On 9 October 2023, Israel launched a “total siege” on the Gaza Strip, which has since become the worst humanitarian catastrophe in history, due to the sheer number of people affected, the scale of violence and the significant impact on International Humanitarian Law (IHL). Following 75 years of Israeli occupation, Gaza has become one of the most densely populated areas in the world, with 2.1 million people living in just 365 km². In the past year, approximately 1.9 million people have been displaced due to the ongoing conflict.
From 7 October 2023 to the end of October 2024, at least 43,391 Palestinians and 1,568 Israelis have lost their lives due to the escalation of violence. An estimated 10,000 Palestinians remain missing, buried under the rubble. Additionally, 102,347 Palestinians and 7,794 Israelis have been injured.
All sectors of humanitarian assistance have been severely impacted, including food security, access to clean water and sanitation, shelter, protection, education and healthcare. Humanitarian aid reaching Gaza has plummeted to historic lows and the situation in northern Gaza has been described as “apocalyptic” by 15 representatives from UN agencies and international NGOs.
17 hospitals are partially operational, while 19 out of 36 hospitals are non-functional.
11 field hospitals are in operation, with 5 fully operational and 6 partially operational.
35% of primary health centres are partially functioning (47 out of 132). Only 26% (7 out of 27) of UNRWA health centres are operational. Only 39% (6,075 out of 15,600) of critical patients who requested medical evacuation had their requests approved. As of 29 October, an estimated 14,000-plus patients require medical evacuation from Gaza.
reliefweb
Under the Fourth Geneva Convention (GCIV Art. 55, 58), Israel, as the occupying power, is legally obliged to ensure the provision of food, medical supplies, shelter and other essential materials for the survival of the civilian population in the occupied territory. While there have been numerous reports of Israeli authorities obstructing aid since the beginning of the siege, the current blockade of essential humanitarian assistance has reached unprecedented levels. Access to humanitarian aid is a fundamental requirement for effective humanitarian action. Various constraints on humanitarian access exist, but not all of these represent direct obstructions to aid. In recent years, however, there has been a troubling increase in actions that violate IHL and lead to the obstruction of humanitarian aid, particularly in the Occupied Palestinian Territory (oPt).
Indiscriminate and relentless attacks. Israeli forces have employed military tactics, such as air strikes in densely populated areas and the use of long-range high-explosive weaponry, which are incompatible with the requirement to distinguish between military and civilian targets. These tactics have had devastating effects on residential areas, refugee camps and essential infrastructure, including schools and health centres. One in three of the victims of these attacks is under 18 years of age. Even within Israel’s unilaterally designated “humanitarian” zones, where minimum security conditions cannot be guaranteed, repeated attacks have been recorded.
Forced displacement. Some 89% of Gaza is under forced displacement orders and 90% of the population has been displaced, often multiple times, further exacerbating overcrowding. This includes the displacement of Palestinian humanitarian staff and aid recipients, which hampers the continuity of operations, increases risks and forces the suspension of critical activities, along with the reallocation of resources. Key services, including water distribution, sanitation and health care, have been severely impacted.
Hunger as a weapon of war. An estimated 91% of Gaza’s population, or 1.95 million people, are experiencing varying degrees of food insecurity, with 345,000 facing catastrophic levels (IPC Phase 5). The looming famine is a direct consequence of Israel’s destruction of essential life-sustaining infrastructure and services. Access to water and sanitation has been decimated, food aid is increasingly obstructed or reduced and health services, particularly those treating malnutrition and undernutrition, are in a state of fragility. Humanitarian actors have been warning of this crisis since March, but the blockade on essential services and supplies continues to worsen. In October 2024, the World Food Programme reported that approximately 1.7 million people, 80% of Gaza’s population, did not receive their monthly food rations, and the number of meals distributed daily fell by 25% compared to September.
Attacks on humanitarian workers. Gaza has become the deadliest place in the world for humanitarian workers (AWSD Report 2024) (AWSD DB), particularly in the health sector . At least 326 humanitarian workers have been killed (319 nationals and 7 foreigners), including 241 UN staff, of whom 237 were part of UNRWA; 33 Palestinian Red Crescent staff and volunteers; and 52 other humanitarian workers. Additionally, 85 Civil Defence personnel lost their lives in the line of duty (source: PCD) . From 7 October 2023 and 30 September 2024, Insecurity Insight recorded 1,736 incidents of violence or obstruction of access to healthcare in Israel and the Occupied Palestinian Territory (oPt). Of these, 1,680 occurred in the OPT, attributed to the Israel Defence Forces (IDF). As a result, at least 518 health workers were killed and 357 were detained. Health facilities were damaged 251 times, with the majority of attacks taking place in Gaza, while in the West Bank and East Jerusalem, incidents primarily targeted refugee camps.
In October 2024, the Israeli parliament passed a law that could effectively halt UNRWA’s operations in the Occupied Palestinian Territory (oPt). The culmination of a prolonged campaign to discredit and criminalise the agency, the decision threatens to trigger a large-scale blockade on the operations of numerous humanitarian actors. An initial assessment by the international humanitarian NGO network in Palestine, AIDA, suggests that at least 4.5 million people could be affected. Currently, there is no capacity within the existing humanitarian actors in the oPt to replace UNRWA’s vital role. The agency provides an essential range of services—such as administering 40% of the region’s polio vaccines—and plays a crucial supporting role for NGOs in areas like security, logistics and coordination. It is also central to key sectors that protect and care for life, including primary health, mental health and psychosocial support. A wide range of international actors, including the UN Secretary-General, the UN Security Council, the UN High Commissioner for Refugees, many international organisations and numerous NGOs, have warned of the devastating consequences that dismantling UNRWA would have not only on the lives of millions in Palestine but also on the broader integrity of the international community.
Impediments to aid entry. Following the catastrophe in Gaza, the US Secretary of State sent a letter in October to Israeli authorities, demanding that they improve humanitarian access within 30 days, with the possibility of restricting US military aid if these demands were not met. Despite this deadline, the situation has continued to deteriorate, with none of the outlined demands being fulfilled. One of the main demands is the removal of a list of items that Israel considers “dual use” and deems essential for humanitarian operations. This list, which remains undisclosed, has led to the obstruction of entire truckloads of aid. Another key demand is that at least 350 trucks of humanitarian aid be allowed into Gaza daily. Before October 2023, the daily average was 500 trucks. However, the procedures for allowing trucks to enter are so complex that they often function as a form of obstruction in themselves. In October 2024, the average number of trucks allowed into Gaza daily was just 37—the lowest in the past year. In the first days of November, this number increased slightly to only 80.
“The entire Palestinian population in northern Gaza is at imminent risk of death from disease, starvation and violence”. Inter-Agency Standing Committee.
Denials and restrictions on aid operations. In October 2024 OCHA reported 580 requests for coordination by humanitarian actors with the Israeli authorities in Gaza. However, only a third of these requests were processed in northern Gaza, and slightly less than half in the south. Almost half were cancelled by humanitarian actors due to logistical or security risks. A total of 254 requests were denied by the Israeli Coordination and Liaison Administration. In 92 cases where authorisation had been granted, there were obstacles or delays to movement which in some cases led to cancellations or partial cancellations. The trend of refusals and obstructions is on the rise. According to Security Insight, emergency medical teams and ambulances were often prevented from reaching people in need of care.
Restriction of permits to access Gaza and the territory as a whole. International organisations working in the oPt are facing growing restrictions on access for their staff. These include: the revocation of all permits to Jerusalem for West Bank ID holders, affecting around 1,300 Palestinian aid workers; the denial of work visas and entry at border crossings for international humanitarian staff; and significant restrictions on movement within Israel and the oPt. All of these obstacles impact the availability of human resources, reducing the capacity of organisations in various technical, operational and programmatic areas, and even jeopardising the duty of care to humanitarian staff already working in extreme conditions.
Access to critical commodities. As the humanitarian crisis worsens, access to basic goods in the local market is becoming increasingly limited, with prices soaring to as much as 100 times their usual cost when they are available (Humanitarian Access Snapshot #7). Fuel shortages, for example, are impacting operations and driving up the cost of essential services like water transport, waste collection and cleaning. Access to cash, which is crucial for meeting even the most basic needs, is severely restricted due to its scarcity, causing delays in payments and transactions, and forcing up fees for financial services.
Risk of militarisation of humanitarian aid. In addition to the current crisis, there’s an even more worrying development. It appears that the Israeli authorities have no intention of halting strategies that violate international humanitarian law (IHL), such as forced displacement and the weaponisation of hunger, all aimed at tightening their control over Palestinian territories. The creation of “bubbles” to isolate populations deemed unrelated to armed groups is also being proposed, with fences restricting movement and trapping people. Additionally, there are discussions about transferring responsibility for humanitarian aid in Gaza to Israeli forces or private companies, which could present significant risks for Palestinian refugees. Although Gaza has endured the brunt of the humanitarian blockade, the West Bank is also experiencing a notable decline in humanitarian conditions.
Israel’s unprecedented levels of violence, alongside its humanitarian blockade, pose severe risks not just to the lives of Palestinians and the broader region, but also to the integrity of international law and the global community. In July 2024, in response to a request from the UN General Assembly in 2022, the International Court of Justice issued a groundbreaking advisory opinion. It stated that Israel must immediately cease its illegal occupation of the West Bank, Gaza and East Jerusalem, highlighting that Israel’s policies and practices violate Article 3 of the International Convention on the Elimination of Racial Discrimination, particularly concerning racial segregation and apartheid. The Court further called on Israel to “take all necessary measures to prevent genocide in Gaza and urgently improve the dire living conditions for Palestinians by facilitating the delivery of essential services and humanitarian aid”.
Decisions by the international community, particularly the most influential countries, are crucial to enforcing international law. A permanent ceasefire, the suspension of military support to Israel and a firm commitment to defending humanitarian access have never been more critical.