direct operations in Gaza since the war started^{[footnote 202]}]. The main operational UN agencies (apart from UNRWA, which essentially functions as a local, major service provider) are WFP [World Food Programme] (food aid and logistics), UNICEF (water, medicines, and other emergency supplies), and World Health Organization  (hospital support)…

‘… When asked to name the most present and effective humanitarian providers, survey responses underscored the critical importance of UNRWA to the aid efforts, followed to a much lesser degree by the local authorities (Ministry of Social Development). Other actors making an impact were members of the International Red Cross and Red Crescent Movement (specifically the Palestine Red Crescent Society, the Red Crescent Society of the United Arab Emirates (UAE), and the International Committee of the Red Cross (ICRC) and the local NGO, MA’AN Development Center. The international NGOs cited by at least 10 respondents for their presence and effectiveness inside Gaza were ‘CHF’ (now Global Communities but still referred to by respondents by its former acronym), Catholic Relief Services (CRS), World Central Kitchen (WCK), and Médecins Sans Frontières (MSF).

‘The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) and operational aid agency situation reports provide fewer details about the Arab world response, but it is clear from interviews and survey responses that states like Qatar, UAE, and Jordan are playing prominent roles in aid efforts. The extent to which remittances and diaspora support to individuals and organisations in Gaza has been able to continue and what role they are playing in people’s survival efforts are also unclear.

‘As one interviewee noted, unlike in other response contexts where the international presence can be bloated and intrusive – crowding out local actors while absorbing much of the funding – in the case of Gaza, local actors are overwhelmed and in need of much more external support. Going by the principle that humanitarian response should be “as local as possible and as international as necessary”, they emphasised this benchmark was far from being met.’^{[footnote 203]}

10.2.3 The joint EU, UN, and The World Bank preliminary damage assessment report stated:

‘Of the approximately 980 registered NGOs in Gaza, the majority have ceased operations. While the full extent of the impacts of the conflict is yet to be determined, it has disrupted ongoing programs and activities, and inflicted significant damage on facilities, affecting physical infrastructure and organizational capacities. This includes the loss of headquarters, displacement of staff, and interruptions in communications. Vulnerable groups, particularly children, women, and persons with disabilities that relied heavily on services provided by the NGO sector, are not only bearing the brunt of these disruptions but are in fact in even more dire and expanded need of services provided by the NGO sector.’^{[footnote 204]}

See Annex 1 of the report for information about the methodology used for, and the limitations of, the assessment.

10.2.4 The OCHA Flash Update #149 of 3 April 2024 stated: ‘The HF [the oPt Humanitarian Fund] is… developing an upcoming reserve allocation to bolster the capacity of national NGOs in the central areas of the Gaza Strip and Khan Younis, taking into account anticipated complexities in aid delivery, to ensure a more robust and effective humanitarian response.’^{[footnote 205]}

10.2.5 On 10 May 2024, the OCHA published ‘Humanitarian Access Snapshot - Gaza Strip - 1-30 April 2024’ which stated: ‘On 1 April, seven aid workers employed by World Central Kitchen (WCK) were killed… At least 254 aid workers have been killed in Gaza between 7 October 2023 and 30 April 2024, including 185 UN staff members [including UNRWA staff – see United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)] and 27 staff and volunteers from the Palestine Red Crescent Society (PRCS)… These conditions prompted multiple humanitarian organizations to temporarily pause, suspend, or delay operations.’^{[footnote 206]}

10.2.6 On 14 May 2024, the UN Security Council published a ‘Report of the Secretary-General: Protection of civilians in armed conflict’ which stated: ‘In Gaza… in conflict-related violence from October to December [2023]. The United Nations Development Programme and WHO… lost a staff member each.’^{[footnote 207]}

10.3 Access to humanitarian aid

10.3.1 The International Rescue Committee (IRC) stated in its ‘2024 Emergency Watchlist’ that:

‘Humanitarian access is both the ability of humanitarian actors to reach populations affected by crisis and the ability of affected populations to access humanitarian assistance and services. Moving trucks of supplies will never be enough if they are not carrying the right supplies or humanitarians cannot deliver programming at their destination.

‘… [A] “complete siege” of Gaza [was announced] after October 7 [2023], stopping all food, water and fuel from entering the area from Israel or via the Rafah crossing with Egypt. It subsequently resumed a limited water supply to southern Gaza and started to allow a few trucks of aid to enter Gaza via Rafah, between 10 and around 100 per day, from October 21 [2023]. However, these truckloads of supplies had a very limited impact for two reasons. Firstly, Israel continued to block the entry of fuel needed to transport the aid onwards to where it was most needed within Gaza. Then, secondly, continued massive airstrikes throughout Gaza meant it wasn’t safe for people to attempt to deliver or reach humanitarian assistance, and that no aid could reach the worst-affected areas in northern Gaza.’^{[footnote 208]}

10.3.2 The same source also stated: ‘More than 100 U.N. aid workers were killed in Gaza in the first month of airstrikes during the Israel-Hamas conflict, the largest number of U.N. aid workers to ever be killed in such a short time span, illustrating the scale of security threats that prevented aid workers from delivering programming.’^{[footnote 209]}

10.3.3 On 8 November 2023, the Palestinian Central Bureau of Statistics (PCBS) published a report which stated: ‘Since October 7th, 2023, the number of aid trucks that entered Gaza Strip carrying food, medicine and water is 569 trucks. Yet and unfortunately, they are not even enough to cover the needs of the households in Gaza and are not distributed fairly. The number of trucks per day that entered Gaza Strip in the time before the war was 500 trucks per day, on average of 15,000 trucks per month…’^{[footnote 210]}

10.3.4 The OCHA Flash Update #63 of 8 December 2023 stated:

• ‘[In Rafah] Thousands of people wait for hours in large crowds around aid distribution centres, in desperate need of food, water, shelter, health, and protection.
• ‘On 8 December [2023] the Rafah governorate remained the almost exclusive area in Gaza where limited aid distributions are taking place. In the Khan Younis governorate and the Middle Area, aid distribution has largely stopped over the past few days due to the intensity of hostilities and restrictions of movement along the main roads, except for limited fuel deliveries to key service providers. Access from the south to areas north of Wadi Gaza… came to a halt on 1 December [2023], with the resumption of hostilities.’^{[footnote 211]}

10.3.5 On 12 December 2023, Deutsche Welle (DW), a German international broadcaster^{[footnote 212]}, published an article entitled ‘Israel announces the opening of Nitzana and Kerem Shalom crossings’ which stated:

‘Israel has announced that it will open its Nitzana and Kerem Shalom crossings on Tuesday [12 December 2023] to allow humanitarian aid into Gaza.

‘… Israel’s Coordinator of Government Activities in the Territories (Cogat) says the move will facilitate aid inspections and double aid delivery into Gaza.

‘The Nitzana and Kerem Shalom crossings will be used as security screening points from which trucks will be forwarded to Rafah, Egypt, the only crossing through which aid has gone into Gaza since the start of the war.’^{[footnote 213]}

10.3.6 The UN Security Council’s 14 December 2023 report stated:

‘Starting on 24 November [2023], as part of an arrangement between Israel and Hamas facilitated by Egypt, Qatar and the United States of America… a seven-day humanitarian pause… saw significant increases in the entry of supplies, including fuel, with an average of 170 trucks per day, enabling some aid to reach areas of northern Gaza that had remained inaccessible for weeks. The quantity of aid, which has averaged 80 trucks per day since the pause ended, nevertheless remained wholly insufficient to address the overwhelming need.’^{[footnote 214]}

10.3.7 On 5 February 2024, the OCHA published its ‘Humanitarian Access Snapshot - Gaza Strip - End-January 2024’ report, covering 1 to 31 January 2024, which stated: ‘In January [2024], amid ongoing intense hostilities, the ability of humanitarian missions to support people in need wherever they are across Gaza deteriorated compared with October-December 2023.’^{[footnote 215]}

10.3.8 The 14 February 2024 ACAPS report stated:

‘Given the magnitude of needs and the level of constraints on the humanitarian response, targeted and specific responses are almost impossible. Only a few humanitarian responders are specifically catering to people with disabilities.

‘… In general, people with disabilities face higher challenges in gaining access to what aid is available, and many are not able to move to the areas where humanitarian aid is distributed.’^{[footnote 216]}

10.3.9 On 24 February 2024, Axios, a US-based news and information company founded in 2016^{[footnote 217]}, published an article which stated:

‘… [A] “total breakdown of law and order” is significantly exacerbating the humanitarian crisis in the enclave, three U.S. and Israeli officials told Axios.

‘… U.S. officials say… a security vacuum and desperation have opened the door for armed gangs to attack and loot aid trucks, putting even more pressure on the Strip’s already strained humanitarian system.

‘… Getting aid to northern Gaza has been especially difficult, according to [James] McGoldrick [UN Humanitarian Coordinator] . OCHA is hoping Israel will open a crossing in the north so aid trucks can directly access the areas most in need of supplies.’^{[footnote 218]}

10.3.10 The ‘Freedom in the World 2024 – Gaza Strip’ report stated: ‘Hamas has been accused of corruption in public service delivery and aid distribution, which is crucial to daily life in Gaza…’^{[footnote 219]}

10.3.11 Humanitarian Outcomes’ March 2024 ‘Gaza Humanitarian Access Report’ stated:

‘The telephone survey of Gaza residents conducted for this report [see relevant paragraph of People in need (PIN) for details] in mid-February [2024] found the following.

• ‘Less than 30% of respondents in the north had received any aid at all since the crisis began.
• ‘… [O]nly 3% of people who received help said it was in the form of medical aid or clean water.
• ‘… While the Israeli border restrictions were named as the biggest obstacle to aid coming in, in terms of their own ability to access the aid inside Gaza, the second largest obstacle according to respondents (after distance) was “local officials took or blocked the aid”. A plurality of commenters reported corruption, diversion, and favouritism in distributions, with many remarking on seeing aid for sale in local markets.

‘… In Gaza… the percentage of survey respondents receiving food relative to any other form of aid is notably high (98% of aid recipients got food while only 12% or less received anything else).

‘… [P]eople that managed to access aid mostly reported that it did not meet their most urgent needs.

‘… Deliveries able to get further into Gaza [beyond the Gaza side of the border at the crossing point from Egypt] often cannot reach their intended destination for offloading and orderly distribution. Instead, people in dire need will surround the vehicles and empty them in what humanitarian workers have termed “spontaneous self-distribution”.’^{[footnote 220]}

10.3.13 On 18 March 2024, BAMF published ‘Briefing Notes’, citing various sources, which stated: ‘Aid deliveries are… being [air] dropped over the north of the Gaza Strip. Around 300,000 Palestinians are still believed to be residing there. In addition, 200 tonnes of relief supplies were brought to the Gaza Strip by ship for the first time. Nevertheless, aid groups are protesting that airdrops and sea shipments are far less efficient ways of delivering the massive amounts of aid needed in Gaza than overland transport by truck.’^{[footnote 221]}

10.3.13 The joint EU, UN, and The World Bank preliminary damage assessment report stated:

‘The amount of humanitarian aid that is reaching Palestinians in Gaza is deeply inadequate relative to the needs.

‘… UN facilities, partner facilities, and related member state facilities have been severely damaged, considerably slowing down the humanitarian response. Given the overall destruction of road infrastructure, more crossings into Gaza need to be opened to allow humanitarians to reach all people in need.

‘… Transport sector damages… [are] affecting 62% of roads, including 92% of primary roads, and a significant proportion of vehicles. This has a profound effect… on the ability of relief aid and necessary social services to reach vulnerable populations.

‘… [Massive interruption of mobile and internet connectivity services] also affected operational activities of the humanitarian aid organizations working in Gaza, jeopardizing the already constrained provision of life-saving assistance.’^{[footnote 222]}

See Annex 1 of the report for information about the methodology used for, and the limitations of, the assessment.

10.3.14 On 5 April 2024, Amnesty International (AI) published an article which stated:

‘Israel’s announcement that it has approved the opening of two humanitarian routes into the occupied Gaza Strip, including the temporary re-opening of Erez crossing in northern Gaza and Ashdod port, is a welcome move but is insufficient to tackle the scale of the catastrophic humanitarian crisis in Gaza, said Amnesty International today.

‘… Humanitarians have repeatedly said that a ceasefire is essential to allow them to provide anywhere near sufficient levels of aid…’^{[footnote 223]}

10.3.15 On 6 April 2024, the OCHA published a ‘Humanitarian Access Snapshot - Gaza Strip - 1-31 March 2024’ which stated:

‘In March [2024], heightened violence affecting humanitarian convoys caused disruptions in aid distributions, as crowds in dire need of essential supplies sought resources for their survival. While previous disruptions were mainly centered around the Wadi Gaza Israeli checkpoint in northern Gaza, new issues arose in southern Gaza during March [2024], including increased incidents of theft, disorganized gathering points, and violence affecting humanitarian personnel and assets.

‘… Remaining operational [road] routes are often impassable and heavily congested due to significant infrastructural damage, heavy debris, and UXO [unexploded ordnance] contamination. As a result, the ability of humanitarian organizations to effectively deliver life-saving assistance to those in need remains compromised.’^{[footnote 224]}

10.3.16 On 23 April 2024, the United States Department of State (USSD) published the ‘2023 Country Reports on Human Rights Practices: Israel, West Bank and Gaza; West Bank and Gaza’ which stated the current conflict caused:

‘… an intensification of the longstanding humanitarian crisis in Gaza. Prior to October 7 [2023], the United Nations reported Israel allowed an average of approximately 500 trucks into Gaza daily carrying food, fuel, and commercial goods, which aid groups noted was insufficient to meet the humanitarian needs of Gaza’s population. Between October 7 and December 31 [2023], Israel allowed an average of fewer than 100 trucks into Gaza daily.

‘… Hamas interfered with the movement of… humanitarian workers inside Gaza, setting up roadblocks and attempting to block humanitarian workers inside buildings to prevent them from leaving areas that Israel announced it would bombard [the report did not provide any further information regarding these instances].

‘… Gaza’s 2.3 million Palestinians [were] repeatedly isolated by communications blackouts… The blackouts significantly impacted humanitarian efforts…’^{[footnote 225]}

10.3.17 On 13 May 2024, the Foundation for Defense of Democracies (FDD), a Washington DC-based research institute which describes itself as nonpartisan and focusing on national security and foreign policy^{[footnote 226]}, published an article entitled which stated:

‘Israel on May 12 [2024] opened a third route for humanitarian aid to enter northern Gaza, the Western Erez crossing in Zikim, near the strip’s northern border… [the] new checkpoint has already facilitated the delivery of 36 trucks carrying flour supplied by the World Food Programme from Israel’s Ashdod Port to the Gaza Strip.

‘… Israel… is currently facilitating ground transportation into northern Gaza via three crossings: Western Erez, Eastern Erez, and Gate 96. Near southern Gaza, Israel additionally operates the Kerem Shalom crossing - which Israel has reopened following Hamas’s six attacks on it since May 5 [2024] -  and the Nitzana crossing.

‘… Between October 8 [2023] and May 12 [2024], Israel facilitated transportation of 27,775 trucks carrying 531,160 tons of humanitarian aid to Gazans, including food, water, shelter, and medical supplies. Israel has also supported 99 airdrops of aid directly into Gaza.

‘… Once humanitarian aid crosses into Gaza, distribution can be challenged by Hamas hijacking attempts or bottlenecking by United Nations partner organizations.’^{[footnote 227]}

10.3.18 On 13 May 2024, BBC News published an article entitled ‘Gaza war: UN hopes for new Western Erez aid crossing’ which stated: ‘Israel has… accused Hamas of stealing the aid designated for civilians. In the south, where most Palestinians have sought refuge, the aid situation is worsening.’^{[footnote 228]}

10.3.19 On 15 May 2024, Amnesty International published an article which claimed:

‘Israeli troops entered the [Rafah] governorate on May 7 [2024]… [which] has interrupted the access of aid to Gaza through Rafah and Kerem Shalom / Karm Abu Salem crossings… completely preventing humanitarian aid and staff from using the Rafah crossing… These two crossings constitute the main critical lifeline for entry of aid into the enclave: their closures are plunging Gaza into an even larger humanitarian disaster.’^{[footnote 229]}

10.3.20 On 16 May 2024, The Guardian published an article entitled ‘US completes installation of floating pier to deliver aid to Gaza’ which stated:

‘The US military has said the installation of a floating pier for the delivery of humanitarian aid off Gaza has been completed, with officials ready to begin ferrying supplies into the territory, where much of the population faces imminent starvation owing to the continuing Israel-Hamas war.

‘… The full operation will involve pallets of food and other humanitarian aid being loaded on to ships in Cyprus and transported to a large floating dock a few miles off the Gaza coast, where they will be put on trucks. Smaller US naval ships will take the trucks the last few miles to the floating pier, near the end of the militarised Netzarim corridor. The trucks will be driven off the ships and along the pier roughly 500 metres to the landing zone, where the pallets will be unloaded for collection by UN vehicles.

‘According to officials, the delivery of food and other crucial aid is expected to start within 24-48 hours.’^{[footnote 230]}

10.3.21 The graph below was produced by CPIT using data collected by UNRWA and extracted from their ‘Gaza: supplies and dispatch tracking’ dashboard^{[footnote 231]}:

10.3.22 According to the dataset used to produce the graph above, the total number of trucks to have entered the Gaza Strip between 21 October 2023 (when the Rafah border crossing was first opened for aid after the start of the conflict on 7 October 2023^{[footnote 232]} and 30 June 2024 was 27,319 of which:

• 11,080 were via the Rafah crossing (from 21 October 2023 to 4 May 2024)
• 15,285 were via the Kerem Shalom crossing (from 16 December 2023 to 30 June 2024); and
• 954 were via the Western Erez crossing (from 19 to 30 June 2024)^{[footnote 233]}

10.3.23 See the dashboard for information on how data was collected. It should be noted that UNRWA stated it was unable to provide comprehensive monitoring of cargo due to safety and security concerns and delays and/or denials in it obtaining approval to distribute entered aid within the Gaza Strip. This has therefore prevented UNRWA from being able to fully verify all trucks which have transited the land crossings.^{[footnote 234]}

10.3.24 The same source also recorded the type of cargo contained in each of the 27,319 lorries it recorded to have entered the Gaza Strip between 21 October 2023 and 30 June 2024 (percentages calculated by CPIT):

• 19,211 (~70%) containing ‘food items’ - including water, flour, cooking oil, and other food and drink items
• 5,571 (~20%) containing ‘non-food items’ - including tents, mattresses, tarpaulins, blankets, sleeping bags, diapers, hygiene kits, toilet paper, clothes, plastic pipes, water tanks, jerry cans, charcoal, kitchen utensils, cleaning supplies, mobile toilets, and various other non-food items
• 1,357 (~5%) containing ‘medical supplies’ - including medicines, wheelchairs, nutritional supplements, hospital beds, vaccines, body bags, and other non-specified medical supplies
• 1,175 (~4.5%) containing ‘mixed items’ - a combination of food, non-food and medical items^{[footnote 235]}

10.3.25 On 22 May 2024, the OCHA published ‘Hostilities in the Gaza Strip and Israel - Flash Update #169’ which stated: ‘Wosornu [Edem Wosornu, Director of OCHA’s Operations and Advocacy Division, in briefing the Security Council on 20 May 2024] welcomed the first aid shipment delivered on 17 May [2024] via the floating dock and reiterated that “land routes remain the most viable and effective way to deliver the scale of aid needed.”’

10.3.26 The 28 May 2024 Save the Children press release stated:

‘Challenges to distribute aid safely within the enclave have… reached a new high… Continued concerns for the protection of aid operations, including the safety of aid workers, and the proliferation of Israeli checkpoints within Gaza also continue to hamper the humanitarian response.

‘… Announcements of additional crossing points and initiatives, including the new “floating dock”, have given an illusion of improvement, but have largely amounted to cosmetic changes. Between May 7 and 27 [2024], just over 1,000 truckloads of aid entered Gaza through all crossing points combined, including the newly built “floating dock,” according to UN counts. This is alarmingly low given the skyrocketing humanitarian needs of Gaza’s 2.2 million people, and much lower when compared to most other periods in the last seven months.

‘The Rafah crossing, one of the main entry points for humanitarian workers and aid into Gaza, has been shut since May 7 [2024]… Meanwhile, more than 2,000 aid trucks remain waiting in Arish in Egypt for Israel to allow them entry, with food rotting and medicines expiring as families face heightened levels of starvation a few miles away. While Kerem Shalom remains officially open, commercial trucks rather have been prioritized, and the movement of aid remains unpredictable, inconsistent, and critically low.’^{[footnote 236]}

10.3.27 The same source also stated:

• ‘Access through Erez West (Zikim) remaining severely restricted.
• ‘More than 266 aid workers, the majority Palestinian have been killed.
• ‘Since May 7 [2024], humanitarian organizations in the Logistics Cluster have been unable to access storage facilities, facilitate storage services or operate the cargo notification system to support humanitarian actors.’^{[footnote 237]}

10.3.28 On 31 May 2024, the Norwegian Refugee Council (NRC) published a Gaza situation update which, quoting its Head of Operations in Gaza, stated:

‘“… Of nine potential gateways into the enclave, two are purportedly open. Zikim, into North Gaza, is open just enough to deliver the basics to hundreds of thousands of people in northern Gaza who have nothing left. Each day, more and more trucks join the kilometres-long queue at Kerem Shalom crossing in the south. Very few actually make it through. The new sea corridor into Gaza is temporarily out of action. Airdrops present many risks and cannot be scaled up to provide the level of aid needed.’^{[footnote 238]}

10.3.29 The OCHA Flash Update #172 of 29 May 2024 stated:

‘The flow of humanitarian aid supplies into Gaza, already insufficient to meet the soaring needs, has dropped by 67 per cent since 7 May [2024].

‘… Insecurity and severe constraints, including on access to border areas and restrictions on the movement between southern and northern Gaza, continue to create a non-permissive and volatile operational environment for humanitarian workers, preventing them from delivering life-saving aid to hundreds of thousands of people across Gaza… In southern Gaza, military operations and movement restrictions have impeded multiple critical humanitarian missions, including preventing the collection of essential humanitarian supplies from Kerem Shalom Crossing and disrupting the rotation of humanitarian personnel into and out of Gaza, a vital operational function for humanitarian organizations.’^{[footnote 239]}

10.3.30 The 4 June 2024 Oxfam article stated:

• ‘Just 19 per cent of the 400,000 litres of fuel a day needed to run the humanitarian operation in Gaza – including transportation, the provision of clean water and sewage removal – is being allowed in and is not delivered every day [since the Rafah crossing was closed on 6 May, until 27 May 2024, Oxfam said only 1.6 million litres of the 8.8 million litres required entered Gaza].
• ‘… Since 6 May [2024], just 216 trucks of humanitarian aid entered via Kerem Shalom and were able to be collected – an average of eight a day
• ‘It’s estimated that hundreds of commercial food trucks are entering daily via the Kerem Shalom crossing. Although important for increasing food availability in Gaza, the consignments include items like non-nutritious energy drinks, chocolate and cookies, and food is often sold at inflated prices that people cannot afford…’^{[footnote 240]}

10.3.31 On 17 June 2024, The New York Times published an article which stated: ‘At least 250 aid workers have been killed since the war there began on Oct. 7 [2024], the United Nations has said, and on Monday [17 June 2024] the U.N. said that nearly 200 of them worked for UNRWA… further hindering the work of organizations already struggling to deliver aid in the enclave… In April [2024] seven World Central Kitchen workers were killed’^{[footnote 241]}

10.3.32 On 17 June 2024, The New Humanitarian (TNH, formerly IRIN News), an independent non-profit news organisation which reports on conflicts and disasters^{[footnote 242]}, published an article entitled ‘Israeli “military pause” to allow limited aid into Gaza’ which stated:

‘… [A] humanitarian corridor in the Gaza Strip [has been opened], but only along one of the main roads and only for 11 hours a day, from 8am to 7pm local time. This is intended to allow aid from the Kerem Shalom crossing, which borders Israel, to the Salah al-Din Road and then towards the north of the enclave, but it will do nothing to help the majority of displaced and desperate Palestinians further south.

‘… The UN welcomed the opening… but said it hadn’t translated into an immediate increase in aid deliveries. The World Food Programme (WFP) said… the corridor… cuts through one of the most dangerous and lawless areas of Gaza.’^{[footnote 243]}

10.3.33 The IPC Global Initiative 25 June 2024 update stated:

‘In the southern governorates, the situation deteriorated following renewed hostilities in early May [2024]… Humanitarian access to the two million people in the southern governorates has notably reduced with the closure of the Rafah border crossing and disruptions to the Karem Shalom crossing… and repeated displacement continue[s] to erode people’s ability to… access humanitarian assistance…

‘… The humanitarian space in the Gaza Strip continues to shrink and the ability to safely deliver assistance to populations is dwindling. The recent trajectory is negative and highly unstable. Should this continue, the improvements seen in April [2024, when food deliveries and nutrition services for northern governorates increased] could be rapidly reversed.’^{[footnote 244]}

10.3.34 On 25 June 2024, NBC News published an article entitled ‘Reporters get rare glimpse of the U.S. military’s troubled pier system in Gaza’ which stated:

‘… [T]he fixed pier and floating dock system… has been beset by bad weather and rough seas, forcing repairs and delaying the delivery of aid. The pier was operational for only a week before heavy winds and large waves broke a large section of the causeway apart on May 25 [2024].

‘The U.S. military has delivered aid via the… pier system on only 17 of the last 40 days… [B]ut the vast majority has not left the beach.

‘… Even when the seas are calm, the transfer of aid from water to land presents a logistical challenge.

‘… Even when aid trucks have been able to pick up the packages of food, they have sometimes run into problems. Some aid has failed to reach its intended destinations as civilians desperate for food stormed and ransacked the trucks.

‘… [I]t [the pier] will most likely have to be dismantled in the next month or so, according to U.S. officials.

‘There are potential options to replace it.

‘The U.S. is working on plans to deliver humanitarian aid through the Israeli port at Ashdod. And Fogbow, a private company made up of retired U.S. military and U.N. officials, says it can replace the temporary pier system with a more stable and reliable one in just a few weeks.’^{[footnote 245]}

10.3.35 On 28 June 2024, NBC News published a further article about the floating aid dock in Gaza which stated:

‘The U.N. World Food Programme on Friday [28 June 2024] distributed food aid brought ashore by the U.S. military pier system to Gaza’s population for the first time since June 9 [2024], according to two U.S. officials.

‘… There are now an estimated 15 million pounds of aid on the shore, officials say, awaiting movement to nearby warehouses.

‘“The current environment here is complex and more challenging than anything I’ve seen,” said Doug Stropes, chief of the USAID’s Bureau of Humanitarian Assistance. “There is a tremendous challenge right now with trucks that are being looted.”’^{[footnote 246]}

10.3.36 On 18 July 2024, the BBC published an article entitled ‘US military ends Gaza floating aid pier mission’ which stated:

‘The US military has ended its mission to operate a temporary floating pier to deliver more aid to the Gaza Strip, after it was beset by weather, technical and security problems.

‘Supplies from Cyprus would now by shipped by US vessels to the Israeli port of Ashdod and then transported by lorry to northern Gaza via an Israeli-controlled crossing, the deputy head of Central Command said.

‘Vice-Adm Brad Cooper insisted the pier had enabled a “surge” in aid deliveries, noting that more than 9,000 tonnes had been delivered over two months. However, it was operational for only about 20 days and had been out of action since 28 June because of bad weather.

‘The UN and other humanitarian organisations have said the total delivered via the pier represents a tiny fraction of the aid required by the 2.2 million Palestinians in Gaza. They say 500 lorries of aid and commercial supplies - equivalent to 10,000 tonnes - are needed daily. They have also consistently stated - and the US has acknowledged - that the most effective and efficient way to get aid into Gaza is through land routes.’^{[footnote 247]}

Research methodology

The country of origin information (COI) in this note has been carefully selected in accordance with the general principles of COI research as set out in the Common EU [European Union] Guidelines for Processing Country of Origin Information (COI), April 2008, and the Austrian Centre for Country of Origin and Asylum Research and Documentation’s (ACCORD), Researching Country Origin Information – Training Manual, 2024. Namely, taking into account the COI’s relevance, reliability, accuracy, balance, currency, transparency and traceability.

Sources and the information they provide are carefully considered before inclusion. Factors relevant to the assessment of the reliability of sources and information include:

• the motivation, purpose, knowledge and experience of the source
• how the information was obtained, including specific methodologies used
• the currency and detail of information
• whether the COI is consistent with and/or corroborated by other sources

Commentary may be provided on source(s) and information to help readers understand the meaning and limits of the COI.

Wherever possible, multiple sourcing is used and the COI compared to ensure that it is accurate and balanced, and provides a comprehensive and up-to-date picture of the issues relevant to this note at the time of publication.

The inclusion of a source is not, however, an endorsement of it or any view(s) expressed.

Each piece of information is referenced in a footnote.

Full details of all sources cited and consulted in compiling the note are listed alphabetically in the bibliography.

Terms of Reference

The ‘Terms of Reference’ (ToR) provides a broad outline of the issues relevant to the scope of this note and forms the basis for the country information.

The following topics were identified prior to drafting as relevant and on which research was undertaken:

• socio-economic indicators, including statistics on life expectancy, literacy, school enrolment, poverty rates, levels of malnutrition
• socio-economic situation, including access and availability to:
  • food
  • water for drinking and washing
  • accommodation and shelter
  • employment
  • healthcare – physical and mental
  • education
  • support providers, including government and international and domestic non-government organisations
  • variation of conditions by location and/or group
  • whether government is purposely withholding or not delivering support services, if so to which areas/groups
• internally displaced persons (IDPs) – numbers, trends and location

Bibliography

Sources cited

ACAPS

• ‘Palestine: Impact of the conflict on children in the Gaza strip’, 1 February 2024. Accessed: 12 July 2024

• ‘Palestine: Impact of the conflict on people with disabilities in the Gaza Strip’, 14 February 2024. Accessed: 29 July 2024

• ‘Who we are’, undated. Accessed: 9 July 2024

Al Jazeera

• ‘The Gaza Strip explained in maps’, 7 August 2022, updated 9 October 2023. Accessed: 5 July 2024

Amnesty International (AI)

• ‘Israel/ OPT: With famine setting in a ceasefire and more aid routes into Gaza are urgently needed’, 5 April 2024. Accessed: 26 July 2024

• ‘World leaders fail to act as Israeli invasion of Rafah worsens humanitarian catastrophe’, 15 May 2024. Accessed: 26 July 2024

Axios

• ‘U.S. officials warn: Gaza “is turning into Mogadishu”’, 24 February 2024. Accessed: 22 March 2024

BBC News

• ‘Gaza’s abandoned airport in ruins’, 12 September 2018. Accessed: 5 July 2024

• ‘Gaza war: UN hopes for new Western Erez aid crossing’, 13 May 2024. Accessed: 23 July 2024

• ‘US military ends Gaza floating aid pier mission’, 18 July 2024. Accessed: 23 July 2024

• ‘“Wounded child, no surviving family”: The pain of Gaza’s orphans’, 4 December 2023. Accessed: 2 September 2024

Central Intelligence Agency (CIA) World Factbook

• ‘About the World Factbook – Frequently Asked Questions (FAQs)’, undated. Accessed: 4 September 2024

• ‘Gaza Strip’, last updated 3 July 2024. Accessed: 8 July 2024

• ‘United Kingdom’, last updated 3 July 2024. Accessed: 5 July 2024

• ‘2023 Archive: Country Comparisons – Infant mortality rate’, undated. Accessed: 8 July 2024

• ‘2023 Archive: Country Comparisons – Life expectancy at birth’, undated. Accessed: 8 July 2024

• ‘2023 Archive: Field Listing – Population’, undated. Accessed: 5 July 2024

CNN

• ‘CNN Worldwide Fact Sheet’, August 2023. Accessed: 5 July 2024

• ‘Gaza explained: What to know about the enclave’, 24 October 2023. Accessed: 5 July 2024

Court of Justice of the European Union (CJEU)

• ‘SN and LN v Zamestnik-predsedatel na Darzhavna agentsia za bezhantsite (Directive 2011/95/EU – Person registered with UNRWA) Case C-563/22’ (accessed via Refworld), promulgated 13 June 2024, published 19 June 2024. Accessed: 10 October 2024 

Deutsche Welle (DW)

• ‘Israel announces the opening of Nitzana and Kerem Shalom crossings’, 12 December 2023. Accessed: 1 August 2024

• ‘Who We Are’, undated. Accessed: 1 August 2024

European Union (EU), United Nations (UN), and The World Bank

• ‘Gaza Strip Interim Damage Assessment: Summary Note – March 29, 2024’, 29 March 2024. Accessed: 8 April 2024

Federal Office for Migration and Refugees (Germany) (BAMF)

• ‘Briefing Notes (KW12/2024)’, 18 March 2024. Accessed: 25 March 2024

• ‘Briefing Notes (KW20/2024)’, 13 May 2024. Accessed: 26 July 2024

Financial Times

• ‘The Gaza Strip – in charts’, 16 October 2023. Accessed: 5 July 2024

Foundation for Defense of Democracies (FDD)

• ‘About’, undated. Accessed: 25 July 2024

• ‘Israel Opens Third Humanitarian Aid Crossing Into Northern Gaza’, 13 May 2024. Accessed: 25 July 2024

Freedom House

• ‘Freedom in the World 2024 – Gaza Strip’, 29 February 2024. Accessed: 8 July 2024

GeoPoll

• ‘About Us’, undated. Accessed: 31 July 2024

Global Nutrition Cluster (GNC)

• ‘Nutrition Vulnerability and Situation Analysis /Gaza’, 18 February 2024. Accessed: 13 May 2024

• ‘About us’, undated. Accessed: 13 May 2024

Humanitarian Outcomes

• ‘About’, undated. Accessed: 9 July 2024

• ‘Humanitarian Access SCORE Report: Gaza - the first six months’, March 2024. Accessed: 9 July 2024

Insecurity Insight

• ‘Critical Condition: Violence Against Healthcare in Conflict – 2023’, 24 June 2024. Accessed: 15 July 2024

• ‘Our vision and mission’, undated. Accessed: 15 July 2024

International Crisis Group (ICG)

• ‘About Us’, undated. Accessed: 31 July 2024

• ‘Israel has made Gaza the deadliest place for aid workers’, 7 May 2024. Accessed: 31 July 2024

International Labour Organization (ILO)

• ‘About the ILO’, undated. Accessed: 8 July 2024

International Labour Organization (ILO) & Palestinian Central Bureau of Statistics (PCBS),

• ‘Impact of the escalation of hostilities in Gaza on the labour market and livelihoods in the Occupied Palestinian Territory: Bulletin No. 2’, 20 December 2023. Accessed: 10 July 2024

• ‘Impact of the war in Gaza on the labour market and livelihoods in the Occupied Palestinian Territory: Bulletin No. 3’, 18 March 2024. Accessed: 9 July 2024

• ‘Impact of the war in Gaza on the labour market and livelihoods in the Occupied Palestinian Territory: Bulletin No. 4’, 7 June 2024. Accessed: 8 July 2024

Integrated Food Security Phase Classification (IPC)

• ‘Famine Review Committee: Gaza Strip, March 2024 – Conclusions and Recommendations’, 18 March 2024. Accessed: 25 March 2024

• ‘Gaza Strip: IPC Acute Food Insecurity Special Snapshot - 1 May - 30 September 2024’, 25 June 2024. Accessed: 15 July 2024

• ‘IPC Overview and Classification System’, undated. Accessed: 15 July 2024

• ‘The IPC Famine Fact Sheet’, last updated March 2024. Accessed: 16 July 2024

International Rescue Committee (IRC)

• ‘2024 Emergency Watchlist’, 14 December 2023. Accessed: 9 July 2024

London School of Hygiene and Tropical Medicine, the Health in Humanitarian Crises Centre, and the Johns Hopkins Center for Humanitarian Health

• ‘Crisis in Gaza: Scenario-based Health Impact Projections’, 19 February 2024. Accessed: 13 May 2024

Mapsland

• ‘Large detailed map of Gaza Strip with roads and cities’, undated. Accessed: 5 July 2024

Medecins Sans Frontieres

• ‘MSF-supported health facilities across Gaza face critical shortage of medical supplies’, 21 June 2024. Accessed: 15 July 2024

Media Bias Fact Check

• ‘Axios - Bias and Credibility’, last updated 12 May 2023. Accessed: 22 March 2024

NBC News

• ‘About NBC News Digital’, 26 June 2020. Accessed: 5 July 2024

• ‘Reporters get rare glimpse of the U.S. military’s troubled pier system in Gaza’, 25 June 2024. Accessed: 24 July 2024

• ‘The Gaza Strip’s density, visualized’, 10 October 2023. Accessed: 5 July 2024

• ‘The U.N. begins distributing food aid in Gaza brought ashore by the U.S. military for the first time since June 9’, 28 June 2024. Accessed: 24 July 2024

Norwegian Refugee Council (NRC)

• ‘Gaza: Israel’s military operation in Rafah would be fatal for displaced civilians and humanitarian aid’, 8 February 2024. Accessed: 5 April 2024

• ‘On-the-record update #2 on situation in Gaza, Palestine’, 31 May 2024. Accessed: 25 July 2024

• ‘On-the-record update #3 on situation in Gaza, Palestine’, 13 June 2024. Accessed: 25 July 2024

• ‘On-the-record update #4 on situation in Gaza, Palestine’, 27 June 2024. Accessed: 25 July 2024

Occupied Palestinian Territory (OPT) Education Cluster

• ‘Damaged Schools Dashboard – Gaza’, 2023 (updated periodically). Accessed: 14 May 2024

OnTheWorldMap.com

• ‘Gaza Strip Map’, 2021. Accessed: 5 July 2024

Oxfam

• ‘Famine risk increases as Israel makes Gaza aid response virtually impossible’, 4 June 2024. Accessed: 22 July 2024

• ‘People in northern Gaza forced to survive on 245 calories a day, less than a can of beans – Oxfam’, 4 April 2024. Accessed: 26 July 2024

Palestinian Central Bureau of Statistics (PCBS)

• ‘Impact of Israeli Occupation Aggression on Consumer Prices in Gaza Strip’, 8 November 2023. Accessed: 15 May 2024

• ‘The Impact of the Israeli Occupation Aggression on the Right to Education in Palestine’, 13 November 2023. Accessed: 15 May 2024

Save the Children

• ‘Education under attack in Gaza, with nearly 90% of school buildings damaged or destroyed’, 16 April 2024. Accessed: 14 May 2024

• ‘Gaza: new crossing points and “floating dock” are cosmetic changes, as humanitarian access disintegrates in Gaza, warn aid agencies’, 28 May 2024. Accessed: 23 July 2024

Sphere

• ‘About’, undated. Accessed: 4 September 2024

• ‘Handbook’, undated. Accessed: 4 September 2024

• ‘The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response’, 2018. Accessed: 10 May 2024

The Guardian

• ‘US completes installation of floating pier to deliver aid to Gaza’, 16 May 2024. Accessed: 26 July 2024

The New Humanitarian (TNH)

• ‘About Us’, undated. Accessed: 15 July 2024

• ‘Israeli “military pause” to allow limited aid into Gaza’, 17 June 2024. Accessed: 15 July 2024

The New York Times

• ‘Gaza Is World’s Deadliest Place for Aid Workers, U.N. Says’ (accessed via subscription), 17 June 2024. Accessed: 31 July 2024

Trust for London

• ‘London’s geography and population’, undated. Accessed: 5 July 2024

United Nations (UN)

• ‘Israel-Palestine crisis: UN welcomes first medical evacuations from Gaza’, 1 November 2024. Accessed: 22 May 2024

• ‘Secretary-General’s press encounter in Al Arish, Egypt’, 23 March 2024. Accessed: 26 March 2024

United Nations Children’s Fund (UNICEF)

• ‘Intensifying conflict, malnutrition and disease in the Gaza Strip creates a deadly cycle that threatens over 1.1 million children’, 5 January 2024. Accessed: 30 July 2024

• ‘Stories of loss and grief: At least 17,000 children are estimated to be unaccompanied or separated from their parents in the Gaza Strip’, 2 February 2024. Accessed: 8 April 2024

United Nations Economic and Social Commission for Western Asia (ESCWA) and United Nations Development Programme (UNDP)

• ‘Gaza war: expected socioeconomic impacts on the State of Palestine Update - May 2024’, 2 May 2024. Accessed: 9 July 2024

United Nations Environment Programme (UNEP

• ‘Environmental Impact of the Conflict in Gaza: Preliminary Assessment of Environmental Impacts’, 18 June 2024. Accessed: 11 July 2024

United Nations Human Rights Council (HRC)

• ‘Report of the Independent International Commission of Inquiry on the Occupied Palestinian Territory, including East Jerusalem, and Israel (A/HRC/56/26) (Advance unedited version)’, 27 May 2024. Accessed: 26 July 2024

• ‘Report of the Special Rapporteur on the situation of human rights in the Palestinian territories occupied since 1967, Francesca Albanese (A/HRC/55/73) (Advance unedited version)’, 25 March 2024. Accessed: 23 April 2024

United Nations Office for the Coordination of Humanitarian Affairs (OCHA),

• ‘Cash Working Group - Gaza Strip: Mobile money and e-wallet modalities: Gaza CWG guiding note – June 2024’, 30 June 2024. Accessed: 10 July 2024

• ‘Gaza Humanitarian Response Update - 10-23 June 2024’, 26 June 2024. Accessed: 9 July 2024

• ‘Gaza Humanitarian Response Update - 20-26 May 2024’, 27 May 2024. Accessed: 9 July 2024

• ‘Gaza Humanitarian Response Update - 5-18 August 2024’, 21 August 2024. Accessed: 10 October 2024

• ‘Hostilities in the Gaza Strip and Israel - Flash Update #149’, 3 April 2024. Accessed: 5 April 2024

• ‘Hostilities in the Gaza Strip and Israel - Flash Update #172’, 29 May 2024. Accessed: 22 July 2024

• ‘Hostilities in the Gaza Strip and Israel - Flash Update #63’, 8 December 2023. Accessed: 16 May 2024

• ‘Hostilities in the Gaza Strip and Israel - reported impact - Day 234’, 27 May 2024. Accessed: 9 July 2024

• ‘Humanitarian Access Snapshot - Gaza Strip - End-January 2024’, 5 February 2024. Accessed: 17 May 2024

• ‘Humanitarian Access Snapshot - Gaza Strip - 1-30 April 2024’, 10 May 2024. Accessed: 31 July 2024

• ‘Humanitarian Access Snapshot - Gaza Strip - 1-31 March 2024’, 6 April 2024. Accessed: 14 May 2024

• ‘Humanitarian Needs and Response Update - 26 March - 01 April 2024’, 5 April 2024. Accessed: 31 July 2024

• ‘Humanitarian Needs and Response Update - 27 February - 4 March 2024’, 8 March 2024. Accessed: 20 May 2024

• ‘Humanitarian Situation Update #181 - Gaza Strip’, 21 June 2024. Accessed: 12 July 2024

• ‘Humanitarian Situation Update #185 - Gaza Strip’, 1 July 2024. Accessed: 12 July 2024

• ‘Reported impact snapshot - Gaza Strip (3 July 2024)’, 3 July 2024. Accessed: 9 July 2024

• ‘Updates’ (all reported impact reports/snapshots from day 175 to day 271), 27 March 2024-3 July 2024. Accessed: 9 July 2024

United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)

• ‘Gaza: supplies and dispatch tracking’, undated, updated 24 July 2024. Accessed: 26 July 2024

• ‘General Assembly Resolution 302’, 8 December 1949. Accessed: 31 July 2024

‘Letter from the Commissioner-General to the President of the UN General Assembly’, 22 February 2024. Accessed: 22 May 2024

• ‘Statement of the Commissioner-General of UNRWA to the General Assembly’, 4 March 2024. Accessed: 22 May 2024

• ‘UNRWA Situation Report #114 on the Situation in the Gaza Strip and the West Bank, including East Jerusalem’, 3 July 2024. Accessed: 31 July 2024

• ‘UNRWA Situation Report #115 on the Situation in the Gaza Strip and the West Bank, including East Jerusalem’, 3 July 2024. Accessed: 1 August 2024

• ‘UNRWA Situation Report #117 on the Situation in the Gaza Strip and the West Bank, including East Jerusalem’, 3 July 2024. Accessed: 25 July 2024

• ‘UNRWA Situation Report #98 on the Situation in the Gaza Strip and the West Bank, including East Jerusalem’, 2 April 2024. Accessed: 4 April 2024

• ‘UNRWA Commissioner-General Philippe Lazzarini remarks on the situation in the Gaza Strip’, 15 October 2023. Accessed: 22 May 2024

• ‘Where we work’, last updated August 2023. Accessed: 5 July 2024

United Nations Security Council

• ‘Report of the Secretary-General: Protection of civilians in armed conflict’, 14 May 2024. Accessed: 26 July 2024

United Nations Statistics Division (UNSD)

• ‘Country Profile of Occupied Palestinian Territory’, undated. Accessed: 8 July 2024

UN Women

• ‘About UN Women’, undated. Accessed: 12 July 2024

• ‘Gender Alert: The Gendered Impact of the Crisis in Gaza’, January 2024. Accessed: 12 July 2024

• ‘Gender Alert: Scarcity and Fear: A Gender Analysis of the Impact of the War in Gaza on Vital Services Essential to Women’s and Girls’ Health, Safety, and Dignity - Water, Sanitation and Hygiene (WASH)’, April 2024. Accessed: 25 July 2024     

UN World Food Programme (WFP)

• ‘Food Security Update: For Internally Displaced Populations in Southern Gaza Strip’, 14 December 2023. Accessed: 10 May 2024

• ‘Gaza Food Security Assessment’, 6 December 2023. Accessed: 10 May 2024

• ‘Gaza updates: WFP targets soup kitchens as supplies dwindle and bakeries close in Rafah’, 22 May 2024. Accessed: 23 July 2024

UN World Health Organization (WHO)

• ‘Gaza Hostilities 2023 / 2024 - Emergency Situation Reports’, 20 February 2024-6 June 2024. Accessed: 10 July 2024

• ‘Lethal combination of hunger and disease to lead to more deaths in Gaza’, 21 December 2023. Accessed: 10 July 2024

• ‘oPt Emergency Situation Update – Issue 20’, 11 January 2024. Accessed: 10 July 2024

• ‘oPt Emergency Situation Update – Issue 27’, 2 April 2024. Accessed: 8 May 2024

• ‘oPt Emergency Situation Update – Issue 33’, 6 June 2024. Accessed: 10 June 2024

• ‘oPt Emergency Situation Update – Issue 6’, 21 October 2023. Accessed: 10 July 2024

• ‘Six months of war leave Al-Shifa hospital in ruins, WHO mission reports’, 6 April 2024. Accessed: 26 July 2024

United States Department of State (USSD)

• ‘2023 Country Reports on Human Rights Practices: Israel, West Bank and Gaza; West Bank and Gaza’, 23 April 2024. Accessed: 26 July 2024

World Bank Group

• ‘Economic Monitoring Report to the Ad Hoc Liaison Committee’, 17 November 2021. Accessed: 8 July 2024

• ‘Impacts of the Conflict in the Middle East on the Palestinian Economy – December 2023 Update’, December 2023. Accessed: 11 July 2024

• ‘Impacts of the Conflict in the Middle East on the Palestinian Economy – May 2024 Update’, 23 May 2024. Accessed: 11 July 2024

• ‘Literacy rate, adult total (% of people ages 15 and above)’, undated. Accessed: 8 July 2024

• ‘Multidimensional Poverty Measure’, last updated April 2024. Accessed: 11 July 2024

XE.com

• ‘Currency Converter – Israeli Shekels to British Pounds’, undated. Last accessed 12 July 2024

• ‘Currency Converter – US Dollars to British Pounds’, undated. Accessed: 31 July 2024

Sources consulted but not cited

ActionAid

• ‘Unemployment and poverty in Gaza reach unprecedented levels’, 1 May 2024. Accessed: 11 July 2024

BBC News

• ‘Gaza Strip in maps: How life has changed’, 22 March 2024. Accessed: 25 March 2024

• ‘Israel Gaza: What Gaza’s death toll says about the war’, 20 December 2023. Accessed: 24 May 2024

• ‘What is Hamas and why is it fighting with Israel in Gaza?’, 13 February 2024. Accessed: 22 March 2024

Christian Aid

• ‘Food prices skyrocket as Gaza on the brink of famine’, 22 March 2024. Accessed: 26 March 2024

Euronews Green

• ‘The UN is investigating the environmental impact of the war in Gaza. Here’s what it says so far’, 6 March 2024. Accessed: 21 May 2024

HelpAge International

• ‘The Long Road Ahead: Rebuilding the Health Sector in Gaza’, 15 February 2024. Accessed: 9 May 2024

Internal Displacement Monitoring Centre (IDMC) and Norwegian Refugee Council (NRC)

• ‘Global Report on Internal Displacement (GRID) 2024’, 14 May 2024. Accessed: 16 May 2024

Palestinian Central Bureau of Statistics (PCBS)

• ‘An environmental catastrophe threatens livelihoods in Gaza…’, 16 November 2023. Accessed: 15 May 2024

• ‘Highlighting that the children and women of Gaza Strip face an unprecedented humanitarian disaster’, 24 October 2023. Accessed: 14 May 2024

• ‘Indicators’, undated. Accessed: 14 May 2024

• ‘Literacy Rate of Persons (15 Years and Over) in Gaza Strip by Age Groups and Sex, 1995, 1997, 2000-2022’, undated. Accessed: 24 April 2024

• ‘Mean Years of Schooling for Persons (15 years and above) by Region and Sex for Years 2000-2022’, undated. Accessed: 24 April 2024

• ‘PCBS: Highlights Socio-Economic Indicators on the Impact of the Israeli Occupation War on Gaza Strip, 2023’, 16 October 2023. Accessed: 14 May 2024

• ‘The Losses of Private Sector in Palestine due to the Israeli occupation Aggression on Gaza Strip’, 9 November 2023. Accessed: 15 May 2024

• ‘The Palestinian Expenditure and Consumption Survey (October 2016 – September 2017)’, 15 April 2018. Accessed: 24 April 2024

Palestinian Central Bureau of Statistics (PCBS) & Palestine Monetary Authority (PMA)

• ‘The Performance of the Palestinian Economy for 2023, and Economic Forecasts for 2024’, 30 December 2023. Accessed: 8 April 2024

Save the Children

• ‘Life in Gaza: What’s It Like for Children Growing Up in Conflict?’, undated. Accessed: 9 May 2024

The Lancet

• ‘An urgent call to save and protect lives of vulnerable populations in the Gaza Strip’, 21 October 2023. Accessed: 24 April 2024

United Nations Human Rights Office of the High Commissioner (OHCHR)

• ‘UN experts deeply concerned over “scholasticide” in Gaza’, 18 April 2024. Accessed: 26 July 2024

United Nations News

• ‘Gaza economic recovery could take decades: UN report’, 31 January 2024. Accessed: 24 April 2024

United Nations Office for the Coordination of Humanitarian Affairs (OCHA)

• ‘Gaza Humanitarian Response Update - 27 May - 9 June 2024’, 12 June 2024. Accessed: 8 July 2024

• ‘Gaza Strip: Access constraints on humanitarian aid’, 27 March 2024. Accessed: 5 April 2024

• ‘Hostilities in the Gaza Strip and Israel - Flash Update #56’, 1 December 2023. Accessed: 16 May 2024

• ‘Hostilities in the Gaza Strip and Israel - reported impact - Day 173’, 27 March 2024. Accessed: 9 July 2024

• ‘Humanitarian Access Snapshot - Gaza Strip - End-February 2024’, 6 March 2024. Accessed: 17 May 2024

• ‘Humanitarian Situation Update #173 - Gaza Strip’, 31 May 2024. Accessed: 24 July 2024

• ‘More aid delivered into Gaza on first day of humanitarian pause’, 24 November 2023. Accessed: 16 May 2024

United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)

• ‘UNRWA Situation Report #66 on the Situation in the Gaza Strip and the West Bank, including East Jerusalem’, 19 January 2024. Accessed: 5 April 2024

United Nations Security Council

• ‘Implementation of Security Council resolution 2334 (2016); Report of the Secretary-General [S/2023/988]’, 14 December 2023. Accessed: 22 May 2024

UN World Food Programme (WFP)

• ‘UN Food Agency pauses deliveries to the North of Gaza’, 20 February 2024. Accessed: 9 April 2024

• ‘WFP Palestine Emergency Response: Situation Report 23’, 8 June 2024. Accessed: 25 July 2024

• ‘WFP Palestine Emergency Response: Situation Report 24’, 26 June 2024. Accessed: 24 July 2024

UN World Health Organization (WHO)

• ‘oPt Emergency Situation Update – Issue 11’, 6 November 2023. Accessed: 10 July 2024

• ‘oPt Emergency Situation Update – Issue 12’, 10 November 2023. Accessed: 10 July 2024

• ‘oPt Emergency Situation Update – Issue 16’, 7 December 2023. Accessed: 10 July 2024

• ‘oPt Emergency Situation Update – Issue 19’, 29 December 2023. Accessed: 10 July 2024

• ‘oPt Emergency Situation Update – Issue 2’, 10 October 2023. Accessed: 10 July 2024

• ‘oPt Emergency Situation Update – Issue 22’, 30 January 2024. Accessed: 9 May 2024. Accessed: 13 May 2024

• ‘oPt Emergency Situation Update – Issue 23’, 20 February 2024. Accessed: 10 July 2024

• ‘oPt Emergency Situation Update – Issue 3’, 12 October 2023. Accessed: 10 July 2024

UN World Health Organization (WHO) and UNICEF

• ‘Infection prevention and control and water, sanitation and hygiene measures in health-care settings and shelters/ congregate settings in Gaza’, 22 February 2024. Accessed: 9 May 2024

WeWorld

• ‘Flash Update #18 - War on Gaza: starvation on top of displacement’, 26 June 2024. Accessed: 15 July 2024

World Bank Group

• ‘World Bank Group Supports Delivery of Essential Education Services’, 21 February 2024. Accessed: 24 April 2024

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1. CNN, ‘CNN Worldwide Fact Sheet’, August 2023 ↩

2. CNN, ‘Gaza explained: What to know about the enclave’, 24 October 2023 ↩

3. CIA World Factbook, ‘Gaza Strip’ (Geography), last updated 3 July 2024 ↩

4. CIA World Factbook, ‘United Kingdom’ (Geography), last updated 3 July 2024 ↩

5. CIA World Factbook, ‘Gaza Strip’ (Geography), last updated 3 July 2024 ↩

6. Al Jazeera, ‘The Gaza Strip explained in maps’, 7 August 2022, updated 9 October 2023 ↩

7. Mapsland, ‘Large detailed map of Gaza Strip with roads and cities’, undated ↩

8. OnTheWorldMap.com, ‘Gaza Strip Map’, 2021 ↩

9. BBC News, ‘Gaza’s abandoned airport in ruins’, 12 September 2018 ↩

10. CIA World Factbook, ‘2023 Archive: Field listing – Population’, undated ↩

11. CIA World Factbook, ‘Gaza Strip’ (People and Society), last updated 3 July 2024 ↩

12. CIA World Factbook, ‘Gaza Strip’ (People and Society), last updated 3 July 2024 ↩

13. UNRWA, ‘Where we work’ (Gaza Strip), last updated August 2023 ↩

14. Trust for London, ‘London’s geography and population’, undated ↩

15. Financial Times, ‘The Gaza Strip – in charts’, 16 October 2023 ↩

16. NBC News, ‘About NBC News Digital’, 26 June 2020 ↩

17. NBC News, ‘The Gaza Strip’s density, visualized’, 10 October 2023 ↩

18. CIA World Factbook, ‘2023 Archive: Field Listing – Population’, undated ↩

19. CIA World Factbook, ‘Gaza Strip’ (People and Society), last updated 3 July 2024 ↩

20. CIA World Factbook, ‘2023 Archive: Country Comparisons – Life expectancy at birth’, undated ↩

21. CIA World Factbook, ‘Gaza Strip’ (People and Society), last updated 3 July 2024 ↩

22. CIA World Factbook, ‘Gaza Strip’ (People and Society), last updated 3 July 2024 ↩

23. CIA World Factbook, ‘2023 Archive: Country Comparisons – Infant mortality rate’, undated ↩

24. CIA World Factbook, ‘Gaza Strip’ (People and Society), last updated 3 July 2024 ↩

25. World Bank Group, ‘Economic Monitoring Report…’ (p4,8), 17 November 2021 ↩

26. XE.com, ‘Currency Converter – US Dollars to British Pounds’, 8 July 2024 ↩

27. World Bank Group, ‘Economic Monitoring Report…’ (p4,8), 17 November 2021 ↩

28. World Bank Group, ‘Literacy rate, adult total (% of people ages 15 and above)’, undated ↩

29. CIA World Factbook, ‘Gaza Strip’ (People and Society), last updated 3 July 2024 ↩

30. UNRWA, ‘Where we work’ (Gaza Strip), last updated August 2023 ↩

31. Freedom House, ‘Freedom in the World 2024 – Gaza Strip’ (Section E3), 29 February 2024 ↩

32. Freedom House, ‘Freedom in the World 2024 – Gaza Strip’ (Section G4), 29 February 2024 ↩

33. EU, UN & The World Bank, ‘Gaza Strip… Assessment…’ (Disclaimer,p1,4), 29 March 2024 ↩

34. EU, UN & The World Bank, ‘Gaza Strip… Damage Assessment…’ (p19), 29 March 2024 ↩

35. United Nations Statistics Division (UNSD), ‘… Profile of Occupied Palestinian Territory’, undated ↩

36. ESCWA & UNDP, ‘Gaza war: expected socioeconomic impacts…’ (p9), 2 May 2024 ↩

37. EU, UN & The World Bank, ‘Gaza Strip… Damage Assessment…’, 29 March 2024 ↩

38. The World Bank, ‘Impacts of the Conflict… Economy… Update’ (p7), 23 May 2024 ↩

39. (https://www.ilo.org/about-ilo), undated ↩

40. XE.com, ‘Currency Converter – US Dollars to British Pounds’, 8 July 2024 ↩

41. ILO & PCBS, ‘Impact of the war in Gaza on the labour market… Bulletin No. 4’ (p1-3), 7 June 2024 ↩

42. OCHA, ‘Cash Working Group - Gaza Strip… June 2024’ (p1), 30 June 2024 ↩

43. UNRWA, ‘Where we work’ (Gaza Strip), last updated August 2023 ↩

44. Freedom House, ‘Freedom in the World 2024 – Gaza Strip’ (Section E3,G2,G4), 29 February 2024 ↩

45. ILO & PCBS, ‘Impact… on the labour market… Bulletin No. 2’ (p1), 20 December 2023 ↩

46. ILO & PCBS, ‘Impact of the war in Gaza on the labour market… Bulletin No. 3’, 18 March 2024 ↩

47. EU, UN & The World Bank, ‘Gaza Strip Interim Damage Assessment…’ (p5,17), 29 March 2024 ↩

48. ILO & PCBS, ‘Impact of the war in Gaza on the labour market… Bulletin No. 4’ (p1), 7 June 2024 ↩

49. Sphere, ‘About’, undated ↩

50. Sphere, ‘Handbook’, undated ↩

51. Sphere, ‘Handbook’, undated ↩

52. IRC, ‘2024 Emergency Watchlist’ (p34), 14 December 2023 ↩

53. UN Women, ‘About UN Women’, undated ↩

54. UN Women, ‘Gender Alert: The Gendered Impact of the Crisis in Gaza’, January 2024 ↩

55. Humanitarian Outcomes, ‘About’, undated ↩

56. GeoPoll, ‘About Us’, undated ↩

57. Humanitarian Outcomes, ‘Humanitarian Access… Gaza - the first six months’ (p2), March 2024 ↩

58. Humanitarian Outcomes, ‘Humanitarian Access… Gaza - the first six months’ (p8), March 2024 ↩

59. Humanitarian Outcomes, ‘Humanitarian Access… Gaza - the first six months’ (p8), March 2024 ↩

60. Sphere, ‘… Handbook… Minimum Standards in Humanitarian Response’ (p254), 2018 ↩

61. NRC, ‘Gaza…’, 8 February 2024 ↩

62. Freedom House, ‘Freedom in the World 2024 – Gaza Strip’ (Section G2), 29 February 2024 ↩

63. OCHA, ‘Humanitarian Needs and Response Update - 27 February - 4 March 2024’, 8 March 2024 ↩

64. HRC, ‘Report of the Special Rapporteur…’ (para 1), 25 March 2024 ↩

65. HRC, ‘Report of the Special Rapporteur…’ (Summary), 25 March 2024 ↩

66. XE.com, ‘Currency Converter – US Dollars to British Pounds’, 8 July 2024 ↩

67. XE.com, ‘Currency Converter – US Dollars to British Pounds’, 9 July 2024 ↩

68. EU, UN & The World Bank, ‘Gaza Strip Interim Damage Assessment…’ (p6,11), 29 March 2024 ↩

69. ESCWA & UNDP, ‘Gaza war: expected socioeconomic impacts…’ (p6), 2 May 2024 ↩

70. OCHA, ‘Gaza Humanitarian Response Update - 20-26 May 2024’, 27 May 2024 ↩

71. OCHA, ‘Hostilities in the Gaza Strip and Israel - reported impact - Day 234’, 27 May 2024 ↩

72. OCHA, ‘Updates’ (reported impact reports from day 175 to day 234), 27 March 2024-27 May 2024 ↩

73. XE.com, ‘Currency Converter – US Dollars to British Pounds’, 9 July 2024 ↩

74. Oxfam, ‘… Gaza aid response virtually impossible’, 4 June 2024 ↩

75. OCHA, ‘Gaza Humanitarian Response Update - 10 - 23 June 2024’, 26 June 2024 ↩

76. NRC, ‘On-the-record update #4 on situation in Gaza, Palestine’, 27 June 2024 ↩

77. NRC, ‘On-the-record update #4 on situation in Gaza, Palestine’, 27 June 2024 ↩

78. OCHA, ‘Reported impact snapshot - Gaza Strip (3 July 2024)’, 3 July 2024 ↩

79. OCHA, ‘Updates’ (reported impact snapshots from day 243 to day 271), 5 June 2024-3 July 2024 ↩

80. Sphere, ‘… Handbook… Minimum Standards in Humanitarian Response’ (p106-107), 2018 ↩

81. Sphere, ‘… Handbook… Minimum Standards in Humanitarian Response’ (p116-118), 2018 ↩

82. Sphere, ‘… Handbook… Minimum Standards in Humanitarian Response’ (p114), 2018 ↩

83. Sphere, ‘… Handbook… Minimum Standards in Humanitarian Response’ (p119), 2018 ↩

84. WHO, ‘oPt Emergency Situation Update – Issue 6’ (p1), 21 October 2023 ↩

85. WFP, ‘Gaza Food Security Assessment’ (p8), 6 December 2023 ↩

86. WFP, ‘Gaza Food Security Assessment’ (p8), 6 December 2023 ↩

87. WFP, ‘Food Security Update…’ (p5), 14 December 2023 ↩

88. WFP, ‘Food Security Update…’ (p2), 14 December 2023 ↩

89. WFP, ‘Food Security Update…’ (p2), 14 December 2023 ↩

90. IRC, ‘2024 Emergency Watchlist’ (p34), 14 December 2023 ↩

91. WHO, ‘… [H]unger and disease to lead to more deaths in Gaza’, 21 December 2023 ↩

92. WHO, ‘oPt Emergency Situation Update – Issue 20’ (p2), 11 January 2024 ↩

93. GNC, ‘About us’, undated ↩

94. GNC, ‘Nutrition Vulnerability and Situation Analysis /Gaza’ (p1), 18 February 2024 ↩

95. GNC, ‘Nutrition Vulnerability and Situation Analysis /Gaza’ (p3), 18 February 2024 ↩

96. EU, UN & The World Bank, ‘Gaza Strip Interim Damage Assessment…’ (p15), 29 March 2024 ↩

97. Save the Children, ‘… [H]umanitarian access disintegrates in Gaza…’, 28 May 2024 ↩

98. Oxfam, ‘… Gaza aid response virtually impossible’, 4 June 2024 ↩

99. WHO, ‘oPt Emergency Situation Update – Issue 33’ (p4), 6 June 2024 ↩

100. WHO, ‘Gaza Hostilities… Emergency Situation Reports’ (Issues 24-33), 3 March-6 June 2024 ↩

101. XE.com, ‘Currency Converter – Israeli Shekels to British Pounds’, 12 July 2024 ↩

102. XE.com, ‘Currency Converter – Israeli Shekels to British Pounds’, 12 July 2024 ↩

103. UNEP, ‘Environmental Impact of the Conflict in Gaza…’ (p19,21), 18 June 2024 ↩

104. UNEP, ‘Environmental Impact of the Conflict in Gaza…’ (p21), 18 June 2024 ↩

105. IPC, ‘IPC Overview and Classification System’, undated ↩

106. IPC, ‘Gaza Strip: IPC Acute Food Insecurity Special Snapshot…’ (p1), 25 June 2024 ↩

107. OCHA, ‘Humanitarian Situation Update #185 - Gaza Strip’ (p2), 1 July 2024 ↩

108. OCHA, ‘Reported impact snapshot - Gaza Strip (3 July 2024)’, 3 July 2024 ↩

109. World Bank Group, ‘Multidimensional Poverty Measure’, last updated April 2024 ↩

110. The World Bank, ‘Impacts of the Conflict… Economy… Update’ (footnote 12), December 2023 ↩

111. The World Bank, ‘Impacts of the Conflict… Economy… Update’ (p4), December 2023 ↩

112. XE.com, ‘Currency Converter – Israeli Shekels to British Pounds’, 11 July 2024 ↩

113. ESCWA & UNDP, ‘Gaza war: expected socioeconomic impacts…’ (p7), 2 May 2024 ↩

114. The World Bank, ‘Impacts of the Conflict… Economy… Update’ (p12), 23 May 2024 ↩

115. Sphere, ‘… Handbook… Minimum Standards in Humanitarian Response’ (p194,198), 2018 ↩

116. Sphere, ‘… Handbook… Minimum Standards in Humanitarian Response’ (p198), 2018 ↩

117. WFP, ‘Gaza Food Security Assessment’ (p2), 6 December 2023 ↩

118. WFP, ‘Gaza Food Security Assessment’ (p4), 6 December 2023 ↩

119. WFP, ‘Food Security Update…’ (p2), 14 December 2023 ↩

120. WFP, ‘Food Security Update…’ (p3), 14 December 2023 ↩

121. WFP, ‘Gaza Food Security Assessment’ (footnote 2(p5)), 6 December 2023 ↩

122. WFP, ‘Food Security Update…’ (p4), 14 December 2023 ↩

123. IPC, ‘… Gaza Strip, March 2024 – Conclusions and Recommendations’ (p6), 18 March 2024 ↩

124. IPC, ‘… Gaza Strip, March 2024 – Conclusions…’ (p2), 18 March 2024 ↩

125. IPC, ‘… Gaza Strip, March 2024 – Conclusions and Recommendations’ (p6), 18 March 2024 ↩

126. WHO, ‘oPt Emergency Situation Update – Issue 27’ (p2), 2 April 2024 ↩

127. IPC, ‘… Gaza Strip, March 2024 – Conclusions and Recommendations’ (p10), 18 March 2024 ↩

128. EU, UN & The World Bank, ‘Gaza Strip Interim Damage Assessment…’ (p20), 29 March 2024 ↩

129. Oxfam, ‘People in northern Gaza forced to survive on 245 calories a day…’, 4 April 2024 ↩

130. WFP, ‘Gaza updates… supplies dwindle and bakeries close in Rafah’, 22 May 2024 ↩

131. IPC, ‘Gaza Strip: IPC Acute Food Insecurity Special Snapshot…’ (p1), 25 June 2024 ↩

132. IPC, ‘Gaza Strip: IPC Acute Food Insecurity Special Snapshot…’ (p1), 25 June 2024 ↩

133. IPC, ‘The IPC Famine Fact Sheet’, last updated March 2024 ↩

134. IPC, ‘Gaza Strip: IPC Acute Food Insecurity Special Snapshot…’ (p1), 25 June 2024 ↩

135. PCBS, ‘Impact… on Consumer Prices in Gaza Strip’, 8 November 2023 ↩

136. BBC News, ‘“Wounded child, no surviving family”: The pain of Gaza’s orphans’, 4 December 2023 ↩

137. UNICEF, ‘Intensifying conflict… threatens over 1.1 million children’, 5 January 2024 ↩

138. ACAPS, Who we are, undated ↩

139. ACAPS, ‘… Impact of the conflict on children in the Gaza Strip’ (p2), 1 February 2024 ↩

140. ACAPS, ‘… Impact of the conflict on children in the Gaza Strip’ (p1), 1 February 2024 ↩

141. UNICEF, ‘… [C]hildren… separated from their parents in the Gaza Strip’, 2 February 2024 ↩

142. GNC, ‘Nutrition Vulnerability and Situation Analysis /Gaza’ (p3), 18 February 2024 ↩

143. London School of Hygiene and Tropical Medicine et al, ‘Crisis in Gaza…’ (p10), 19 February 2024 ↩

144. UN Women, ‘Gender Alert: Scarcity and Fear…’ (p6), April 2024 ↩

145. UN Human Rights Council, ‘Report of the Independent…’ (para 55,71-72), 27 May 2024 ↩

146. OCHA, ‘Hostilities in the Gaza Strip and Israel - Flash Update #172’, 29 May 2024 ↩

147. OCHA, ‘Gaza Humanitarian Response Update - 10-23 June 2024’, 26 June 2024 ↩

148. NRC, ‘On-the-record update #4 on situation in Gaza, Palestine’, 27 June 2024 ↩

149. PCBS, ‘The Impact… on the Right to Education in Palestine’ (p2), 13 November 2023 ↩

150. Freedom House, ‘Freedom in the World 2024 – Gaza Strip’ (Section D3), 29 February 2024 ↩

151. XE.com, ‘Currency Converter – US Dollars to British Pounds’, 4  September 2024 ↩

152. EU, UN & The World Bank, ‘Gaza Strip Interim Damage Assessment…’ (p6-7), 29 March 2024 ↩

153. EU, UN & The World Bank, ‘Gaza Strip… Damage Assessment …’ (p12-13,17), 29 March 2024 ↩

154. OCHA, ‘Humanitarian Needs and Response Update - 26 March - 01 April 2024’, 5 April 2024 ↩

155. OPT Education Cluster, ‘Damaged Schools Dashboard – Gaza’, 2023 (updated periodically) ↩

156. Save the Children, ‘Gaza… nearly 90% of school buildings damaged or destroyed’, 16 April 2024 ↩

157. ESCWA & UNDP, ‘Gaza war: expected socioeconomic impacts…’ (p12), 2 May 2024 ↩

158. OCHA, ‘Gaza Humanitarian Response Update - 20-26 May 2024’, 27 May 2024 ↩

159. NRC, ‘On-the-record update #3 on situation in Gaza, Palestine’, 13 June 2024 ↩

160. OCHA, ‘Humanitarian Situation Update #181 - Gaza Strip’, 21 June 2024 ↩

161. OCHA, ‘Gaza Humanitarian Response Update - 10-23 June 2024’, 26 June 2024 ↩

162. OCHA, ‘Reported impact snapshot - Gaza Strip (3 July 2024)’, 3 July 2024 ↩

163. Sphere, ‘… Handbook… Minimum Standards in Humanitarian Response’ (p290-348), 2018 ↩

164. UN, ‘Israel-Palestine crisis: UN welcomes first medical evacuations from Gaza’, 1 November 2024 ↩

165. ACAPS, ‘… Impact of the conflict on people with disabilities in… Gaza…’ (p2), 14 February 2024 ↩

166. ACAPS, ‘… Impact of the conflict on people with disabilities in… Gaza…’ (p5), 14 February 2024 ↩

167. Humanitarian Outcomes, ‘Humanitarian Access… Gaza - the first six months’ (p17), March 2024 ↩

168. IPC, ‘… Gaza Strip, March 2024 – Conclusions and Recommendations’ (p9), 18 March 2024 ↩

169. XE.com, ‘Currency Converter – US Dollars to British Pounds’, 31 July 2024 ↩

170. EU, UN & The World Bank, ‘Gaza Strip Interim Damage Assessment…’ (p6-7), 29 March 2024 ↩

171. XE.com, ‘Currency Converter – US Dollars to British Pounds’, 31 July 2024 ↩

172. XE.com, ‘Currency Converter – US Dollars to British Pounds’, 31 July 2024 ↩

173. EU, UN & The World Bank, ‘Gaza Strip Interim Damage Assessment…’ (p12), 29 March 2024 ↩

174. WHO, ‘Six months of war leave Al-Shifa hospital in ruins, WHO mission reports’, 6 April 2024 ↩

175. BAMF, ‘Briefing Notes (KW20/2024)’ (p6), 13 May 2024 ↩

176. Save the Children, ‘… [H]umanitarian access disintegrates in Gaza…’, 28 May 2024 ↩

177. OCHA, ‘Hostilities in the Gaza Strip and Israel - Flash Update #172’, 29 May 2024 ↩

178. WHO, ‘oPt Emergency Situation Update – Issue 33’ (p1), 6 June 2024 ↩

179. WHO, ‘oPt Emergency Situation Update – Issue 33’ (p2), 6 June 2024 ↩

180. Medecins Sans Frontieres, ‘MSF… critical shortage of medical supplies’, 21 June 2024 ↩

181. Insecurity Insight, ‘Our vision and mission’, undated ↩

182. Insecurity Insight, ‘… Violence Against Healthcare in Conflict – 2023’ (p89-90), 24 June 2024 ↩

183. OCHA, ‘Humanitarian Situation Update #185 - Gaza Strip’ (p2), 1 July 2024 ↩

184. OCHA, ‘Humanitarian Situation Update #185 - Gaza Strip’ (p2), 1 July 2024 ↩

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186. OCHA, ‘Gaza Humanitarian Response Update - 5-18 August 2024’, 21 August 2024 ↩

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188. UN Security Council, ‘… Report of the Secretary-General…’ (para 73), 14 December 2023 ↩

189. UNRWA, ‘General Assembly Resolution 302’, 8 December 1949 ↩

190. UNRWA, ‘Letter from the Commissioner-General…’, 22 February 2024 ↩

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195. ICG, ‘About Us’, undated ↩

196. ICG, ‘Israel has made Gaza the deadliest place for aid workers’, 7 May 2024 ↩

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204. EU, UN & The World Bank, ‘Gaza Strip Interim Damage Assessment…’ (p18), 29 March 2024 ↩

205. OCHA, ‘Hostilities in the Gaza Strip and Israel - Flash Update #149’, 3 April 2024 ↩

206. OCHA, ‘Humanitarian Access Snapshot - Gaza Strip - 1-30 April 2024’ (p1), 10 May 2024 ↩

207. UN Security Council, ‘Report of the Secretary-General…’ (para 35), 14 May 2024 ↩

208. IRC, ‘2024 Emergency Watchlist’ (p15), 14 December 2023 ↩

209. IRC, ‘2024 Emergency Watchlist’ (p12), 14 December 2023 ↩

210. PCBS, ‘Impact… on Consumer Prices in Gaza Strip’, 8 November 2023 ↩

211. OCHA, ‘Hostilities in the Gaza Strip and Israel - Flash Update #63’, 8 December 2023 ↩

212. DW, ‘Who We Are’, undated ↩

213. DW, ‘Israel announces the opening of Nitzana and Kerem Shalom crossings’, 12 December 2023 ↩

214. UN Security Council, ‘… Report of the Secretary-General…’ (para 13,40), 14 December 2023 ↩

215. OCHA, ‘Humanitarian Access Snapshot - Gaza Strip - End-January 2024’, 5 February 2024 ↩

216. ACAPS, ‘… Impact of the conflict on people with disabilities in… Gaza…’ (p7), 14 February 2024 ↩

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219. Freedom House, ‘Freedom in the World 2024 – Gaza Strip’ (Section C2), 29 February 2024 ↩

220. Humanitarian Outcomes, ‘Humanitarian Access… Gaza…’ (p3,10,12), March 2024 ↩

221. BAMF, ‘Briefing Notes (KW12/2024)’ (p4), 18 March 2024 ↩

222. EU, UN & The World Bank, ‘Gaza Strip Interim Damage Assessment…’ (p15), 29 March 2024 ↩

223. AI, ‘… [A] ceasefire and more aid routes into Gaza are urgently needed’, 5 April 2024 ↩

224. OCHA, ‘Humanitarian Access Snapshot - Gaza Strip - 1-31 March 2024’ (p2), 6 April 2024 ↩

225. USSD, ‘2023 Country Reports on Human Rights Practices…’ (Section 1I), 23 April 2024 ↩

226. FDD, ‘About’, undated ↩

227. FDD, ‘Israel Opens Third Humanitarian Aid Crossing Into Northern Gaza’, 13 May 2024 ↩

228. BBC News, ‘Gaza war: UN hopes for new Western Erez aid crossing’, 13 May 2024 ↩

229. AI, ‘… Israeli invasion of Rafah worsens humanitarian catastrophe’, 15 May 2024 ↩

230. The Guardian, ‘US completes installation of floating pier to deliver aid to Gaza’, 16 May 2024 ↩

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237. Save the Children, ‘… [H]umanitarian access disintegrates in Gaza…’, 28 May 2024 ↩

238. NRC, ‘On-the-record update #2 on situation in Gaza, Palestine’, 31 May 2024 ↩

239. OCHA, ‘Hostilities in the Gaza Strip and Israel - Flash Update #172’, 29 May 2024 ↩

240. Oxfam, ‘… Gaza aid response virtually impossible’, 4 June 2024 ↩

241. The New York Times, ‘… Deadliest Place for Aid…’ (accessed via subscription), 17 June 2024 ↩

242. TNH, ‘About Us’, undated ↩

243. TNH, ‘Israeli “military pause” to allow limited aid into Gaza’, 17 June 2024 ↩

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245. NBC News, ‘… [T]he U.S. military’s troubled pier system in Gaza’, 25 June 2024 ↩

246. NBC News, ‘… [F]ood aid in Gaza brought ashore by the U.S. military…’, 28 June 2024 ↩

247. BBC, ‘US military ends Gaza floating aid pier mission’, 18 July 2024 ↩