The situation is unfolding as “lives are hanging by a thread”, including those of babies in incubators at hospitals that depend on fuel for electricity, Andrea De Domenico, Head of OCHA’s office in the Occupied Palestinian Territory, told journalists in New York on Monday.

“Humanitarian ceasefire, fuel supplies – all of these should be happening now. We are running out of time before really facing major disaster,” he said, speaking from Jerusalem.

Death, displacement and devastation

The UN continues to address the dire humanitarian situation in Gaza since Hamas militants launched deadly attacks against Israel six weeks ago and seized some 240 hostages, including babies and older persons.

Israel’s response to the incursion and massacre of 1,200 citizens has included continued bombardment, electricity and communications blackouts, and restrictions in accessing the enclave, which is home to 2.2 million people, some 1.5 million of whom have displaced mostly to the south.

Thousands have been killed, including 101 staff from the UN agency that assists Palestine refugees, UNRWA. They were remembered during a minute of silence observed by personnel across the UN system worldwide on Monday.

Snipers, shooting and staying put

This past weekend saw intensified fighting around Al-Shifa Hospital, the largest in the Gaza Strip, said De Domenico.  Critical infrastructure was damaged, such as water tanks, oxygen stations, the cardiovascular facility, and the maternity ward.  Three nurses reportedly were killed.

The Palestinian Red Crescent Society also reported on Sunday that Al Quds Hospital in Gaza City – the second largest in the enclave - was no longer operational due to damage to the main generator line, which could not be fixed.

“In any case, PRCS told us that they have fuel only for 24 hours, and any possibility of looking (for) or finding fuel was almost impossible and very dangerous given that there were snipers shooting in and around the hospital,” he continued.

Efforts were underway to evacuate seven intensive care patients and four babies in incubators, he said. While some staff and patients have managed to flee the hospital, others remain trapped inside either because they fear leaving or are unable to do so for medical reasons.

Fleeing northern Gaza

De Domenico underscored the critical need for fuel and medical supplies in Gaza, noting that some patients have already died, while access to water and food has become increasingly difficult.

OCHA teams have observed the movement of some 10,000 people from north Gaza who have headed south following evacuation orders issued by Israel. People are arriving mainly by foot.  They are thirsty, exhausted, and often have no concrete idea on where they will be staying, with shelters already overstretched.

On Sunday, 76 trucks delivered aid into Gaza through the Rafah crossing with Egypt, an arrangement that has been in place since 21 October. On board were health supplies, bottled water, blankets, tents and hygiene products. To date some 980 trucks have made the journey butis still far below the level needed.

No fuel, no comms, no aid

“Actually, instead of a much-needed increase of this assistance, we have been informed by the colleagues of UNRWA that due to the lack of fuel, as of tomorrow the operations of receiving trucks will no longer be possible,” he said.

“Operational conditions in general are deteriorating by the hour,” he added. “We have no fuel, no comms, and no guarantee of respecting UN premises or in any case notify(ing) premises, which is of course reducing progressively our ability to operate.”

Humanitarian ceasefire critical

UN agencies continue to amplify the Secretary-General’s call for an immediate humanitarian ceasefire in Gaza, the unconditional release of all hostages, and sustained and continued aid access to people in need, wherever they are located.Earlier on Monday, humanitarians from across the region highlighted their appeal for $1.2 billion to meet the needs of 2.2 million people in Gaza and another 500,000 in the West Bank through the end of the year.

A grim toll

Lynn Hastings, UN Resident and Humanitarian Coordinator, said the situation in Gaza is beyond any they have ever seen “almost anywhere in the world”.

She said at least 10,000 Palestinians have been killed, according to authorities – together with around 1,200 Israelis – a death toll that is “the same as in 18 months in Ukraine and as in Sudan in six months.”

Furthermore, an estimated 55 per cent of the water supply infrastructure requires repair or rehabilitation. People have resorted to using unhealthy water sources “and we're expecting this to lead to more of a public health crisis”.

She also drew attention to the devastation sustained by the humanitarian community in Gaza, which is “heavily localized and reliant on national staff”.

Hastings also urged humanitarians to be mindful of rising fatalities in the West Bank, where 100 Palestinians and three Israelis have been killed since the start of the Gaza conflict on 7 October.