23,336	103,574	854	67
Active cases	Cumulative Cases	Fatalities	Patients in ICU

Situation Overview

The reporting period witnessed an unprecedented surge in COVID-19 cases in the oPt, with over 23,000 additional Palestinians testing positive, and approximately 10,000 recovering. The number of cumulative cases has now surpassed 100,000. Active cases across the oPt more than doubled during the reporting period, from 9,748 to 23,336, according to the Palestinian Ministry of Health (MoH).  Sixty-seven patients are in intensive care units (ICU), 14 of whom require mechanical ventilation. 

Some 178 people died, bringing to 854 the cumulative number of fatalities due to the virus, 736 in the West Bank, including East Jerusalem, and 118 in the Gaza Strip. The Case Fatality Rate (CFR), the proportion of deaths among identified confirmed cases, has remained at 0.8 per cent in the oPt since the beginning of the outbreak, the same figure as in Israel and Lebanon, but lower than Jordan (1.3 per cent), and Egypt (six per cent).

Although the health sector in the oPt is still coping with the rise in people requiring treatment for the disease, the World Health Organization (WHO) warns of an increasing risk of the system becoming overwhelmed. According to WHO, the respective authorities should put measures in place to promote greater adherence to public health.

The rise is particularly pronounced in Gaza, where active cases tripled during the reporting period. Gaza now accounts for 43 per cent of all active cases in the oPt, followed by the governorates of Nablus (15 per cent), Bethlehem (seven per cent), Hebron (6.5 per cent), Jenin (five per cent), and Ramallah (five per cent). An increase in the number of infected health workers is also raising concerns about adherence to infection prevention and control measures in hospitals. Since the start of the academic year, more than 220 schools across the oPt have closed for up to 14 days, following confirmed COVID-19 cases among pupils or staff, or in Gaza, due to their location in a ‘red zone’. 

UNRWA’s financial crisis continues, despite the Agency securing a loan of US$20 million from the Central Emergency Relief Fund (CERF). Several smaller contributions have helped to reduce an immediate funding gap of $114 million, but are still insufficient to cover salaries, in full, for 28,000 staff for November and December. The Gaza Strip, with 13,000 employees, will be the most affected across the Agency’s five fields of operations in the Middle East. 

On 29 November, following the resumption of coordination with the Palestinian Authority (PA), the Israeli security cabinet approved the transfer of NIS 2.5 billion in tax funds it had been withholding. The PA had refused to accept these transfers since May, in response to Israel's plans to formally annex parts of the West Bank. The renewal of coordination and tax clearance is expected to alleviate the PA’s severe financial deficit, and facilitate the import of COVID-related supplies to, and the movement of patients and staff within the oPt.

West Bank

The number of active cases in the West Bank, including East Jerusalem, more than doubled in the reporting period, from 6,461 to 13,336. 

In response to the surge, the PA announced the closure of commercial and service providers, except bakeries and pharmacies, between 27 and 29 November, and a nightly lockdown between 19:00 and 06:00, from 29 November to 13 December. Fines will be issued for people not adhering to safety measures, including the wearing of masks and distancing requirements. Following the announcement, an increase in public adherence to safety measures is being observed, with most shops and restaurants observing the nightly closure. 

Nablus governorate again witnessed the largest increase, accounting for the largest proportion of active cases (3,408) after Gaza. On 1 December, the district recorded the highest daily number of new cases, 336, since the pandemic began. According to local sources, this increase is mainly due to people violating the isolation requirements. The villages of Tell, Madama, Jamma’in (Nablus), Anabta (Tulkarm), Marda (Salfit) and Jinsafut (Qalqiliya) are under temporary closure because of local surges.

As of 1 December, according to the MoH, 24 sample collection/diagnosis centres are active in the West Bank, including East Jerusalem. The collection of samples is also available at private and public hospitals. In addition, 16 treatment centres currently operate in the West Bank, excluding East Jerusalem.

The PA’s financial crisis continues to affect the six East Jerusalem hospitals, which have accrued debts and payment arrears of $68 million, due to the decline in referrals and reduced utilization of health services. On 30 November, the European Union provided a contribution of €9.27 million to enable these hospitals to maintain critical services while responding to the pandemic. As of 26 November, according to WHO, 31 COVID-19 patients were being treated in three of the East Jerusalem hospitals. Since March 2020, St. Joseph Hospital has treated 368 COVID-19 patients.

Citing the lack of building permits, during the reporting period, the Israeli authorities demolished, seized, or forced people to demolish at least 42 Palestinian-owned structures in the West Bank, including East Jerusalem, displacing 50 people, including 26 children. On 25 November, the Israeli authorities demolished two donor-funded water networks in the Massafer Yatta area of southern Hebron, disrupting the water supply to four communities (nearly 700 people, half of them children). The continuous targeting of water and sanitation related structures amidst the ongoing COVID-19 pandemic remains of serious concern, with the vulnerability of people affected further compounded by the onset of winter.

In East Jerusalem, the proportion of self-demolitions, following pressure from Jerusalem Municipality inspectors, is increasing. Since the beginning of the COVID-19 pandemic, 43 per cent of the 119 targeted structures in East Jerusalem were demolished by their owners to reduce the fines and expenses imposed by the Municipality, displacing 195 people including 96 children.

Gaza Strip

In Gaza, 9,757 new COVID-19 cases were recorded in the reporting period. The number of active cases tripled, from 3,827 to 10,000, out of a total of 22,186 cases overall since the start of the pandemic. Sixty-two people died, bringing the death toll to 118. 

While the continued supply of laboratory testing kits and consumables remains a challenge, testing has been sustained at around 2,500 a day, prioritizing the elderly and those with underlying health conditions. The overall occupancy rate of dedicated COVID-19 beds in health facilities stands at 61 per cent (307 beds). The local authorities have expanded capacity to manage critical and severe cases at European Gaza Hospital to 150 beds, including 70 in intensive care units equipped with ventilators, and 80 high-dependency beds. The authorities have identified the provision of oxygen for the treatment of COVID-19 patients through the central supply system in the European Hospital as critical.  On 29 November, WHO delivered 15 ventilators to the health authorities in Gaza for critically-ill COVID-19 patients. The Health Cluster is working with partners to mobilize essential oxygen-generation equipment through international suppliers, but delivery will likely not take place before early 2021. 

Around 20 per cent of the active cases, about 2,150 people, are being isolated in either of the two designated hospitals for COVID-19 (European and Turkish) or in 14 isolation facilities, if they show symptoms and/or need medical care, or if they are unable to isolate themselves at home without impacting family members. The remained are referred to home isolation. 

The delivery of essential routine health services continues to be affected by the pandemic. The health authorities in Gaza announced the closure of all public outpatient clinics and the temporary suspension of elective surgeries for two weeks on November 24, while maintaining urgent and life-saving surgeries only. 

All commercial outlets, except pharmacies, restaurants and bakeries must close by 17:00. Gatherings of more than 15 people indoors are prohibited, including for weddings and wakes at home. The authorities have also designated 56 out of the 94 geographic areas in Gaza as red, where no movement is allowed; 125 schools (108 government and 17 UNRWA) are in such areas and have been closed.  

People entering Gaza through the Rafah or Erez crossings, including international staff/foreign delegations, are not required to undergo home quarantine, if they can present a negative PCR test result taken within 48 hours prior to entry. Those unable to present the test result on arrival can be tested at the border, but they are required to undergo home quarantine until the results are issued. 

The Rafah Crossing closed on 26 November, having been exceptionally opened for three days in both directions, during which period 1,337 people entered Gaza and 3,171 exited. The entry of goods continued from Israel through the Kerem Shalom Crossing, as did imports from Egypt via the Rafah Crossing. The Erez passenger crossing with Israel was also open for the exit of a small number of exceptional cases, mostly medical patients. The number of Palestinians entering Gaza through Erez has been relatively consistent, at approximately 250 people per week.

Coordination

The Inter-Agency COVID-19 Task Force, led by the interim Resident/Humanitarian Coordinator (RC/HC), as well as the Inter-Cluster Coordination Group (ICCG), continues to convene on a weekly basis, to set policies and coordinate the implementation of various responses to the crisis. 

In the Gaza Strip, the data collection for the multi-sectorial assessment of households with people in home isolation/quarantine was completed on 20 November. The assessment was led by OCHA on behalf of the ICCG. It consisted of structured phone interviews with an adult member of each of 244 households with at least one infected member since the start of community transmission in August. The results will be circulated among ICCG members in order to improve the assistance provided to families in need.

During the reporting period, the RC/HC’s Access and Coordination Unit (ACU) facilitated the movement between East Jerusalem and the remainder of the West Bank for 181 UN, international NGO and diplomatic staff, in addition to seven trucks with medical, education and other vital equipment. The ACU also facilitated the entry into Israel of two UN and nine international NGO staff. Despite the tightening of restrictions in the Gaza Strip, following the upsurge in cases, humanitarian movement has so far not been affected. The ACU stands ready to resume the critical movement coordination system, should a need for that emerge.

The temporary coordination mechanism operated by WHO to support Palestinian patients from Gaza to apply for Israeli exit permits to access essential health services in hospitals in the West Bank and Israel, has been suspended since 23 November, following the resumption of coordination between the PA and Israel. 

The Logistics Cluster, led by the World Food Programme (WFP), set up in the same context to support the import of needed commodities for the COVID-19 response, has continued processing pending requests. However, its operation will be reconsidered in the coming days, in light of the resumption of coordination between the PA and Israel. The cluster is currently processing 128 requests from UN agencies and international NGOs, of which 106 have been approved by both sides, 15 are pending approval by the Israeli authorities, and six have been cancelled. 

The Health Cluster is tracking the procurement and delivery of critical medical supplies by cluster partners against the immediate needs identified in the COVID-19 Inter-Agency Response Plan, in line with the State of Palestine’s National Response Plan. The following table highlights the availability and gaps regarding the top ten medical items needed. [1]

All partners are encouraged to subscribe and submit their requests for procurement of medical supplies for laboratory testing, case management and infection prevention and control through WHO’s global COVID-19 response coordination portal.

The Risk Communication and Community Engagement (RCCE) campaign continues to target media outlets and governorates in COVID-19 hotspots to encourage people to follow protective measures. Messaging focused on supporting the Elimination of Violence against Women during COVID-19, preventative measures for children supporting World Children’s Day, and encouraging people to make wearing masks socially acceptable. RCCE materials are available online.

Supply Category	Medical item	Estimated Response Plan needs (by unit)	Delivered	Pipeline/procured	Current Gap
Case Management	Ventilator, medical, invasive, adult/child	250	80	140	30
	Patient Monitor (vital signs)	250	70	169	11
	Oxygen Concentrator	250	20	154	76
	ICU Hospital Beds	250	37	129	84
	Patient Beds	400	86	264	50
Infection Prevention and Control (IPC)	Surgical Mask	4,000,000	1,555,750	829,050	1,615,200
	N-95 Respirator	300,000	297,148	68,380	-
	Surgical gloves	8,000,000	5,358,323	1,563,800	1,077,877
Laboratory Testing	COVID-19 PCR Tests	500,000	127,872	9,600	362,528
	Swabs / Medium, sample collection	500,000	211,500		288,500

Funding

The initial COVID-19 Inter-Agency Response Plan for the oPt, which requested $42.4 million to support an immediate response to the crisis and the efforts led by the Government of Palestine, covered interventions through the end of June.  In early August, the Plan was extended until the end of 2020 and the total requirement expanded to $72 million. Following confirmation of community transmission in the Gaza Strip on 25 August, there was increased concern about the ability of Gaza’s health system to manage the surge in cases. WHO estimated an additional $5.75 million was required to address these concerns. Consequently, the overall funding requirements reached nearly $78 million. 

So far, $45.6 million, or 58 per cent of this amount has been raised. Including resources outside the Response Plan, $64.5 million have been mobilized in support of COVID-19 related response activities in the oPt. During the past two weeks, the Government of Germany has provided $804,000 towards the activities of the WASH Cluster.

Total funding for COVID-19 response by cluster (in Million US$)

Developments, concerns and funding status by cluster

Health

• Health Cluster partners delivered critical COVID-19 medical equipment and supplies to multiple facilities across the oPt. Partners procured and delivered four defibrillators, 15 ventilators, 20 intravenous stands and two laryngoscope sets to support the management of COVID-19 patients in severe and critical condition. Additional items delivered included 70,000 swabs, 200 testing kits and five blood analyser machines. Nearly 2,000 people also received remote counselling. 
• The National Immunisation Technical Advisory Group (NITAG) held two meetings to discuss the distribution modalities for a COVID-19 vaccine, once available. The NITAG operates under the Palestinian Prime Minister’s Office.

Protection

• Cluster partners provided remote and in-person Mental Health and Psychosocial Support Services (MHPSS) to nearly 2,000 vulnerable people across the oPt, including the distribution of psychosocial and educational kits to nearly 1,000 people. In the Gaza Strip, almost 100 children benefited from specialized case management support, provided by partners through remote case management services.
• A cluster partner operating a MHPSS helpline, SAWA, received ten calls by women and men across the oPt reporting suicidal intentions during the first two weeks of November. Fourteen such calls were received in all of October. 
• Cluster partners continued to support the RCCE taskforce by disseminating awareness-raising messages and materials related to COVID-19 and child protection and psychosocial support principles, reaching over 6,000 people across the oPt.

Education

• Since the start of the academic year, more than 220 schools across the oPt have been either temporarily, or fully, closed for one to 14 days, following confirmed COVID-19 cases among pupils or school staff. With the support of Education Cluster partners, all schools across the oPt have received cleaning and hygiene kits, copies of the safe schools and health protocols, and training for children and staff.  
• 125 Schools in ‘red areas’ across the Gaza Strip are closed, as of 30 November. On 11 November, classes resumed for grade one to six students, following grade seven to twelve students who returned to school on 10 and 26 October. UNRWA schools re-opened on 2 November for students in grade seven to nine, with three days of face-to-face learning and three days of distance learning. 
• The Education Cluster is working with the MoE and UNRWA to support the delivery of distance learning, MHPSS services, Infection Prevention and Control (IPC) measures, and the provision of hygiene kits and rehabilitation of WASH facilities.

Shelter & NFI

• In the Gaza Strip, Shelter Cluster partners provided Non-Food items (NFIs) to all active quarantine/isolation facilities. These included bedding sets, individual hygiene kits and dignity kits. Partners have completed procuring additional NFIs, which are available in stock and ready for distribution to vulnerable families, when needed.  
• In the West Bank, cluster partners continue supporting families suffering from overcrowding, unhygienic or otherwise inadequate living conditions, particularly in Area C, and stand ready to support quarantine centres.

Water, Sanitation and Hygiene

• WASH Cluster partners reached around 6,600 people across the oPt. In the Gaza Strip, this included the delivery of 1,500 bottles of water to 2,200 people in isolation centres, in addition to hygiene kits, jerrycans and PPE kits for 157 families in home isolation. In the West Bank, six latrines for persons with disabilities and 34 hygiene kits for families in home isolation were delivered. Cluster partners rehabilitated WASH facilities in four health clinics, as well as water networks in seven Bedouin communities in Area C. 
• WASH Cluster partners developed a plan for the supply of chlorine to Gaza’s water facilities through September 2021. The plan was devised in coordination with the Palestinian Water Authority (PWA) and the Coastal Municipalities Water Utility.

Food Security

• The Food Consumption Score (FCS) was found to be ‘acceptable’ for 77 per cent of World Food Programme (WFP) beneficiaries in the Gaza Strip, according to a new survey based on a representative sample. The FCS was found to be ‘borderline’ for 19 per cent and ‘poor’ for four cent. In the West Bank, the comparable FSC figures among sampled households were 69 per cent acceptable; 22 per cent borderline; and nine per cent poor. 
• 89 per cent of business across the oPt are facing a decrease in the availability of cash, while 37 per cent have delayed payments to suppliers and employees, according to a Ministry of National Economy survey. To cope with the consequences of pandemic restrictions, 14 per cent of businesses reported that they had to dismiss employees; nine per cent had to reduce salaries; 11 per cent placed employees on unpaid leave; and nine per cent placed employees on paid leave.
• Following additional donor contributions and internal loans, WFP has been able to secure the maintenance of Cash Based Transfers to some 274,000 beneficiaries in need of food assistance until the end of February 2021.

COVID-19 response funding in the oPt (through and outside the Inter-Agency Response Plan) in US$

Total funding for COVID-19 response by donors

Donors	Through the Response Plan	Outside the Response Plan	Total in US$
Austria		229,564	229,564
Canada	2,215,757		2,215,757
CERF	527,000		527,000
DFID	1,423,772		1,423,772
ECHO	3,720,950	6,491,0001	10,211,950
Education Cannot Wait	555,000	1,550,000	2,105,000
Foreign Disaster Assistance (OFDA)	225,000		225,000
France	1,005,415		1,005,415
Germany	4,878,042	43,000	4,921,042
Ireland (Irish Aid)	235,200		235,200
Islamic Relief Worldwide	307,800		307,800
Italian Agency for Development Cooperation [AICS]	152,008	10,970	162,978
Japan	878,506		878,506
Kuwait	747,500	8,252,500	9,000,000
Norway	70,000	91,083	161,083
OPT Humanitarian Fund2	16,694,406	347,768	17,042,174
Other sources3	1,558,588	338,955	1,897,543
Private Sector Fundraising	386,786		386,786
Qatar Fund for Development		562,455	562,455
Qatar Red Crescent		410,000	410,000
Save the Children4	326,435		326,435
Start fund	251,000		251,000
Sweden (SIDA)	500,000		500,000
Swiss Agency for Development and Cooperation “SDC”	1,450,000	268,000	1,718,000
UNFPA Humanitarian Thematic Fund	332,000		332,000
UNICEF	792,000		792,000
USAID	250,000		250,000
War Child Holland5	252,000	85,000	337,000
WFP (loan)	5,000,000		5,000,000
	834,000		834,000
World Vision International		304,658	304,658
Grand Total	$45,569,164	$18,984,953	$64,554,117
1 Attribution to the Inter-Agency COVID-19 Response Plane under verification. 2 As of today, oPt Humanitarian Fund has received generous contributions from Germany ($13.8m), Belgium ($4.3m), Sweden ($3.2m), Switzerland ($3.1m), Norway ($0.9m), Italy ($0.6m), Iceland ($0.4m), Ireland ($0.3m), Korea ($0.3m), Cyprus ($12,500), United Nations Foundation ($3,461). 3 Funding contributions below $150,000 including funding towards and outside Covid-19 Response Plan, received from: Action Aid, AECID, African Women Development Fund, AICS, Ana-GEGHT, Cantabria 19, Care International Emergency Fund, Christian Aid&ACPP, Denmark, DRO, EIHDR, Federal Ministry for Economic Cooperation and Development (BMZ), Fridresh Nauman Foundation, Gazze Destek (GDD), Global fund for women, Grass Roots, HEKS, Holland, ICO-UAE, International Charity Organisation, IR – Canada, IR – UK, Italy (IADC), Jerrahi Order of America, Kvinna Till Kvinna, Luxemburg government - ARDI Program, McNulty Foundation, Medico International, Mennonite Central Committee, Mixed funds (German, Italian, Spanish and Dutch), NCA, DCA, NMFA, Norwegian Representative Office to the Palestinian Authority, Nous Cims, NRC, Open Society Foundation, Oxfam, PHG, Private Donors, Rawa Funds, Representative Office of Switzerland in Ramallah, Secours Islamique France, SIDA+DFAT, StartNetwork, Suisse Cooperation, Trocare, UN Trust Fund, UNDP, United Palestinian Appeal, UNWOMEN HQ, Urgent Action Fund, WELFARE (Taawon), WHO, World Vision USA. 4 This includes contributions of Save the Children individual and pooled funds.  5 This includes contributions of War Child Holland and War Child Holland Head Office.

For more information including a detailed list of activities by cluster in both Gaza and the West Bank and for detailed maps of the Quarantine Centres please visit the COVID 19 Webpage found on the OCHA Website.  Please go to the OCHA Website: 

OCHA COVID-19 DEDICATED WEBPAGE

DETAILED LIST OF ACTIVITIES BY CLUSTER

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[1] For a more comprehensive list, please contact the Health Cluster Coordination Team: [email protected] and [email protected].