UNRWA Situation Report #103 on the situation in the Gaza Strip and the West Bank, including East Jerusalem

Tuesday, April 23, 2024

All information from 18–21 April 2024, is valid as of 21 April 2024 at 22:30 

Days 195-198 of Hostilities

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Key Points  

The Gaza Strip 

  • Israeli Security Forced (ISF) operations from air, land and sea continue across the Gaza Strip. On 11 April, ISF announced that a ground operation had begun in central Gaza. ISF operations continue to cause civilian casualties, displacement and destruction of houses and other civilian infrastructure.  
  • According to Save the Children and the World Health Organization, the rate of attacks per month on healthcare in Gaza is higher than in any other recent conflict globally.  There have been at least 435 attacks on health facilities or personnel across Gaza in the last six months, equivalent to 73 attacks every month since the war began on 7 October.    
  • Aid missions to the north continue to be denied by Israel Authorities, 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. The last time UNRWA was able to deliver food supplies to the area was on 23 January 2024; however, UNRWA remains critical in both the northern and southern response, with key distributions of food and non-food items such as medicines occurring in UNRWA installations such as health centres, emergency shelters and distribution centres. 
  • The destruction of waste management installations and medical waste disposal centres severely restricts the collection and disposal of solid waste management. In January and February, UNRWA and UNDP collected 10,000 tons of solid waste. Over 270,000 tons of solid waste across the entirety of the Gaza Strip remains uncollected.
  • There has been very little significant change in the volume of humanitarian supplies entering Gaza or improved access to the north. Since the beginning of April, an average of 186 aid trucks have crossed into Gaza per day via the Karem Abu Salem (Kerem Shalom) and Rafah land crossings. This remains well below the operational capacity of both border crossings and the minimum target of 500 trucks per day.   
  • As of 21 April, the total number of UNRWA colleagues killed since the beginning of hostilities is 180, an increase of two.
  • As of 21 April, up to 1.7 million* people (over 75 per cent of the population)** have been displaced across the Gaza Strip, the majority multiple times.*** Families are forced to move repeatedly in search of safety. Following intense Israeli bombardments and fighting in Khan Younis and the Middle Area in recent weeks, a significant number of displaced people have moved further south. 

*This includes 1 million people living in or near emergency shelters or informal shelters. As of 12 October, approximately 160,000 internally displaced persons (IDPs) were recorded in UNRWA shelters in Northern Gaza and Gaza City governorates. UNRWA currently estimates that the population of Northern Gaza and Gaza City governorates is up to 300,000 people. The ability of UNRWA to provide humanitarian support and updated data in these areas has been severely restricted. The ongoing hostilities, evacuation orders issued by ISF, and the constant need for safer locations have resulted in people being displaced multiple times.

**UNRWA reported on 15 January in Situation Report 64 that up to 1.9 million IDPs were either residing in 154 UNRWA shelters or near these shelters. Due to the continued escalation of fighting and evacuation orders, some households have moved away from the shelters where they were initially registered.

*** There are instances where the same IDPs are registered in multiple shelters due to the fluid movement of populations; hereafter, estimates are used for these shelters. UNRWA plans to conduct a more accurate count of IDPs in shelters, including informal shelters, as soon as the security situation allows. 

The West Bank, including East Jerusalem

The West Bank, including East Jerusalem update will shift to once a week, every Monday. 

  • Between 15 and 21 April there were more than 195 ISF operations reported across the West Bank, with at least 21 Palestinians killed during this period. Of these fatalities, two were children.
  • A large-scale ISF operation commenced on 18 April in Nur Shams Camp in the northern West Bank, lasting approximately 50 hours and concluding on 20 April with significant casualties and massive damage sustained, including to UNRWA facilities. At least 14 Palestinians, including Palestine refugees, were killed during the course of the operation, with 25 reported injuries and eight Palestinians detained. Anti-tank missiles and armoured bulldozers were deployed by ISF during the operation, with Palestinian armed groups detonating improvised explosive devices. Widespread damage to private property as well as camp infrastructure was reported, with water, electricity and internet both cut. Ambulance access to Nur Shams camp was severely hampered during the operation, and a Palestinian Red Crescent Society ambulance was allegedly fired upon. ISF also reportedly blocked routes to the hospital in Tulkarm and temporarily held several paramedics.
  • In a separate incident on 20 April a Palestinian Red Crescent Society paramedic was reportedly shot dead by Israeli settlers who opened fire on an ambulance transporting injured Palestinians following settler violence in the town of As Sawiya, in the northern West Bank. Settler violence continued across the West Bank, with violent confrontations also reported in Burka, in the central West Bank, where six Palestinians were injured in clashes with settlers and ISF on 21 April. 

Destruction at the Nuseirat Preparatory Boys’ school at Nuseirat refugee camp, Deir al-Balah, April 2024. © 2024 UNRWA Photo by Ashraf Amra
Destruction at the Nuseirat Preparatory Boys’ school at Nuseirat refugee camp, Deir al-Balah, April 2024. © 2024 UNRWA Photo by Ashraf Amra

Overall Situation 

The Gaza Strip

  • According to the Ministry of Health in Gaza as of 19 April, at least 34,012 Palestinians have been killed in the Gaza Strip since 7 October. About 70 per cent of those killed are reported to be women and children. Another 76,833 Palestinians have been reportedly injured. 


The West Bank, including East Jerusalem

  • According to OCHA, between 7 October 2023– 17 April 2024, 451 Palestinians, including at least 112 children, have been killed in the West Bank, including East Jerusalem.


Humanitarian Access, Protection of Civilians 

The Gaza Strip

  • All information remains the same as per last update.
  • UNRWA is working to verify the details of incidents reportedly affecting UNRWA premises. Further information will be provided once it becomes available.
  • 360* 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 50 incidents of military use and/or interference at UNRWA premises. 164 different UNRWA installations have been impacted.  
  • UNRWA estimates that in total at least 428* internally displaced people (IDPs) sheltering in UNRWA shelters have been killed and at least a further 1,430* 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.

 *numbers are subject to change once further verifications have been conducted.

UNRWA Response  

The Gaza Strip  

UNRWA Shelters 

  • As of 17 April, nearly 1.7 million displaced people are now sheltering across emergency shelters (UNRWA and public shelters), informal sites or in the vicinity of UNRWA shelters and distribution sites and within host communities.  



  • As of 17 April, eight (out of 24[1]) UNRWA health centres were operational. Of those, one is in the north, two are in the Middle Area, two in Khan Younis and three in Rafah. These health centres provide primary health care services, including outpatient services, non-communicable disease care, medication, vaccination, antenatal and postnatal health care and dressing for injured patients. 
  • On 13 March, UNRWA opened a temporary health centre to provide health services for the people in al-Mawasi, west of Khan Younis. 
  • Nearly 816 healthcare staff continue to work in operational health centres. On 17 April, they provided 10,781 medical consultations.
  • UNRWA conducted another 8,854 medical consultations through 365 staff at the shelters, including at the newly established medical points in al-Mawasi area to serve an influx of displaced persons from Khan Younis. The total registered population in al-Mawasi is currently 403,447.
  • As of 17 April, UNRWA provided mental health and psychosocial support (MHPSS) services in the Middle and Khan Younis areas with teams of psychiatrists and supervisors to assist special cases referred from health centres and shelters. UNRWA teams responded to cases in health centres and in medical points through individual consultations, awareness sessions and support for cases of gender-based violence.  UNRWA teams provided medical care for 343 post-natal and pregnant women at high risk. 
  • In early January, UNRWA received vaccines from UNICEF for its health centres. Eleven different types of vaccines were received (refrigerated and freezer storage). This allowed for vaccinations to restart. Between 3 January and 14 April over 74,296 children were vaccinated against measles, mumps and rubella and others diseases. On 17 April, an additional 967 children were vaccinated.

Psychosocial support (PSS)

  • UNRWA counsellors continues to provide live-saving psychosocial support services in Gaza, including psychosocial first aid, individual and group counselling, fatigue management sessions, recreational activities, Explosive Ordnance Risk Education (EORE) as well as protection cash assistance targeting children , youth and adults.
  •  Since the onset of the conflict, it is estimated that 590,000 IDPs, including over 320,000 children, have benefited from a total of 167,559 PSS sessions/activities. During the period 9 – 19 April 2024, a total of 20,361 IDPs, including 13,399 children, received these services. Specifically, counsellors addressed 850 individual cases and provided 644 group awareness sessions benefiting 5,543 adults. Additionally, they conducted 515 recreational activities engaging 11,431 children. Counsellors also provided 119 EORE sessions to 1,487 adults and 1,740 children and contributed to supporting 160 protection cases.


 Food Security

  • As of 8 April, UNRWA continued to distribute flour outside of shelters in the southern governorates. To date, a total of 380,224 families (nearly 1.9 million people) have been reached, of whom 276,447 families have received two rounds of flour and another 75,423 families have received three rounds.

[1] Pre-conflict UNRWA had 22 health centres, following the conflict an additional 2 temporary health centres are operational in the Mawasi area. 


Water, Sanitation and Hygiene (WASH)

Due to the security situation, in combination with challenges to internet connectivity, we have been unable to provide any additional updates since Sitrep 67. 

Tweet from Philippe Lazzarini, UNRWA Commissioner-General

"The situation in the West Bank is worsening by the day including in Palestine refugee camps. […] Hundreds of people among them at least 112 Palestinian children were killed in the West Bank since 7 October. Movement restrictions & Israeli settlers’ violence hamper people’s access to jobs and livelihoods + impose a state of constant fear. It is time to end the occupation & address the longest lasting unresolved conflict through political means + a genuine commitment to #peace."





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Destruction at the Nuseirat Preparatory Boys’ school at Nuseirat refugee camp, Deir al-Balah, April 2024. © 2024 UNRWA Photo by Ashraf Amra