Access and Humanitarian Space

Delays and impediments to humanitarian movements continue, including for missions from southern to northern Gaza. Missions that are approved by Israeli authorities still take hours to complete and teams have been compelled to travel on roads that are often congested.* Between 17 and 23 September, out of 94 attempts to coordinate planned movements with Israeli authorities across the Gaza Strip, 35 were facilitated (37 per cent), 13 were impeded (14 per cent), 30 were denied (32 per cent) and 16 had to be withdrawn by the organizers for logistical, operational, or security reasons (17 per cent). Since the closure of Zikim crossing on 12 September and until 22 September, the denial rate of movements to northern Gaza has increased to 40 per cent, up from 18 per cent in the preceding 11 days, between 1 and 11 September.

Shrinking Space for Lifesaving Services in Gaza City

Since 1 September, four hospitals in North Gaza and Gaza governorates were forced to shut down, bringing the total number of functioning hospitals in Gaza to only 14, including eight in Gaza city, three in Deir al Balah and three in Khan Younis. None of them, however, is functioning at full capacity. The four hospitals that were rendered out of service are Al Rantisi Children's Hospital, Ophthalmic Hospital, and St. John Eye Hospital in Gaza city and Hamad Hospital for Rehabilitation and Prosthetics in North Gaza. Hamad Hospital is one of the main three specialized rehabilitation facilities in the Gaza Strip, which was serving 250 outpatients with rehabilitation services, in addition to providing medical care for people injured while seeking aid in North Gaza at its trauma stabilization point, with about 200 patients served daily. Al Rantisi Hospital had sustained severe damage from a direct strike days earlier and most of its medical equipment, according to the Health Cluster, were transferred to Al Helou, As Sahaba and Patient Friendly hospitals, all in Gaza city, on 21 September.

Challenges Facing the Health-care System in Central and Southern Gaza

At Nasser Medical Complex in Khan Younis, the situation is extremely dire. Patients, especially children, face critical shortages in both treatment services and hospital beds. According to Nasser Medical Complex, dozens are crowded into hallways and shared rooms, while families are left sitting on the floor amid a severe lack of medicines and essential care. The extreme overcrowding is largely due to the mass displacement of families from northern Gaza, leaving the facility unable to absorb the surge in patients. On 22 September, Dr. Ahmed Al-Fara, Director of the Children's and Maternity Center at Nasser Medical Complex, described the situation as one of unprecedented overcrowding across the entire facility, and particularly in the paediatric departments. “We are witnessing extreme congestion in the neonatal units, with up to three babies sharing a single incubator – a very serious precedent in the nursery departments,” he said. He added that the paediatric departments are beyond capacity, receiving approximately 1,000 cases in just 24 hours, with nearly 200 children admitted, despite the department's capacity of only 40 beds. “These are numbers we’ve never seen before,” he emphasized. Dr. Al-Fara also reported a dramatic increase in the number of premature and low-birth-weight infants, now accounting for 60-70 per cent of newborns, compared with 20 per cent before October 2023. “The conditions are catastrophic in every sense of the word,” he concluded.

Displacement and the Struggle for Survival

The journey to the south is long and dangerous. On 19 September, the Israeli military announced that Salah al Din Road, which opened for 48 hours only, is closed for southward movement. Since mid-August, Al Rashid Road has been the main route available for people moving from Gaza city southward. Prior to departure, many report waiting many days to secure space on trucks for their belongings, with high transportation costs placing an additional burden on already exhausted families. UNRWA reports that costs can reach more than US$3,000, including for transportation, purchasing a tent and land space to set up the tent - where such space is available. According to SMC partners, many families cannot afford transport to the south, forcing some to travel on foot. Families are also facing multi-day delays and travelling along overcrowded and arduous displacement routes, often increasing the risk of family separation. This is especially the case for children under 10, UNICEF highlights. Reports from partners at the four flow monitoring points on Al Rashid Road – comprising partners working on site management and protection, including child protection and addressing gender-based violence (GBV) – indicate that the road is heavily congested, with vehicles, donkey carts, tuk-tuks, and large numbers of exhausted and worn-out people travelling on foot. With the majority of people in Gaza already displaced multiple times, the most vulnerable, particularly children and the elderly, are bearing the brunt of the hardship, including the risk of dehydration during the journey. Layan, an 11-year-old student, told UNRWA: “I am supposed to be in sixth grade. My school was destroyed… I am so tired of evacuation and displacement. This is our sixth time to move in search for a safe place.