A sampling of reports indicate the shocking toll on civilians in Gaza:

World Health Organization, Jan. 5:
Two shells hit 15 meters from Al Awda hospital’s emergency room. A nurse sustained severe head injuries.

Three mobile clinics were destroyed 5 January. All vehicles are now unusable.

One paramedic was killed and two injured en route to evacuating a patient and their ambulance destroyed by munitions. This raises total of medical staff killed since 27 December to six and ambulances hit to three.

All Gaza hospitals continue working on back-up generators for the third consecutive day. International humanitarian law requires all medical personnel and facilities be protected at all times, even during armed conflict. Attacks on them are grave violations of international humanitarian and human rights laws.

Hospitals warn that the generators are close to collapse and they have four more days of fuel, even with services limited t0 the mere essentials.

Physicians for Human Rights – Israel, Jan. 5:
Israeli army firing on first response units in Gaza; ambulances unable to reach injured persons nor evacuate them from the scene of attacks to Gaza hospitals. Several ambulances have sustained direct artillery or helicopter fire, medical personnel have been killed, others critically injured. There is no possibility for the rapid evacuation of patients; those whose lives could have been saved are left to bleed to death.

“The PRCS [Palestine Red Crescent Society] reported to PHR-Israel that they have no way of dispatching ambulances without prior coordination since ambulances that set out for evacuation duties at AlAtatra were fired at by Apache helicopters. … AlAwda hospital in Beit Lahiya also asked for our assistance since they must send out ambulances to AlAtatra and Tel Zaatar but cannot dispatch ambulances without being shot at.

International Rehabilitation Council for Torture Victims, Jan. 6:
Since its premises were destroyed by Israeli bombs on 30 December the Gaza Community Mental Health Programme (GCMHP) — a member of the International Rehabilitation Council for Torture Victims (IRCT) — has been unable to provide care to an ever increasing number of traumatised civilians. Another IRCT member centre in Gaza, the Jesoor Organization, is also unable to operate due to the security situation. …

From the headquarters of the IRCT in Copenhagen, Denmark, Secretary-General Brita Sydhoff says: “I am absolutely appalled by Israel’s targeting of densely populated urban areas. Attacks on civilian areas by both sides are deplorable, but Israel’s attacks are grossly disproportionate and are disrupting vital health services.”

“I am extremely alarmed that our two member centres in Gaza, the GCMHP and the Jesoor Organization, are unable to operate during a time when their services are desperately needed” she adds and concludes:

“Israel’s reckless attacks and blockade are endangering the lives and health of the entire population of Gaza in blatant breach of international law and fundamental human rights. I urge the government of Israel to cease its offensive and immediately take all necessary measures to ensure the access of Gaza’s civilian population to vital health services and other fundamental humanitarian needs.”

International Committee of the Red Cross, Jan. 4:
The situation in Gaza since the Israel Defense Forces launched their ground offensive on Saturday night has become both chaotic and extremely dangerous. It is difficult for the ICRC to move around and assess the urgent humanitarian needs created by the continued shelling and bombing, and by fighting on the ground. The ground attack has forced a number of people in the north of the Gaza Strip to flee their homes.

The fighting is causing damage to hospitals, water supply systems, government buildings and mosques. A number of water supply lines have been severed during bombardments, making it very difficult for families in certain areas of the Gaza Strip to get hold of safe drinking water.

At the same time, rocket attacks from Gaza on southern Israel continued.

‘We are seriously concerned about the reports we are receiving with regard to civilian casualties and damage to civilian objects,’ said Pierre Wettach, the ICRC’s head of delegation in Israel and the occupied Palestinian territories. ‘The safety of civilians is our primary concern in this conflict and we are calling on all parties to spare the lives of all those who are not directly participating in hostilities.’

Hospitals are having to deal with a new influx of wounded people. It is extremely important that they receive new supplies almost every day. The ICRC has received urgent requests for strong painkillers, anaesthetics, body bags and sheets to wrap dead bodies.

Hospitals are now completely dependent on generators for electricity. Many of these generators are unreliable due to lack of maintenance and because of the Israeli restrictions on the import of spare parts. The generators are running around the clock, which means that some of them may break down at any moment, making it impossible to use life-saving medical equipment.

An ICRC war-surgery team that had been awaiting Israeli authorization to enter Gaza for the past three days has now received permission. It is on standby in Jerusalem, and will be moving in to Gaza on 5 January. Once the team is able to enter the Strip, it will be helping surgeons at Shifa Hospital to treat complicated injuries. …

Military operations have prevented Palestine Red Crescent ambulance staff responding to many calls. On Sunday, for instance, a woman in Zeitoun in the northern part of Gaza was unable to get to hospital before she gave birth. Her baby was born dead and she suffered a ruptured uterus. Her family had been calling for several hours, and the woman eventually had to be taken to hospital in a donkey cart.

From Saturday mid-day to Sunday mid-day, the Palestine Red Crescent’s medical services handled 176 wounded and 36 fatalities.

The Magen David Adom is continuing to provide medical services in southern Israel to people affected by the rockets launched from Gaza. The MDA reports that over the last nine days four people have been killed in southern Israel and 60 injured, four of them seriously.

United Nations Office for the Coordination of Humanitarian Affairs, Jan. 5:
Situation Report from the Humanitarian Coordinator:
The Israeli military operation has entered its tenth day, with the population of Gaza bearing the brunt of the violence. Israeli ground forces are currently deployed around the large Palestinian population centres in the northern Gaza Strip (Gaza City, Beit Hanoun, Beit Lahiya, and the Jabalia Refugee Camp), eastern Gaza Strip, between the Gaza governorate and Middle Area, and in southeast Rafah.

Gaza is now divided into two sections with internal movement within the Strip extremely dangerous. It is increasingly difficult for humanitarian staff to distribute aid or reach casualties. More than a million Gazans still have no electricity or water, and thousands of people have fled their homes for safe shelter. In addition to the destruction of essential infrastructure including electricity, water and waste water, communications and roads, hospitals are unable to provide adequate intensive care to the high number of casualties.


The number of casualties since the beginning of the ground operation on 3 January has risen to approximately 94 Palestinians killed and many more injured. Many of the recent fatalities are women and children with entire families among the dead. This morning, an Israeli shell killed seven members of a Palestinian family (five children and their parents) in their home in the Beach refugee camp. Since this morning until 1500 hours, 25 Palestinians have been killed. The main premises of the Union of Health Care Committees in Gaza City was hit, damaging three mobile clinics and a vehicle. On 4 January, a shell struck Gaza City’s main vegetable market, resulting in five fatalities and 40 wounded. A paramedic working for the UHWC, an Oxfam-funded organisation, was killed when an Israeli shell struck an ambulance trying to evacuate an injured person in the Beit Lahiya area; another paramedic lost his foot and a driver was injured in the same incident.

MoH figures as of 1500 hours are 534 dead and at least 2470 injured since 27 December. However, the danger to medical staff and the difficulty of extracting the injured from collapsed buildings makes proper evacuation and estimation of casualties difficult.

An Israeli soldier was killed on Sunday. Overall, close to 60 IDF soldiers have been wounded in Gaza since Saturday, including four who remain in serious condition. Gaza militants fired at least 45 rockets on Sunday, wounding three Israelis.


75% of Gaza’s electricity has been cut off. Since the ground operation, all Gaza governorate and most of North Gaza and the Middle Area are without electricity and there is limited electricity in Rafah, following attacks which damaged 6 of 10 power lines from Israel and one of two power lines from Egypt. The Gaza Strip is currently receiving just 25% of its total electricity need. Palestinian technicians face difficulties to reach the damaged lines because of the military attacks. Although extremely difficult for ICRC staff to move, they have managed to escort technicians to repair the damaged electricity supply lines providing electricity from Israel to the northern part of Gaza.


Hospitals are struggling to function under 24-hour per day power outages. Hospital electricity is still being provided by back-up generators and fuel for generators is precariously low. Today, generators at MoH ambulance stations, vaccine stores, labs and warehouses shut down due to lack of fuel, until UNRWA delivered fuel to the MoH. UNRWA and ICRC are working to deliver additional fuel supplies as a short- term solution.

While stabilized patients are being discharged as soon as possible to free up space in the hospitals, the Intensive Care Units (ICUs) throughout the Gaza strip are overloaded, and all ICU beds are occupied.

There is an urgent need to evacuate patients out of Gaza.

Although a large quantity of medicines has been supplied by various donors and organizations, humanitarian organizations are now receiving urgent requests for strong pain killers as well as for body bags and bed sheets used for wrapping the dead. There is also an urgent need for more neuro-, vascular-, orthopedic- and open heart surgeons.

Collateral damage to hospitals is not being repaired; broken windows, for example, have not been fixed because of lack of glass.

Five of UNRWA’s health centers are now closed due to hostilities nearby.

Palestine Red Crescent ambulance staff has been unable to respond to many calls due to the military operations. From midday 3 January to noon 4 January, the Palestine Red Crescent’s medical services handled 176 wounded and 36 fatalities. Safety of ambulances and medical staff is a major concern.


A large number of people from the border areas are reportedly being displaced deeper into Gaza as the ground operation progresses. UNRWA has now opened 11 shelters for those displaced. 5,000 persons are currently staying at them, though the number is quickly increasing. UNRWA has distributed non-food items (including mattresses and blankets) to those in need, though its stocks are quickly running out. UNRWA will increasingly need items including hygiene kits. UNRWA has also started to distribute food parcels which include bread, beans and meat.


Gaza’s water and sewage system is on the verge of collapse due to the lack of power and fuel. The CMWU warns that 48 of Gaza’s 130 water wells are not working at all due to lack of electricity, damage to the pipes and/or depleting fuel reserves on which the generators depend (sufficient only for coming 2-3 days).

At least 45 additional water wells are operating only partially and will shut down within days without additional supplies of fuel and electricity. Over 530,000 people (approximately 400,000 people in Gaza and North Gaza, 100,000 people in Rafah, and 30,000 people in the Middle Area) are entirely cut off from running water, and the rest are receiving water only intermittently, every few days.

The CMWU is facing difficulties to repair the damages to the networks because of security reasons.

However, if the electricity was functioning, the CMWU could redirect water those people from other sources.

The sewage situation is highly dangerous, posing serious risks of the spread of water-borne disease. Sewage is flooding into Beit Lahiya, farmland, and the sea, after five of Gaza’s 37 waste water pumping stations shut down due to lack of electricity. The remaining 32 stations are operating only partially and will shut down within 3-4 days unless they receive more diesel. The most dangerous problem is the wastewater treatment plant in Beit Lahiya. In addition to the risks of any strikes near the lake, the sewage level of the lake is rising by approximately 1.5 cm to 2 cm each day due to lack of electricity or fuel to pump overflow sewage from the main lake into the lagoons. Within a week, an increase of 15-20 cm is expected in the water level, which is close to overflowing.


Food distributions continue to be difficult due to the precarious security situation. The Bakery Owners Association has 70 tonnes of cooking gas stored at gas stations near the border and on the eastern road. Access to this gas, only possible with permission from Israeli authorities, would allow them to increase the number of operating bakeries.


Movement of humanitarian aid within the Gaza Strip is difficult due to the dangerous situation on the ground. In coordination with the Israeli authorities, the ICRC is helping coordinate safe passage for a number of ambulances, a fire brigade team, GEDCO and CMWU technical staff to ensure that they are not shelled while assisting people in need or repairing damages.


Kerem Shalom, the Nahal Oz fuel pipelines and Erez are open today. 60 truckloads of humanitarian supplies are expected to enter through Kerem Shalom. Nearly 215,000 litres of industrial fuel along with 47 tonnes of cooking gas have been pumped from Israel to Gaza but not collected due to the prevailing security situation; 100,000 litres of diesel have entered for UNRWA. Erez crossing is partially open for a limited number of medical evacuations and foreign nationals.

Rafah crossing is also open today: 4 truckloads of medical supplies are expected to arrive and 17 medical cases are scheduled to be evacuated. Medical professional volunteers (doctors, surgeons and others) from various countries are waiting on the Egyptian side of Rafah to enter Gaza to help treat injured Palestinians.


Fuel: Industrial fuel is needed to power the Gaza Power Plant, which has been shut down since 30 December.

Replacement of ten transformers which were completely damaged is also urgently needed, as well as coordination to allow technical teams to fix other damages. Nahal Oz crossing must remain open as it is the only crossing which can facilitate the transfer of sufficient amounts of fuel to restart and maintain operations of the power plant, and restock other types of fuel needed in the Strip.

Wheat grain, essential to provide flour for local bakeries and humanitarian food distribution to the population of Gaza. The Karni Crossing conveyor belt is the only mechanism which can facilitate the import of the amount of grain required in the Strip at this time. This crossing remains closed.

Cash has still not entered the Gaza Strip and is urgently needed, including for the UNRWA cash distribution program to some 94,000 dependent beneficiaries, as well as its “cash for work” program, salaries to its staff and payments to suppliers.
Internal movement within the Gaza Strip: Currently movement within the Strip is very restricted. It is essential that patients and ambulances are able to reach hospitals, that agencies are able to access warehouses in order to conduct distributions, and that staff are able to move to fix damages to public
services. Bakeries also need to have access to gas stored in gas stations along the border area.

Agence France Presse, Jan. 4
The Israeli army said the World Food Program halted emergency shipments to Gaza because its warehouses are full but the UN agency insisted it was desperate to get supplies into the enclave.

‘The military incursion compounds the humanitarian crisis following more than a week of shelling and an 18-month long blockade of the territory,’ the UN humanitarian coordinator said in a daily report.

There was an ‘almost total blackout’ across most of Gaza and land and mobile phone networks were also down because they depend on backup generators which had no fuel, the report said.

All Gaza City hospitals have been without electricity for 48 hours and now rely on backup generators which the UN said were ‘close to collapse.’

The report said that ‘for the second consecutive day Israeli authorities have refused to allow an ICRC (International Committee of the Red Cross) emergency medical team into Gaza’ to help at the main Shifa hospital. The territory has been sealed off for more than two days.

At the hospital the breakdown of temporary generators would threaten 70 patients linked to machines in the intensive care unit, including 30 infants.

More than 510 Palestinians have already been killed in Israel’s nine day old offensive on Hamas targets in the Gaza Strip, which on Saturday was intensified with the launch of a massive ground operation.

The UN said the tank fire and air attacks were preventing medical staff reaching hospitals and ambulances could not get to the injured ‘because of continuous fire.’

The World Food Program has coordinated emergency food deliveries into Gaza in recent months but the Israeli army said there was plenty of food in Gaza warehouses and that the territory’s Hamas rulers had halted distribution.

The Israeli government is adamant there is no humanitarian crisis in Gaza.

‘The WFP stopped sending food in there because their warehouses are full to the top,’ military spokeswoman Major Avital Leibovitz told AFP

‘The question is why Hamas is not moving the food around the territory. They say the roads are blocked. Why are the roads blocked for food but they can get around to fire rockets?’

Christine Van Nieuwenhuyse, the WFP representative for the Palestinian territories, told AFP however that the Gaza food warehouses were at less than half capacity.

She said food could not be distributed because it is ‘too dangerous’ in the conflict or because warehouses were in military zones.

Gaza border crossings have been closed for two days and she said the WFP had asked the Israeli government to allow more trucks to go into Gaza.

‘Tomorrow (Monday) we hope to send some in. But some roads have been destroyed and some of the Palestinian transporters are afraid to go to the border,’ Van Nieuwenhuyse said.

Ha’aretz correspondent Amira Hass, reporting from Gaza, Jan. 5:
Three hours after the Israel Defense Forces began their ground operation in the Gaza Strip, at about 10:30 P.M. Saturday night, a shell or missile hit the house owned by Hussein al A’aiedy and his brothers. Twenty-one people live in the isolated house, located in an agricultural area east of Gaza City’s Zeitoun neighborhood. Five of them were wounded in the strike: Two women in their eighties (his mother and aunt), his 14-year-old son, his 13-year-old niece and his 10-year-old nephew.

Twenty hours later, the wounded were still bleeding in a shed in the courtyard of the house. There was no electricity, no heat, no water. Their relatives were with them, but every time they tried to leave the courtyard to fetch water, the army shot at them.

Al A’aiedy tried to summon help on his cell phone, but Gaza’s cell phone network is collapsing. Shells have hit transponders, there is no electricity and no diesel fuel to run the generators. Every time the telephone works, it is a minor miracle.

At about noon Sunday, Al A’aiedy finally managed to reach S., who called me. There was nothing else that S., who lives nearby, could do.

I had known Al A’aiedy for eight years, and I called Physicians for Human Rights. They called the IDF’s liaison office to ask it to arrange to have the wounded evacuated. That was shortly after noon – and as of press time, the liaison office had still not called PHR back.

Meanwhile, someone else had managed to reach the Red Crescent Society. It called the Red Cross and asked it to coordinate the evacuation of the wounded with the IDF. That was at 10:30 A.M. – and as of press time Sunday night, the Red Cross had still not been able to do so.

While I was on the phone with PHR, at about noon, H. called. He just wanted to report: Two children, Ahmed Sabih and Mohammed al-Mashharawi, aged 10 and 11, had gone up on the roof of their Gaza City house to heat water over a fire. There is no electricity or gas, so fire is all that remains.

Tanks are spitting shells, helicopters are raining fire, warplanes are causing earthquakes. But it is still hard for people to grasp that heating water has become no less dangerous than joining Hamas’ military wing.

An IDF missile hit the two boys, killing Ahmed and seriously wounding Mohammed. Later Sunday, an Internet news site reported that both had died. But H.’s cell phone was not answering, so I could not verify that report.

And there was no point in trying H.’s land line: A bomb destroyed his neighborhood’s entire phone system on Saturday. The target was a print shop (yet another of the IDF’s ‘military’ targets). Its owner, a retired UNRWA employee, had invested his entire pension in the shop.

In B.’s neighborhood, the bombs hit the water mains, so she has had no water since yesterday morning. ‘I’m already used to coping without electricity,’ she said. ‘There’s no television, but I hear what happens from friends who call. One friend called from Lebanon, another from Haifa. And Ramallah. But without water, how will we manage?’

A. offered his own take on the situation: ‘I keep the children away from the windows because the F-16s are in the air; I forbid them to play below because it’s dangerous. They’re bombing us from the sea and from the east, they’re bombing us from the air. When the telephone works, people tell us about relatives or friends who were killed. My wife cries all the time. At night she hugs the children and cries. It’s cold and the windows are open; there’s fire and smoke in open areas; at home there’s no water, no electricity, no heating gas. And you [the Israelis] say there’s no humanitarian crisis in Gaza. Tell me, are you normal?’

Washington Post:
As Israeli forces attacked Gaza by land, sea and air, residents living in the congested coastal strip faced a fateful question: Flee the shelling and shooting, or hole up inside their homes and hope for the best?

The five-member al-Jarou family decided to make a break for it around midday Sunday. They abandoned their home in the Shaaf neighborhood east of Gaza City and dashed by car to a relative’s house a mile and a half away, thinking it would be safer, according to interviews with family members and neighbors.

For a little while, it was. Then came a series of explosions. Concrete and debris hammered through the air. Hassan al-Jarou, 10, was struck in the head. ‘I was in the house, with my uncles, my dad and my grandfather, and I saw stones flying,’ he said as nurses attended to his injuries at Shifa Hospital in Gaza City. ‘I don’t know what happened after that.’

Hassan’s grandfather and father were injured as well. Husam al-Shurafa, 26, a neighbor, helped rush them to the hospital. He said he had seen enough mayhem on the streets to persuade him to head back home and take his chances there. ‘I’d rather die with my family in my house,’ he said. …

Beneath one sheet in the morgue was the body of a 17-year-old girl still dressed in a black head scarf, identified by relatives as Jehad Ahmed. They said the family had fled their home in the Jabalya refugee camp in northern Gaza, running from the sounds of artillery fire. But they then ran into shelling from another direction, they said.

Jehad sustained a severe head wound and was taken to the hospital. When her mother arrived later, relatives didn’t have the heart to tell her that the teenager had died. ‘My daughter, oh, God, dear God!’ the mother cried as she found her way to the morgue.

Los Angeles Times:
Sewage is spilling into Gaza’s streets and more than half a million residents have no water supply after bombardments destroyed electricity lines, shutting down pumping stations, officials said. The phone company said 90% of Gaza’s cellular service is down.

Doctors at Shifa Hospital said its generators barely have enough fuel to last through the week and run the machines that keep 30 infants and 40 other patients alive in the ICU.