The OCHA oPt Flash Update is published three times a week, with an update on the West Bank included once a week on Wednesdays. The next update will be issued on 22 April.

Key Highlights

• Every ten minutes, one child is killed or injured in Gaza, UNICEF warns, based on figures by the Ministry of Health, stressing the urgent need to increase medical evacuations of children. 
• With 178 UNRWA staff killed and nearly 350 incidents affecting agency premises in Gaza, UNRWA calls for an independent investigation and accountability.  
• Some 270,000 tons of solid waste have accumulated across the Gaza Strip, according to the Union of Gaza Strip Municipalities, and the International Rescue Committee warns that children are dying from preventable or easily treatable diseases amid an unfolding public health catastrophe. 
• Between 1 and 19 April, 15 per cent of aid missions to northern Gaza and areas in southern Gaza that require coordination have been denied or impeded by Israeli authorities. 

Gaza Strip Updates 

• Israeli bombardment from the air, land, and sea continues to be reported across much of the Gaza Strip, resulting in further civilian casualties, displacement, and destruction of houses and other civilian infrastructure. In a briefing to the Security Council on 18 April, Secretary-General António Guterres stated: “Two million Palestinians have endured death, destruction, and the denial of lifesaving humanitarian aid; they are now staring down on starvation. An Israeli operation in Rafah would compound this humanitarian catastrophe… To avert imminent famine, and further preventable deaths from disease, we need a quantum leap in humanitarian aid to Palestinians in Gaza… Delivering aid at scale requires Israel’s full and active facilitation of humanitarian operations.” 
• Between the afternoon of 17 April and 15:00 on 19 April, according to the Ministry of Health (MoH) in Gaza, 113 Palestinians were killed and 169 Palestinians were injured, including 71 killed and 106 injured in the last 24 hours. Between 7 October 2023 and 15:00 on 19 April 2024, at least 34,012 Palestinians were killed in Gaza and 76,833 Palestinians were injured, according to MoH in Gaza.
• The following are among the deadly incidents between 16 and 17 April: 
  • On 16 April, at about 15:50, at least 12 Palestinians, including children, were reportedly killed when a group of people was hit near Al Muhandis roundabout in Al Maghazi Refugee Camp, in Deir al Balah. The location was reportedly a space for children to play. 
  • On 17 April, at about 9:50, 13 Palestinians were reportedly killed when a group of people was hit at Ash Sheikh Radwan Bridge, in northern Gaza city. 
  • On 17 April, at about 17:40, four Palestinian internally displaced persons (IDPs) were reportedly killed, and others injured, when Shuhayber school in Beach (Ash Shati’) Refugee Camp, in western Gaza city, was hit. 
  • On 17 April, at about 21:15, at least ten Palestinians, including two women and five children, were reportedly killed and others injured when a house sheltering IDPs in As Salam neighbourhood in eastern Rafah was hit. 
• Between the afternoons of 17 and 19 April, no Israeli soldiers were reported killed in Gaza. As of 19 April, 259 soldiers have been killed and 1,582 soldiers have been injured in Gaza since the beginning of the ground operation, according to the Israeli military. In addition, over 1,200 Israelis and foreign nationals, including 33 children, have been killed in Israel, the vast majority on 7 October. As of 19 April, Israeli authorities estimate that 133 Israelis and foreign nationals remain captive in Gaza, including fatalities whose bodies are withheld. 
• At least 408 IDPs were killed and another 1,406 were injured in 349 incidents where munitions fired by parties to the conflict and incidents of interference, including use for military purposes, affected UNRWA premises in Gaza between 7 October 2023 and 15 March 2024, according to an UNRWA report released on 16 April. Over 85 per cent of incidents involved munitions, with at least 160 instances of direct hits, of which 122 affected schools. Another 15 per cent of incidents involved interference by parties to the conflict with UNRWA premises, including unauthorized entry, forced evacuation of IDPs, and use of facilities “as ring positions, to store weapons, as barracks, and for resupply missions.” Many premises have been affected multiple times; for example, 261 incidents were documented at 120 UNRWA schools, with an average of 2.2 incidents per school. UNRWA additionally documented 23 incidents affecting the Khan Younis Training Centre, which was sheltering over 34,000 IDPs prior to the outbreak of fighting in the area in late January. Moreover, since 7 October, 178 UNRWA staff have been killed in the Gaza Strip. In a briefing to the Security Council on 17 April, UNRWA Commissioner-General Philippe Lazzarini highlighted that, although “UNRWA is the backbone of the humanitarian operation,” its “premises and staff have been targeted since the beginning of the war,” demanding “an independent investigation and accountability for the blatant disregard for the protected status of humanitarian workers, operations, and facilities under international law.” 
• “Children are wearing a tremendous share of the scars of this war,” and every ten minutes a child is either killed or injured in Gaza, stated UNICEF spokesperson Tess Ingram, based on MoH figures, in a briefing to the press on 16 April, following a two-week mission to Gaza. More than 12,000 children have been injured in Gaza since the onset of hostilities according to MoH, an average of nearly 70 children every day. The real toll, however, is believed to be much higher as injuries are rarely disaggregated by age, explained Ingram. Recounting the harrowing stories of some of the children she met at hospitals—including a 13-year-old boy whose arm had to be amputated without anaesthesia and a 10-year-old boy shot in the head who did not survive—Ingram emphasized that only a ceasefire can stop the killing and maiming of children. She appealed for an immediate increase in the number of children being medically evacuated outside Gaza, stressing that they are “languishing in pain” in decimated health facilities lacking personnel and basic supplies like needles or stitches. Following a recent assessment mission to northern Gaza, WHO reported that a medical point operated by the Palestinian Medical Relief Society (PMRS) was in dire need of fuel and medical supplies as it continued to receive trauma patients and provide basic health services. The mission team also noted that rehabilitation efforts are underway at the Indonesian Hospital, and a thorough engineering mission is needed to determine the safety of facilities at Al Shifa Hospital, where the removal of dead bodies is still ongoing. On 18 April, the MoH in Gaza appealed again for the establishment of field hospitals and the deployment of international medical teams to Gaza and North Gaza governorates. 
• The public health catastrophe underway in Gaza is disproportionately affecting children, warned the International Rescue Committee (IRC) this week. Amid overcrowding in shelters and severe shortages of clean water, sanitation and basic health services, children as young as four-months-old are dying from preventable or easily treatable diseases like pneumonia, gastroenteritis and diarrhea, with malnourishment rendering them particularly vulnerable. About 30 per cent of roughly 346,000 cases of diarrhea recorded since mid-October are among children under five years of age, according to WHO. As Hepatitis A and other illnesses continue to spread, the IRC also warned that six months of conflict have disrupted essential vaccination cycles, compromising children’s immunity to Hepatitis B, polio and rotavirus. Projections by the London School of Hygiene and Tropical Medicine and the Johns Hopkins Center for Humanitarian Health highlight that epidemics such as cholera, polio, measles and meningococcal meningitis would cause the highest mortality rate in Gaza should they occur, including under an immediate ceasefire scenario where about 11 per cent of estimated deaths due to epidemic disease are projected to occur among children under 59 months in the period between 7 February and 6 August.  
• About 270,000 tons of solid waste have accumulated across the Gaza Strip, creating an environmental and public health catastrophe, according to the Union of Gaza Strip Municipalities. Gaza city accounts for some 90,000 tons, or about a third, of accumulated waste, which the municipality mainly attributes to restricted access to fuel, the destruction of solid waste collection vehicles, and Israeli authorities’ denial of access to the main landfill in Juhr ad Dik area in eastern Gaza city.  The destruction of waste management facilities and medical waste disposal centres has also severely hampered the collection and disposal of solid waste by municipalities. In January and February 2024, about 10,000 tons of solid waste had been successfully collected from Rafah and Khan Younis under a UNDP-UNRWA partnership in support of the Joint Service Council for solid waste management (JSC-KRM) to help mitigate the impact of the solid waste crisis. The partnership involved UNDP-monitored distribution of fuel and the deployment of workers to oversee waste collection operations. While pre-dating the onset of hostilities, the solid waste crisis has been significantly exacerbated; for example, the Executive Director of the JSC-KRM highlighted that, following the mass displacement of people to the southern and central areas of the Strip, the daily amount of generated waste increased from 600 to 1,400 tons, exceeding the council’s capacity. Moreover, a water, sanitation and hygiene (WASH) rapid assessment in Rafah between 4 and 29 February found that 92 per cent of 75 assessed sites for IDPs had some type of visible waste and 75 per cent had informal and uncontrolled dumping areas. 
• Multiple obstacles continue to impede the timely and efficient delivery of urgent humanitarian assistance across Gaza. A limited number of functional land crossings force aid organizations to heavily rely on Kerem Shalom Crossing, where lengthy inspection processes introduce significant delays, leading to bottlenecks and logistical challenges. In a new development, and for the first time in more than six months, three convoys facilitated by the World Food Programme (WFP) crossed Erez Crossing into northern Gaza on 14, 15, and 16 April and some bakeries have resumed operations in northern and central Gaza. The convoys comprised 25 trucks carrying about 404 metric tons of food parcels and wheat flour to nearly 80,000 people, WFP reports. Two additional convoys carrying 374 tons of wheat flour have crossed into Gaza from Ashdod Port through Kerem Shalom Crossing on 16 and 17 April. Within Gaza, ongoing hostilities, the destruction of roads and the prevalence of unexploded ordnance pose significant risks for humanitarian workers, impeding the physical movement of aid supplies. This is in addition to fuel supply constraints, delays and insecurity at Al Rasheed (coastal) Road checkpoint, restrictions on telecommunications, an insufficient number of drivers and trucks cleared by Israel to use the fence road, and a limited number of available trucks. On 17 and 18 April, the United Nations transferred into Gaza 15 of 30 trucks it had purchased to enhance aid delivery by augmenting the available fleet. The purchase and shipment are funded through the occupied Palestinian territory Humanitarian Fund (oPt HF) at a cost of US$3.5 million. Finally, denied access to aid missions also represents a key constraint; between 1 and 19 April, 15 per cent (27 out of 181) of aid missions to northern Gaza and areas in southern Gaza that require coordination have been denied or impeded by Israeli authorities. In the past week (13-19 April), there has been an increase in the number of facilitated food missions to northern Gaza, accounting for 14 out of 17 missions facilitated by Israeli authorities.  

Funding 

• On 17 April, the Humanitarian Country Team released a new Flash Appeal for the occupied Palestinian territory (oPt), which requests $2.8 billion to meet the most critical needs of 2.3 million people in Gaza and 800,000 people in the West Bank, including East Jerusalem, between April and December 2024. The figure reflects what is deemed most likely to be implemented over the next nine months, under access constraints and security challenges that limit the rapid scale-up of the humanitarian response, and represents only a part of the requirement that the UN and partners estimate is needed to meet the scale of humanitarian needs across the oPt. This Flash Appeal replaces the initial appeal launched in October 2023 and extended until March 2024, which sought $1.23 billion; roughly half of this amount was utilized in the last quarter of 2023 and the remaining half in the first quarter of 2024. 
• The oPt HF has 118 ongoing projects, for a total of $72.5 million, addressing urgent needs in the Gaza Strip (85 per cent) and West Bank (15 per cent). In light of the updated Flash Appeal, the HF has allocated an additional $22 million to bolster prioritized HF-funded projects in Gaza to enhance the operational capacity of humanitarian partners as well as ensure the continuity and expansion of essential services amid escalating challenges. In the West Bank, the oPt HF has allocated $5 million for key partners to enhance system readiness and responsiveness to sudden-onset emergencies. Since 7 October, the oPt HF has mobilized $90 million from Member States and private donors, designated for programmes throughout Gaza. A summary of the oPt HF activities and challenges in March 2024 is available through this link and the 2023 Annual report of the oPt HF can be accessed here. Private donations are collected directly through the Humanitarian Fund. 

For the Humanitarian Needs and Cluster Response Update for the period between 9 and 15 April, please visit: Humanitarian Needs and Response Update | 9–15 April 2024. It is updated throughout the week to reflect new content.