The Israel-Hamas War: The Humanitarian Crisis in Gaza

In October 2023, the Palestinian militant group Hamas launched a massive surprise assault on southern Israel, the deadliest single attack on Israelis in history. Israel’s subsequent declaration of war with the intent to destroy Hamas has further worsened an already dire situation in the Gaza Strip, where more than two million Palestinians lived prior to the conflict. International efforts to negotiate a full humanitarian cease-fire have failed as the war’s death toll has climbed.

During their assault, Hamas militants killed around 1,200 Israelis, about 70 percent of them civilians, and took roughly 240 hostages. While Hamas freed more than 100 hostages under a weeklong cease-fire deal in November, it still holds some 136 people captive, though an estimated 32 of them have died, according to an assessment conducted by the Israeli military and reported by the New York Times. In a January 2024 ruling, the International Court of Justice ordered Israel to contain the civilian death toll in Gaza, though it did not issue an order demanding a cease-fire.

How bad is the humanitarian situation in Gaza?

The Gaza Strip, a small territory of about 139 square miles (360 square kilometers), or roughly the size of the city of Detroit, was already experiencing a severe humanitarian crisis before the current hostilities broke out. As a result of a sixteen-year blockade by Israel, more than half of all Gazans depend on international assistance for basic services. Additionally, some 80 percent of Gaza’s residents are considered refugees under international law, and Palestinians overall compose the largest stateless community in the world.

Israel’s military operations in response to Hamas’s attack have resulted in “colossal human suffering,” UN Secretary-General António Guterres said in January. As of February, Israel’s retaliation has killed 27,748 people [PDF] and injured more than 66,800 others, according to the Hamas-run Gaza Ministry of Health. (These figures could not be independently verified, but outside sources have also reported similar numbers.) More than 120 journalists and media workers have also been killed, as well as over 150 UN employees, the highest number of aid workers killed in any conflict in UN history.

Israel maintains a complete siege of Gaza, cutting off electricity and water, and supplies of food and medicine remain scarce. A December report [PDF] by the Integrated Food Security Phase Classification, an initiative composed of independent international food security and nutrition experts, warned that an estimated more than 90 percent of Gaza’s population is facing crisis levels of food insecurity. Without fuel, meanwhile, Gaza’s only power station has gone dark. The lack of electricity has shut down desalination and waste-water treatment plants, further compromising access to safe drinking water. 

Israel’s aerial bombardments have demolished neighborhoods, schools, and mosques; satellite imagery analyzed by the United Nations shows that approximately 30 percent of Gaza’s total structures have been destroyed or damaged. (Similar satellite imagery analysis by the BBC puts this number higher, at between 50 and 61 percent.) The Israeli military has said that Hamas has placed portions of its command network and military tunnel system below civilian infrastructure, including hospitals, which Israeli strikes have hit.

Gaza’s health system, which was reported to have collapsed in November 2023, remains crippled, with hospitals running extremely low on rationed fuel reserves and medical supplies. Northern Gaza’s two major hospitals have long greatly exceeded their capacity, and Nasser Hospital, the largest functioning medical facility in southern Gaza, is now unable to provide critical medical care. Health authorities have also warned of the growing risk of disease outbreaks as health conditions rapidly decline.

What are the refuge options for Palestinians in Gaza?

Gazans’ options for refuge are severely limited. As of January, some 75 percent of the territory’s population of more than two million have been displaced. Hundreds of thousands of Palestinians have fled bombing in the north, cramming inside the southern city of Rafah, considered the last designated safe zone for those seeking shelter. However, Israel’s defense minister announced in February that the Israeli military plans to expand its ground campaign into Rafah, now the strip’s most populous city. Aid groups say such a move could lead to a large-scale loss of life and place more pressure on neighboring countries to take in refugees, though Israeli officials have said they will coordinate with Egypt before any ground offensive takes place to evacuate displaced Palestinians northward.

Egypt, which shares the Rafah border crossing with Gaza and already hosts some 390,000 refugees and asylum seekers, primarily from around the region, is the only viable outlet left. The Egyptian government was initially reluctant to open the crossing following the outbreak of war. Since then, Israel has allowed aid trucks carrying water, food, fuel, and medical supplies to enter Gaza. (UN agencies have said that aid delivery has been hindered by ongoing fighting, a slow vetting process, and the lack of crossings into Gaza.) A few hundred foreign nationals and injured civilians have also been allowed to flee Gaza via the border crossing, which has temporarily closed several times due to Israeli strikes.

How are humanitarian aid organizations responding?

In November 2023, the United Nations launched an updated $481 million flash appeal to address the needs of people in Gaza and the West Bank; as of December, nearly half of total funding requirements had been pledged. In Gaza, the UN Children’s Fund (UNICEF) and UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) are helping to provide essential goods and services, such as medical supplies, fuel, and emergency assistance. However, the Joe Biden administration announced in January that it is temporarily suspending new funding to UNRWA following allegations by Israel that a dozen agency employees participated in Hamas’s October 7 attack; many other countries, including Canada, Germany, and Japan, have also suspended their donations.

Several other major organizations, including the International Red Cross and Red Crescent Movement—which comprises the Palestine Red Crescent Society—and Doctors Without Borders, are also supplying humanitarian aid. As the fighting continues, international calls for a humanitarian cease-fire have grown; in December, the UN General Assembly passed a resolution calling for the immediate cessation of hostilities; ten countries, including the United States, voted against the measure.

Recommended Resources

This article by CFR Senior Fellow David J. Scheffer explains humanitarian law in the context of the Israel-Hamas war.

At this CFR media briefing, panelists discuss international law and the humanitarian crisis in Gaza.

The Center for Preventive Action tracks the Israeli-Palestinian conflict.

CFR’s World101 library explores the history behind the Israeli-Palestinian conflict.

Will Merrow created the graphic for this In Brief.