also provides a range of crucial services. In Gaza, the year-long war has severely threatened their ability to deliver.Emergency relief: Drastically hitBefore the war:Over one million Palestine refugees were estimated to be living in absolute poverty, which means they cannot meet their most basic food needs.Those living in Gaza have been struggling to cope with life under Israel’s 15-year air, land and sea blockade.To alleviate the conditions, UNRWA has assisted with food and medical assistance, and cash-based transfers.Since the war:UNRWA’s ability to provide any kind of aid has been drastically hit. This is not due to a lack of available aid, but rather access restrictions imposed by Israeli authorities, which prevent UNRWA from distributing supplies.The head of the agency, Philippe Lazzarini, announced in October of this year that some 30 humanitarian trucks were getting into Gaza every day – just six per cent of the amount of commercial and humanitarian supplies allowed in before the war.According to the UN office for humanitarian affairs, OCHA, nearly half the population lacks the minimum 15 litres of water per person per day for drinking, cooking and hygiene.Healthcare: Hanging by a threadBefore the war:UNRWA has been delivering comprehensive primary healthcare to Palestine refugees for over 60 years.22 healthcare centres were in Gaza, with clinic and laboratory facilities, personalised maternal health care and family planning services.Psychosocial counsellors were in several Gazan schools and special education needs clinics in a number of health centres to help children to cope with anxiety, distress and depression.Since the war:Hospitals have, on several occasions since 7 October, been targeted by the Israeli military. In recent days, the Kamal Adwan Hospital in northern Gaza has become a “besieged war zone”, in the words of Adele Khodr, a senior UN Children’s Fund (UNICEF) official. “Vulnerable newborns and sick and wounded children in need of intensive care are being killed in tents, in incubators and in the arms of their parents,” she said on Tuesday. “That this hasn’t galvanised enough political will to end the war represents a fundamental crisis of our humanity.”The agency has been a key part of an inter-agency polio vaccination campaign, inoculating around 560,000 children across the Strip during the first round, and around 545,000 during the second round.Thousands remain out of reach, though, and Israel’s constant displacement orders and bombings have presented serious delays and obstacles.UNRWA has, nevertheless, been able to keep eight of its health centres operational, and despite the extremely hazardous conditions in which they have to operate – there have been over 500 attacks on health workers, patients, hospitals and other medical infrastructure – UNRWA’s medical teams still managed to provide around 6.2 million primary healthcare consultations over the last year, up from almost 2.6 million the year before.Education: A year lostBefore the war:The UNRWA education programme in Gaza was the largest of those run by the agency, with 284 schools operating in 183 education premises in the Strip, staffed by more than 10,500 education personnel, serving around 300,000 registered students.Although UNRWA has no mandate to alter curricula or textbooks (these are a matter of national sovereignty), the agency is committed to ensuring that what is being taught in the schools it runs adheres to UN values and principles.Since the war:UNRWA considers that children in the Strip have no safe space to learn but, in spite of the dangers, the agency remains committed to providing educational opportunities, and in August, launched a programme to provide “learning spaces” to provide basic support, including recreational and learning activities. Around 9,500 children, 60 per cent of them girls, have benefited these initiatives in 36 dedicated shelters across Gaza.Nearly 85 per cent of the agency’s schools have been hit or damaged during the war, some several times. Some have been flattened, and many have been severely damaged. Most were being used as shelters for displaced people, among them many children, when they were hit.As a result, children in Gaza only completed six weeks of the 38-week long 2023-2024 school year. They have essentially lost a year of education.Economic development: ‘Back to 1955 levels’Before the war:Over several years, UNRWA has run programmes to boost economic development by supporting entrepreneurs, helping women to enter the workforce and empowering people with disabilities.The agency’s department of microfinance gives poor or marginalised people the ability to build sustainable ways of generating income, extending credit to those who would otherwise not have access to loans.In 2020, UNRWA set up the IT Service Centre to address unemployment, help Palestine refugees access opportunities in the digital sector and kickstart their careers.Since the war:These and other initiatives have been badly affected by the war in Gaza. According to a UN report released in late October, economic development in Gaza and the West Bank has been set back by almost 70 years (equivalent to June 1955 levels).“Our assessments serve to sound the alarm over the millions of lives that are being shattered and the decades of development efforts that are being wiped out,” declared Rola Dashti, Executive Director of the UN Economic and Social Commission for Western Asia (UNESCWA).Refugee camps: Under attackBefore the war:UNRWA programmes designed to improve the living conditions of Palestine refugees have existed for many years, leading to the construction of hundreds of housing units as well as the development of sewage and drainage facilities.Since the war:Over the past year, military operations, fighting and escalating violence have damaged or destroyed an estimated 66 per cent of all buildings in Gaza and devastated densely populated refugee camps. A total of 227,591 housing units have been affected, according to UN figures.Jabalia refugee camp, for example, has been hit several times by strikes. In June, UNRWA reported “horrific” scenes of devastation in the camp, and in November of this year, over 50 children were reportedly killed in strikes that levelled two residential buildings sheltering hundreds of people.Sewage and waste systems are at a breaking point. Speaking during a visit to Gaza City on 5 November, Muhannad Hadi, the UN Resident Coordinator for the Occupied Palestinian Territory, described seeing hundreds of people with no access to toilets and streets covered in garbage and sewage.
 

During his first visit to the area since Israel launched its latest military operation in the north a month ago. Muhannad Hadi spoke to UN News from the Al-Mamouniya School in Gaza City run by the UN agency that assists Palestine refugee, UNRWA.Like the rest of UNRWA’s schools that are still standing as war continues, it now serves as a shelter for displaced people seeking safety in the besieged enclave where nowhere is safe.An ‘unbearable’ situation“This is not a place for humans to survive,” he said. “This must end. This misery must end. This war must end. This is beyond imagination.”Mr. Hadi stated that what he saw was “very different” from what he saw in northern Gaza in September.“At this school, I have seen families and people living on top of each other. It is unbearable here. I can't imagine how those people are surviving,” he said.“There were 500 people in this school in September, and now there are more than 1,500 people. There is no access to bathroom. There are shortages of food. The situation is unbearable. Sewage water is everywhere. Waste is everywhere. The place has garbage everywhere.” ‘Just water and lentils’From a window on the second floor of the damaged school, mountains of garbage can be seen piling up in the yard – a symbol of the immense health hazards and harsh conditions that the people inside face. Critical supplies including food are scarce in northern Gaza. As Mr. Hadi walked around the school, whose structure had been damaged by the bombing, he met a man who was preparing lentil soup for his family.Mr. Hadi was told that the lentils had been provided by UNRWA and that the small pot the man carried was supposed to feed 12 people. "It's just water and lentils; no garlic or onions,” he remarked, noting that “one chili pepper pod costs 10 shekels today."‘We want to have fun’The senior UN official also visited a temporary learning space called Al-Nayzak on Al-Jalaa Street. Tents have been set up on the destroyed thoroughfare to provide a minimum education and a safe place for local children to deal with the horrors they have endured since the war erupted last October.At the temporary school, 11 teachers - men and women - provide courses in Arabic, English, maths,  science and psychosocial support to 510 students.Mr. Hadi played with young children, aged between three and five years old.  Many were supposed to be in kindergarten, but the war has deprived them of the opportunity to learn in real classrooms. He met a girl who said she lost her parents and home in the war, and now lives with her cousins who have also become orphans. Her school used to be located near the Al-Nayzak learning space, but like most schools in Gaza it was destroyed by shelling.The girl told him that they cook rice at home when given the opportunity, but often rely on humanitarian organizations to provide them with meals. When Mr. Hadi asked her what she wanted to do when the war ended, she replied, "We want to have fun and enjoy ourselves, and go where we want to go."The top UN humanitarian official also visited the headquarters of the Atfaluna Association for Deaf Children, where students taught him sign language.The association provides lessons in English, Arabic, maths, science, physical education and the arts to 35 children, some of whom are learning how to deal with their new disability after losing their hearing due to heavy shelling.Stop the warMr. Hadi told UN News that he had heard horrific stories from people he met in northern Gaza and stressed the need to stop the war. “What people are going through here, no one can tolerate. Those are the victims of this war. Those are the ones who are paying the price for this war - those children around me here, the women, elderly,” he said.The heads of 15 UN and international humanitarian organizations recently affirmed that “the entire Palestinian population in North Gaza is at imminent risk of dying from disease, famine and violence.”The officials said humanitarian workers were not safe to do their work, and that Israeli forces and insecurity prevented them from reaching those in need.Since the war began in October 2023, more than 43,000 Palestinians have been killed and 100,000 injured, according to Gaza's Ministry of Health. The UN estimates that more than 1.9 million people have been forcibly displaced from their homes within the enclave, many of whom have fled from one unsafe place to another multiple times. 

highlighting the continued need for its lifesaving work even as Israel moves to end its activities. The Israeli Parliament, known as the Knesset, recently approved two laws banning UNRWA from operating in its territory and prohibiting officials from having any contact with the agency. Israel has officially informed the President of the UN General Assembly of the adoption of the new legislation. The letter says all cooperation with the agency will cease after 90 days. Record low aidUNRWA Commissioner-General Philippe Lazzarini said on Monday that last month, Israel allowed a daily average of 30 humanitarian trucks into Gaza, which is only six per cent of the commercial and humanitarian supplies allowed in before the war.“This is the lowest in a long time, bringing the assistance back to the level of the beginning of the war,” he wrote on the social media platform X.“This cannot meet the needs of over two million people, many of whom are starving, sick and in desperate conditions.”A lifeline for millionsHe said that “meanwhile, UNRWA continues to distribute whatever is allowed in.”Staff have provided food aid to more than 1.9 million Gazans since the war erupted last October, while hundreds of thousands in and around its shelters have received basic supplies.The UN agency is also the largest primary healthcare provider in the enclave, and its teams have provided over six million medical consultations.Mr. Lazzarini stressed that much more aid must be allowed into Gaza, including through UNRWA, the largest humanitarian organization and service provider there.“Restricting humanitarian access and at the same time dismantling UNRWA will add an additional layer of suffering to already unspeakable suffering. Only political will can put an end to a politically made situation,” he said.‘No alternative’ to UNRWAIn an earlier tweet, Mr. Lazzarini focused on how UNRWA also educates scores of young Palestinians.He said children and their education are not featured in discussions by “experts” or politicians as debate intensifies on replacing the agency.“Why? Because in the absence of a functioning State, there is no alternative,” he said.Until last October, over 300,000 boys and girls in Gaza – half of all schoolchildren there – attended UNRWA schools, and they are now losing out on a second year of studies.Nearly 50,000 children in the West Bank also go to UNRWA schools.Potential dire consequencesMr. Lazzarini explained that UNRWA is the only UN agency that directly provides education in UN schools.  The agency runs the only system in the region that includes a human rights programme following UN standards and values.“Dismantling UNRWA in the absence of a viable alternative will deprive Palestinian children of learning in the foreseeable future,” he said.“Without learning, children slip into hopelessness, poverty and radicalization. Without learning, children fall prey into exploitation including joining armed groups. Without learning, this region will remain unstable and volatile,” he warned.He said that instead of focusing on banning UNRWA or finding alternatives, attention should be on reaching an agreement to end the conflict.Deadly weekend for childrenIn the interim, the fighting continues to exact a heavy toll on young lives across the Gaza Strip.UN Children’s Fund, UNICEF, said on Saturday that more than 50 boys and girls were killed in strikes in Jabalya, North Gaza, over the previous two days.The personal vehicle of one of its staff members working on the mass campaign to vaccinate young children against polio also came under fire while she was driving, causing damage.Additionally, at least three children were reportedly injured by another attack in the proximity of a vaccination clinic in Sheikh Radwan, while a polio vaccination campaign was underway.Risks in the northUNICEF chief Catherine Russell said these attacks are yet further examples of the grave consequences of the indiscriminate strikes on civilians in Gaza.“Attacks on civilians, including humanitarian workers, and what remains of Gaza’s civilian facilities and infrastructure must stop,” she said. Moreover, she warned that “the entire Palestinian population in North Gaza, especially children, is at imminent risk of dying from disease, famine, and the ongoing bombardments.” 

even as reports emerged that one vaccination centre had been hit during a humanitarian pause, according to UN agencies on the ground.Hours after the campaign rolled out, reports indicated that a healthcare centre in the north had been hit, injuring six people, including four children, in a location where a humanitarian pause had been in place, according to the World Health Organization (WHO) chief.“We have received an extremely concerning report that the Sheikh Radwan primary healthcare centre in northern Gaza was struck today while parents were bringing their children to the lifesaving polio vaccination in an area where a humanitarian pause was agreed to allow vaccination to proceed, ” said Tedros Adhanom Ghebreyesus in a social media post.He said a WHO team was at the site just before.“This attack, during humanitarian pause, jeopardises the sanctity of health protection for children and may deter parents from bringing their children for vaccination,” he said. “These vital humanitarian-area-specific pauses must be absolutely respected.”Campaign unrolls despite challenges“To overcome challenges posed by the volatile security situation and constant population movement, robust micro plans have been developed to ensure the campaign is responsive to the significant population shifts and displacement in the north following the first round in September,” the UN agencies for health, WHO, and for children, UNICEF, said in a statement.UN organizations and partners began phase one in September and have had more than 200 teams on stand-by since 23 October to unroll the campaign’s final round, which had been delayed by constant Israeli airstrikes, clashes on the ground and no assurances of the required humanitarian pauses to stop the fighting during the delivery of the vaccines.Polio had been eradicated in the Gaza Strip 25 years ago, but the ongoing war triggered multiple health crises, with a 10-month-old being diagnosed with the paralysing virus earlier this year, prompting health officials to organize a campaign in the war-torn Israeli-occupied territory.Restrictions persistThe campaign will be delivered by 216 teams across 106 fixed sites, 22 of which have been added to ensure increased availability of vaccination in areas where recently displaced people are seeking refuge, according to UN agencies. There will also be 209 social “mobilisers” deployed to engage communities and raise awareness around vaccination efforts, they explained.However, the agencies warned that health workers will not be able to reach all of the children who require a final dose of the vaccine.“The final phase of the campaign had aimed to reach an estimated 119,000 children under 10 years old in northern Gaza with a second dose of novel oral polio vaccine type 2 (nOPV2), however, achieving this target is now unlikely due to access constraints,” the agencies warned.Despite the lack of access to all eligible children in northern Gaza, the Polio Technical Committee for Gaza, which includes the Palestinian Ministry of Health, WHO, UNICEF, the UN agency for Palestine refugees, UNRWA and partners, decided to resume the campaign.The plan aims to mitigate the risk of a long delay in reaching as many children as possible with polio vaccines and the opportunity to vaccinate those recently evacuated to Gaza City from other parts of the northern Strip.Extended humanitarian pausesThe time period for the humanitarian pauses has been extended by two hours and is expected to run from 6am to 4pm daily, WHO and UNICEF said. As in the first two phases, vitamin A will also be co-administered to children between age two and 10 in the north to help boost overall immunity.The campaign in northern Gaza follows the successful implementation of the first two phases of the second round in central and southern Gaza, which reached 451,216 children – 96 per cent of the target in these areas.A total of 364,306 children aged between 2 and 10 years have received vitamin A so far in this round.Regional impactTo interrupt poliovirus transmission, at least 90 per cent of all children in every community and neighbourhood must be vaccinated, which will be challenging to achieve given the situation, the agencies said.A delay in administering a second dose of nOPV2 within six weeks reduces the impact of two closely spaced rounds, decreasing immunity, according to the UN health agency.WHO has also cautioned that having a significant number of children miss out on their second vaccine dose seriously jeopardises efforts to stop the transmission of the virus and could also lead to further cases in the Gaza Strip and neighbouring countries.