1. Introduction
1. In his
report of 5 January 2024 entitled “Recent developments in the Middle East: Hamas’
terrorist attack on Israel and Israel’s response”,

the Parliamentary Assembly’s rapporteur,
Piero Fassino, described the background, which needs to be reiterated.
The attack which Hamas launched on Israel on 7 October 2023 was a
multi-front assault against Israeli towns and cities, resulting
in appalling scenes of violence. The brutality and ruthlessness
of the actions of the Hamas terrorists caused the highest number
of fatalities in a single day in Israel’s history. In response to
the attack by Hamas, the Israeli authorities declared a state of
war and called up military reservists. On the afternoon of 7 October,
the Israel Defence Forces (IDF) launched operation “Iron Swords”
with strikes on the Gaza Strip by air, land and sea. The military
campaign had the explicit objective of annihilating Hamas and securing
the release of the hostages. The scale of the operation has rendered
much of the north of Gaza inhabitable, forcibly displaced the vast
majority of the population and led both directly and indirectly
to major loss of life among the Palestinian people. The blockade
of essential resources such as food, water, fuel, electricity and
medicine has created an unprecedented humanitarian catastrophe.
2. Since Mr Fassino’s report, Israel has continued to conduct
a military offensive particularly in northern and central Gaza,
gradually besieging Jabaliya refugee camp and the surrounding areas,
and cutting off the north of the strip, where Israel claims that
Hamas has attempted to regroup.
3. The IDF have launched almost continuous attacks on Gaza, while
also conducting military operations in the West Bank. The conflict
has spread to other parts of the region, in particular Lebanon,
where the Israeli attacks have claimed at least 3 386 lives and
left over 800 000 people internally displaced.

These areas are under intense military
pressure. Military attacks by the parties to the conflict, in particular
the State of Israel, on humanitarian structures and civilian objects,
are taking place on an almost daily basis. However, in view of the dire
and continually worsening situation in the Gaza Strip, which needs
urgent and immediate redress, this report will focus on the humanitarian
situation of women and children in the geographical area of Gaza.
In Israel, tens of thousands of people had to flee or have been
evacuated to northern parts of Israel, but Israeli authorities and
humanitarian organisations have been able to manage this displacement.
As a result, although the impact of this evacuation for innocent
civilians in Israel is great, a humanitarian crisis in Israel has
been prevented.
4. The speakers in the two hearings held on 13 and 30 September
2024

by the Committee on Social Affairs,
Health and Sustainable Development did not raise any severe humanitarian
problems in Israel, and the rapporteur’s exchanges with other humanitarian
organisations and the Israeli delegation to the Assembly have not
done so either.
5. The large amount of information gathered at these hearings,
which many members of the committee described as the most moving
they have attended, provides the basis for this report.
6. Obviously, the recommendations made in the draft resolution,
in particular the call for an immediate ceasefire and restoration
of free access for humanitarian organisations, apply to the whole
of the Middle East, including in Israel, the West Bank and Lebanon.
There must be no more civilians killed, injured or displaced, and
no more physical destruction of vital infrastructure in this part
of the Middle East. It is time to put an end to this suffering for
good and think about reconstruction. However, given the focus on
humanitarian crisis, the rapporteur proposes to alter the title
of the report and to focus on Gaza, where the humanitarian situation
has spiralled and must be improved with no further delay.
7. The rapporteur is aware that the authorities of Israel do
not accept many or most elements and details reflected in the reports
concerning the humanitarian crisis which are outlined below, nor
the reasons thereof. She would underline in this regard that the
reports, including those from several international bodies as well
as reputed and respected humanitarian organisations present on the
ground, converge to a very great extent and that the appeals for
the situation to be immediately addressed to limit any further humanitarian
catastrophe could not be more clearly expressed.
2. The humanitarian crisis in Gaza
8. A humanitarian crisis is an
event or a series of events which poses a serious threat to the
health, safety or well-being of a community or a group of people
over a wide area. Extraordinary resources extending beyond conventional
humanitarian assistance are then needed to avert a disaster or at
least limit its consequences.
9. Since 7 October 2023, the Israeli Government has almost completely
halted the supply of electricity, food, water and fuel to Gaza,
which before the conflict was already facing crisis-level economic
and humanitarian conditions.

The
bombing and the siege of Gaza have claimed the lives of tens of
thousands of Palestinians, 70% of them women and children, and led
to mass destruction of housing and civilian infrastructure, combined
with major and repeated displacements of the population,

thereby creating a humanitarian disaster
on an unprecedented scale. Safe zones have been attacked on multiple
occasions, leading to enormous and continuous amounts of innocent
deaths. Many humanitarian organisations observe that there are no
safe spaces in Gaza where civilians can shelter from the military
actions of the parties to the conflict, Gaza being a besieged enclave
from which it is basically only possible to enter or leave through
the surrounding countries of Israel and Egypt, and only when such
border passages are open.
2.1. A
majority of women and children among the civilians killed or injured
10. The air, land and sea attacks
and the intense and continuous fighting on the ground in the Gaza
Strip since October 2023 have claimed a huge and unprecedented number
of victims. According to the Gaza health ministry, the fighting
in Gaza has killed at least 43 391 people and injured 102 347 civilians,
including large numbers of women and children, who make up 70% of
the victims, not including those who could not be removed from the
rubble.

Many medical and humanitarian workers
have been killed, including 243 people working for the United Nations
Relief and Works Agency for Palestine Refugees in the Near East
(UNRWA). A conservative estimate is that 120 000 people have died
from ailments and diseases which could not be properly treated or
managed because of the severe damage to the healthcare system in
Gaza.
11. The urban warfare in Gaza is destroying homes, communities
and the social fabric, as can be seen in footage from the region.
It has also caused appalling levels of deaths and injuries among
civilians, even though footage here is not so widely available.
The number and proportion of individuals killed or injured are monstrous.
According to the Office of the United Nations High Commissioner
for Human Rights,

this unprecedented
level of killing and injury of civilians is a direct result of failure
by the IDF to respect the fundamental principles of international
humanitarian law, namely the principles of distinction, proportionality and
precaution in armed conflict. Israel’s conduct of the fighting has
also destroyed Gaza’s civilian infrastructure, in particular hospitals
and schools, and electricity, water supply and sewage infrastructure, leaving
survivors, who are often injured, without access to water, food
or adequate healthcare. The conduct of hostilities by Palestinian
armed groups from densely populated areas and the use of intrinsically
indiscriminate weapons have in all likelihood also exacerbated the
number of victims in Gaza.
2.2. The
specific risks for women and children in Gaza
12. As described by the speakers
at the two hearings held by the Committee on Social Affairs, Health
and Sustainable Development, in addition to the direct deaths of
children as a result of military strikes, the war is cutting off
access to healthcare, education, electricity and drinking water.
The effects are disastrous for the current and future well-being
of the children of Gaza. Given the young age of the Gazan population
(65% of the inhabitants are aged under 25), this is worsening and
jeopardising not only the individual future of every Palestinian,
but also that of society as a whole. Children make up a large proportion
of internally displaced persons in Gaza. They should not just be
seen as mini adults. The risks they face in situations of urban
warfare are distinct and must be understood in the context of their
social, physical, psychosocial and cognitive development.

As regards hospitalisations, there
is insufficient bed capacity; for instance, there are two children
to a bed in the paediatric unit in Nasser hospital, where there
have been increased numbers of trauma, orthopaedic and severe burns
cases since mid-May. Around 70% of major burns victims are under
18 years of age. There has been a huge rise in cases of burns caused
by explosives since July, reaching 53% of the total number of burns
patients, because of the military operations.
13. NGOs have condemned the fact that children are paying the
price for a war for which they bear absolutely no responsibility.
The lack of food and drinking water is particularly critical for
them, as are the restrictions on travel to seek treatment elsewhere.
Some families have been displaced 9 or 10 times, and some even 15 times,
leaving them in an extremely precarious situation and without any
guarantee of returning to their homes. These displacements increase
the risks of violence and neglect for children, and their mental
health is of course especially at risk. Children suffer life-altering
injuries and amputations. After more than a year of war, they are
showing signs of mental illness. Their mental health is described
as critical. Symptoms include extremely high levels of persistent
anxiety, loss of appetite, inability to sleep and emotional or panic
attacks whenever they hear the bombing. Poliomyelitis (a viral disease
that mainly affects children aged under 5 years) has returned to
Gaza two decades after being eradicated, following the destruction
of all infrastructure, including sewage systems. Many children have
lost their parents. Joyce Msuya, UN Acting Under-Secretary-General
for Humanitarian Affairs and Emergency Relief Coordinator, has described
how it has become common for injured children in the enclave to
have the words “wounded child, no surviving family” written on their
arms.
14. Both appropriate immediate care to alleviate children’s suffering
and basic schooling are needed for children to regain a minimum
degree of safety, well-being and human dignity. It is hard to imagine
the trauma of children who have undergone amputations in unspeakable
conditions and sometimes without anaesthetic and who do not even
have access to a minimum level of re-education or to prostheses
that would enable them to resume some sort of life.
15. As regards women, it is clear that the number of births and
related interventions as well as the number of pregnancies has fallen.
There is a lack of women’s hygiene products. UNICEF is working in
appalling conditions for obstetric and neonatal care.
16. Given the destruction of the healthcare system, a possibility
for medical evacuation is all the more important. Approximately
15 000 people are believed to meet the criteria for such evacuation.
Women and children are numerous on the list of those requiring medical
evacuation, and there is no longer any hospital department performing
open-heart surgery in Gaza. Since the beginning of the war, only
around 5 000 persons have been evacuated to Egypt or Qatar. Evacuations
fell in number following the closure of the border in May and are
now almost at a complete standstill, although Médecins sans Frontières/Doctors
without Borders (MSF) is working with the World Health Organization
(WHO) to restart them.
17. Women and children face very significant issues because of
the collapse of public order. Any authority which exists is in the
hands of scattered heads of family, clan chiefs, Hamas leaders and
a few political leaders. In the event of a problem or a violent
incident, people do not know whom to turn to. It is the most vulnerable individuals
who are the worst affected. Women find it more difficult to find
food and water, protect the lives of their children and cope with
violence and abuse. Instances of domestic violence and suicide attempts
are on the increase.
2.3. Collapse
of the healthcare system and catastrophic sanitary conditions
18. Entire sections of the infrastructure
of society in Gaza – homes, schools, hospitals and medical facilities –
are now completely destroyed or unable to function. With the collapse
of the health system and the decline in vaccinations, the health
of the population will further deteriorate. UNRWA’s ability to co-ordinate
polio vaccination in a hostile environment was the only glimmer
of hope, now compromised by the decision of the Parliament of Israel
which could effectively bring UNRWA’s operations in the occupied
Palestinian territories to a halt.
19. Particular reference is made here to the well-reputed and
experienced NGOs interviewed at the hearing of the committee on
13 September 2024, namely MSF, UK-Med and Save the Children, which
all operate in Gaza and were represented during the hearing by humanitarian
personnel who work on the ground there. All these NGOs highlighted
the great difficulties in accessing healthcare and services and
the critical lack of medicines and equipment, in particular for
surgery on war wounds. Almost all medical facilities have been destroyed.
Field hospitals, which are often just tents, are inadequate. The
few establishments still operating, such as Nasser and Al-Aqsa hospitals,
are running at over-capacity, with patients lying on the floor,
but there are no other facilities functioning normally. Field hospitals,
by definition temporary, are inadequate for providing the care needed
by the population. Surgery, when it can be performed, is mainly
carried out in intolerable conditions. There is a severe shortage
of medicines, so some children undergo amputations without anaesthetic.
Others suffer amputations although they could have been treated
without losing a limb if they had had access to the right treatment.
The response capacity of the NGOs dealing with psychological trauma
and physical injuries and also seeking to address the lack of essential
goods such as water and food is woefully inadequate in relation
to the needs.
20. Sanitary conditions are dire, with no water supply or waste
management systems. The sewage system and many drinking water processing
and supply facilities have been destroyed. Apart from lack of public hygiene,
these sanitary conditions encourage the spread of preventable diseases
such as diarrhoea.
2.4. Restrictions
on food aid to Gaza, the siege in northern Gaza and the risk of
famine
21. Food aid is blocked outside
the borders of Gaza. Food aid lorries, under the control of the
Israeli authorities, only get in occasionally, in numbers that are
totally inadequate for feeding the population.
22. According to UNICEF, as long ago as March 2024, the number
of children under two years of age suffering from acute malnutrition
had increased alarmingly in the north of the Gaza Strip. At that
time, one in three children were affected, namely 31% as against
15.6% in January.

23. The rapporteur would like to focus on the siege of Gaza and
especially northern Gaza and its humanitarian consequences, as this
is a particularly alarming development in recent months. The conditions described
above have been exacerbated to the extreme in that area since the
beginning of October 2024 and the Israeli authorities’ decision
not to allow deliveries of essential goods from the south. The
statement
of 13 October 2024 by Muhannad Hadi, Humanitarian Coordinator for the Occupied
Palestinian Territory, on “Civilians in northern Gaza cut off from
supplies and services critical for survival” speaks for itself here:
“Since 1 October 2024, Israeli authorities have increasingly cut
off northern Gaza from essential supplies. Erez and Erez West crossings
have been kept closed, and no essentials have been allowed from
the south. Three renewed orders have been issued – on 7, 9 and 12 October –
directing people’s displacement. In parallel, hostilities continue
to escalate, resulting in more civilian suffering and casualties.
In the past two weeks, over 50 000 people have been displaced from
the Jabalya area, which is cut off, while others remain stranded
in their homes amid increased bombardment and fighting. A military
siege that deprives civilians of essential means of survival is
unacceptable.”
24. Since 7 October, Israel has been conducting a military offensive
in northern Gaza, gradually besieging Jabaliya refugee camp and
the surrounding areas, where Israel claims Hamas has attempted to
regroup.

Without independent
press allowed to enter Gaza these claims cannot be independently
verified. Senior UN officials and humanitarian organisations have
issued several warnings about the devastating impact of the offensive.
In a
press
release on 25 October 2024, Volker Türk, UN High Commissioner
for Human Rights, called on the world to take action in response
to the darkest moment of the Gaza conflict. He said that, in northern
Gaza, the Israeli military was subjecting an entire population to
bombing, siege and risk of starvation, as well as forcing it to
choose between mass displacement and being trapped in an active
conflict zone. On 26 October 2024, Joyce Msuya
declared that “what Israeli forces are doing in besieged North
Gaza cannot be allowed to continue,” adding that hospitals had been
hit, health workers had been detained and first responders had been
“prevented from saving people from under the rubble.” Her conclusion
was that “the entire population of North Gaza is at risk of dying.”
25. The latest military operations in northern Gaza have led to
the closure of water wells, bakeries, medical centres and shelters,
and the suspension of protection services, malnutrition treatment
and temporary learning facilities. At the same time, hospitals have
recorded an increase in the number of trauma cases. On 12 November
2024, Louise Wateridge, UNWRA emergency manager and communications
officer, told the BBC that in Jabaliya, the area under siege, eight
of UNWRA’s wells had been bombed and destroyed and people were not
receiving any water, with UNWRA unable to access the area. She concluded
that the situation in northern Gaza was “absolutely beyond desperate,”
with 500 000 people sleeping on the ground and at risk of flooding
with winter round the corner and weather conditions set to deteriorate.
26. The NGOs at the hearing with the committee in September 2024
also sounded the alarm about the imminent risk of famine.
27. In short, the NGOs and the UN agencies operating in Gaza agree
that the tiny number of lorries entering Gaza is far below the needs
on the ground and that famine may occur for Gaza in the very short
term. The swift and unhindered delivery of food aid is vital given
the latest estimates that over two thirds of cropland and livestock
have been destroyed in Gaza.

3. Recommendations
3.1. International
humanitarian law must be respected
28. International humanitarian
law (IHL) is a set of rules which seek – for humanitarian reasons
– to limit the effects of armed conflict. It is based on the four
1949 Geneva Conventions, which have been universally ratified or
acceded to, and their Additional Protocols. It protects individuals
who are not, or are no longer, participating in the hostilities
and restricts the means and methods of warfare. IHL is also known
as the “law of war” or the “laws of armed conflict”. Persons protected
by IHL are entitled to respect for their life, dignity and physical
and mental integrity. They also benefit from a series of legal guarantees
and must be treated humanely in all circumstances, without any adverse
distinction. For example, it is forbidden to kill protected persons
or subject them to torture. The wounded and sick must be collected
and receive medical care. Medical personnel, facilities and transport
must be respected and protected so that medical duties can be carried
out. Access to humanitarian assistance for civilians affected by
conflict must be granted and facilitated, subject to the consent of
the parties concerned and their right of control. Under IHL, humanitarian
relief personnel and objects used for humanitarian relief operations
must be respected and protected.
29. With regard to the risk of famine, the rapporteur strongly
underlines that IHL explicitly prohibits the use of famine or perfidy
as a method of warfare against civilians.
30. In the humanitarian situation described in the explanatory
memorandum, it is clear that none of the rules of IHL are being
respected.
31. Civilians must be protected and their basic needs met. Civilians
with double nationality must be allowed to leave and those who leave
must also be able to return. Multiple access routes must be opened
so that essential supplies and humanitarian relief services can
be safely delivered, and in sufficient quantity, to people in need
wherever they are. Civilians must not be forced to choose between
displacement and starvation. They must have a safe place to go,
with shelter, food, medicine and water. Any actions that are conflicting
with fulfilling these needs are strong indications that possible
methods of either ethnic cleansing or genocide are in place and
should be treated by third parties accordingly.
32. The rapporteur reiterates that all parties and individuals
in a conflict must always respect IHL, at all times. All world leaders
have a responsibility to ensure respect for IHL, as set out in the
Geneva Conventions. These are universally accepted and binding norms
developed to preserve the very bare minimum of humanity. The rapporteur
shares the view expressed by Volker Türk in his press release of
25 October 2024 that world leaders must “put the protection of civilians
and human rights first, and not [...] abandon that minimum of humanity”.
33. Lastly, we need to prepare for the future so that some kind
of healing process can take place, however distant that may seem
today. This will require a massive effort on all fronts: physical
and mental health, reconstruction, education and the restoration
of order.
3.2. Immediate
ceasefire
34. As many international organisations,
governments and parliaments have already stressed, as well as Volker
Türk, in his
address
to the Assembly on 25 June 2024, the only solution is a ceasefire, as demanded
by the UN Security Council.
35. Even though political tensions between Israel and Palestine
are extremely high, it is clear that an immediate ceasefire is the
only way to spare the lives of civilians, including Gaza’s women
and children, and allow survivors to rebuild their lives as well
as possible, with hope and dignity. In the light of the tremendous humanitarian
crisis in Gaza, and following repeated appeals by international
organisations and NGOs, the rapporteur sees no other solution than
an immediate ceasefire to avoid further death and suffering. This
call goes hand in hand with the need for humanitarian assistance,
which cannot be provided in the context of military strikes.
3.3. Special
protection of children
36. Under IHL, children are entitled
to special respect and protection in situations of armed conflict,
meaning that they must receive appropriate assistance and care in
a variety of specific ways.

The requirement for special protection
is reflected in the many comprehensive provisions of the Geneva
Conventions and their 1977 Additional Protocols, which set out specific
measures for the treatment of children, as well as in State practice. These
measures include continued access to age-appropriate education,
food and medical care in all circumstances in times of war, including
when they are deprived of their liberty; evacuation from combat
zones for safety reasons; and measures to care for and reunite unaccompanied
or separated children and to reunite them with their families.

37. The rationale for this special protection is that the effects
of armed conflict cause particular harm to children. When the Additional
Protocols were drafted in 1977, it was noted that “the psychological
trauma caused by war often leaves an indelible mark” on children,
who therefore require special treatment compared to other civilians.
38. The rapporteur stresses that according to international law
children affected by urban warfare are entitled to special protection.
She proposes the development of a set of legal, policy and operational recommendations
for those in a position to protect the lives of children, for whom
a ceasefire is essential in the specific situation of Gaza. No one
can remain silent when children are dying.
3.4. UNRWA
must be able to continue to carry out its mission
39. On 28 October 2024, Israel’s
Parliament passed two laws banning the UNRWA from operating within Israel
and prohibiting Israeli officials from having any contact with the
organisation, effectively preventing its work in Gaza, the West
Bank and East Jerusalem. The laws are due to come into force within
three months.
40. Much of the international community, humanitarian organisations
and the United Nations have condemned the decision, pointing to
the agency’s key role in providing assistance to Palestinian refugees, particularly
in the war-torn Gaza Strip.
41. UN Secretary-General António Guterres said that “if implemented,
the laws [...] would likely prevent UNRWA from continuing its essential
work in the Occupied Palestinian Territory”.

This view was shared by UNRWA Commissioner-General
Philippe Lazzarini, who said that “these laws will only deepen the
suffering of the Palestinians, particularly in Gaza, where people
have been trapped in living hell for more than a year”.
42. The ban on operating in Israeli territory directly threatens
UNRWA’s headquarters in East Jerusalem, the part of the city occupied
by Israel since its annexation in 1967, and its activities in refugee
camps. The ban on any contact with the agency jeopardises its operations
in the West Bank and Gaza, where UNRWA must work with the Israeli
authorities and army to transport and distribute aid, not least
for its own safety. Under the new legislation, Israel will no longer
provide UNRWA staff with the necessary work permits or visas.
43. As Mr Lazzarini said in a
press conference
on 13 November 2024, Israel’s repeated accusations aimed at discrediting
UNRWA are unfounded. An internal investigation led to the dismissal
of nine staff members because of their possible involvement in the
7 October attacks.

A further report by an independent
panel found no major shortcomings in the organisation’s neutrality.

UNRWA is irreplaceable
in Gaza as the only experienced relief agency working with other
UN mechanisms and civil society.
44. The
report
of the Special Committee to Investigate Israeli Practices Affecting
the Human Rights of the Palestinian People and Other Arabs of the
Occupied Territories, published on 20 September 2024, also noted that Israel’s
extensive bombing campaign in Gaza had decimated essential services
and caused an environmental disaster with lasting health impacts.
It pointed out that by February 2024, the IDF had used over 25 000
tonnes of explosives across the Gaza Strip, “equivalent to two nuclear
bombs”. It also stressed that “civilians have been [...] killed
en masse in Gaza” and pointed to the “life-threatening conditions
[...] deliberately inflicted on the Palestinian people.” The Special
Committee stated that through its siege of Gaza, its obstruction of
humanitarian assistance, its targeted attacks and its killing of
civilians and humanitarian workers, despite repeated appeals by
the UN, binding orders by the International Court of Justice and
Security Council resolutions, Israel is intentionally causing death,
starvation and serious injury, using starvation as a weapon of war
and inflicting collective punishment on the Palestinian population.
45. As early as 17 October 2023, in a joint statement entitled
the “
Escalation
of violence in the Middle East: protect the children”, Simon Moutquin, Chairperson of the Committee on Social
Affairs, Health and Sustainable Development, and Theodoros Rousopoulos,
Chairperson of the Committee on Migration, Refugees and Displaced
Persons, stated that the “abject murder of Israeli civilians – babies
and children, young people enjoying a music festival and whole families
in their homes, and the abduction of almost two hundred hostages –
cannot be justified in any way”. They also noted that “the response
of the Israeli authorities to the aggression suffered must remain
faithful to our democratic values, respect for human rights and
the rule of law”. Their call for Israel to “allow water, food and
power to reach the desperate civilian population of Gaza, immediately
stop the barrage of attacks which are indiscriminately killing civilians,
damaging hospitals, schools, UNWRA shelters and civilian infrastructure
in Gaza” and “allow the international community to bring humanitarian
aid to the people in Gaza, and refrain from using white phosphorus
bombs and forcibly displacing hundreds of thousands of civilians”
went unheeded.
46. More than 13 months into Israel’s military campaign, Palestinian
women and children are being killed and subjected to the horrors
and suffering of war in total violation of IHL. This must stop.
47. The rapporteur therefore calls upon the Assembly to adopt
a resolution focusing on the need to put an end to the humanitarian
crisis in Gaza with no further delay, and to monitor closely over
the coming weeks and months the actions of the Israeli authorities
in this respect. She underlines that the status of observer and
the status of partner for democracy with the Assembly are important
ones, which confer an access to the Assembly and its valuable work,
and with that a duty and obligation to respect the values of the
Council of Europe and of international humanitarian law.