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Behind the numbers: Gaza’s unprecedented aid worker death toll

‘This pattern of attacks is either intentional or indicative of reckless incompetence.’

This photo is taken inside Nasser Hospital and shows a United Nations worker standing between two hospital beds. Medical personnel are tending to injured people on beds. Composite image using photo of Abed Zagout/Anadolu
United Nations workers are brought to the Nasser Hospital after being injured in Israeli attacks in Khan Yunis, Gaza on October 20, 2023. The UN Palestinian refugee agency, UNRWA, has reported the death of at least two additional staff members in Gaza.

Farah* decided to write the name of her children on their wrists and legs after surviving a 5am airstrike that killed several of her neighbours.

That way, her children’s bodies would be identifiable if the family were hit again, the doctor wrote in a text message to her colleagues at the NGO Médecins Sans Frontières (MSF).

“But when I saw human body parts in my family’s backyard and flesh on the roof, I thought that it’s meaningless,” Farah wrote the day after the bombing.

Israel’s siege of Gaza has killed more than 30,000 people, starved a population, and pushed hundreds of thousands to the brink of famine. It has also unleashed unprecedented violence on aid workers like Farah.

They have faced fire from tanks, fighter jets, artillery, and snipers. They have been bombed while asleep with their families at home. They have been struck while at work in hospitals, in ambulances, or in aid convoys.

As of 20 March, at least 196 humanitarians have been killed in the Occupied Palestinian Territories since October 2023, according to figures compiled by the Aid Worker Security Database (AWDS) – the aid community’s main source for tracking attacks on aid workers. Data for 2023 and 2024 is not yet finalised, and the numbers are likely to rise, researchers say.

The number of humanitarians killed in the Occupied Palestinian Territories in only three months last year, 161, is more than the deadliest year ever recorded for aid workers globally, according to preliminary figures.

It’s nearly three times the death toll recorded in any single conflict in a year.

Most work for the UN’s agency for Palestinians, UNRWA – the biggest provider of aid and quasi-government services in Gaza. One in every 100 UNRWA staff in Gaza has been killed – the highest staff death toll in UN history.

Local staff have shouldered the brunt of the violence: All the aid workers killed in Gaza are national Palestinian staff, reflecting who’s responsible for the bulk of aid, and the sector’s continuing inability to extend the protection enjoyed by international staff to its frontline workforce.

Israeli forces have targeted healthcare facilities, aid convoys, and ambulances with apparent impunity. Aid groups say they have shared the GPS coordinates of their facilities and convoys with Israeli authorities to avoid unintentional bombing – a strategy known as deconfliction – but aid facilities continue to be hit.

“There is complete disregard for the norms of modern warfare,” said Bob Kitchen, vice president for emergencies and humanitarian action at the International Rescue Committee.

The IRC has sent two emergency medical teams to Gaza since October, only to pull them out due to security concerns: “Either through carelessness or through intention, [aid workers] are not being protected in Gaza,” Kitchen said.

COGAT, the unit of the Israeli defence ministry responsible for coordinating with the Palestinian Authority in the West Bank and international organisations active in Gaza, did not respond to requests for comment.

Humanitarian analysts and aid officials worry the unchecked violence felt by aid workers and civilians in Gaza is setting a precedent that will bleed into other crises.

“We are seeing a numbing of the international community to the violence,” said Abby Stoddard, the co-founder and director of Humanitarian Outcomes, the research group that maintains the Aid Worker Security Database.

Airstrikes on packed urban areas

The Israeli military’s tactics in its stated war on Hamas have included airstrikes on densely populated urban areas, and the targeting of hospitals and health facilities. This seemingly indiscriminate bombing has led to the staggering death tolls for Gaza’s aid workers, and its wider population, aid security analysts say.

“We’ve never seen such a level of death toll among first responders and health workers,” said Christina Wille, who heads Insecurity Insight, a humanitarian research organisation focused on threats to aid workers and people living in crises.

“If you use long-distance high-explosive weaponry with wide-area effects, you just cannot make meaningful distinctions between civilians and military objectives.”

This is reflected in the causes of death found in the aid casualty figures.

Four in every five aid workers killed in Palestine since 2000 died as a result of aerial bombardment or shelling – almost all of them since October 2023, according to the AWSD data.

“There is no safe place in Gaza.”

In conflicts in Afghanistan, South Sudan, or Somalia, by comparison, the majority of aid workers killed were targeted during shootings in ambushes, raids, or individual attacks, often while driving from one place to another.

Less clear is whether humanitarians in Gaza have been purposefully targeted. UNRWA staff are part of a community besieged by airstrikes and shelling; they’re teachers, healthcare providers, and civil servants. Most UNRWA staff died during aerial bombings while sheltering with their families, the agency said. The proportion of UNRWA staff killed – 168 of 13,000 staff in Gaza, or about 1.3% – roughly corresponds to the wider population. Of the roughly 2 million people living in Gaza, more than 30,000 have been killed since Israel’s siege began following the 7 October Hamas attacks.

Yet some aid workers have also been killed while on the job, and aid facilities – offices, hospitals, schools, shelters – are repeatedly hit.

In December, the UN said Israeli forces fired at a convoy after delivering aid in the northern part of Gaza.

In January, a Red Crescent ambulance was bombed at the entrance to the Deir al-Balah area of central Gaza. The Palestine Red Crescent blamed Israel for the attack, which killed four humanitarians and two civilians. Israel denied being involved.

“There is no safe place in Gaza,” Nebal Farsakh of the Palestine Red Crescent told The New Humanitarian.

Fourteen Red Crescent staff have been killed while on duty, and seven while at home, according to the organisation. Several staff members were also arrested by Israeli forces.

In the same month, the Israeli military carried out a “near-fatal airstrike” just metres away from the International Rescue Committee’s guesthouse in al-Mawasi, an area designated by Israel as a humanitarian safe zone. Several aid workers were wounded.

In February, an Israeli tank shelled a marked MSF shelter – killing two family members of staff and injuring six other people, the NGO reported. A similar strike in January killed the five-year old daughter of another MSF worker.

“This pattern of attacks is either intentional or indicative of reckless incompetence,” Christopher Lockyear, MSF’s secretary-general, told the UN Security Council in February.

The French charity, Médecins du Monde, says its office in Gaza was “intentionally destroyed” in February. The Gaza offices of the NGO Humanity & Inclusion and the Belgian development agency were also destroyed.

The New Humanitarian posed questions about these and other incidents to the Israeli defence ministry and COGAT, but received no reply.

Behind the numbers is “the biggest tragedy to face UN civil servants in the history of the United Nations,” said Jonathan Fowler, UNRWA’s senior communications manager.

As of 18 March, at least 168 UNRWA staff have been killed since the start of Israel’s siege, according to the agency

Each new death adds to what’s already the highest UN staff death toll in the organisation’s history.

Duty of care

Humanitarian deaths in Gaza reflect a broader pattern in aid worker safety: Local aid workers make up the vast majority of of deaths globally.

While the number of international humanitarians killed every year around the world remains roughly stable – roughly 10 people on average – the number of national staff killed has jumped from around 50 per year in the early 2000s to more than 100 every year for the past decade, according to AWSD data.

The rise partly reflects better reporting of violence against local aid workers, as well as an increase in armed conflicts around the world since the beginning of the 2010s, experts told The New Humanitarian.

But it also shows the continuing risk imbalance and double standards between international and local staff. International staff are more likely to receive security support – safety training and briefings, medical and life insurance, post-incident care, and emergency evacuations – and be the focus of an organisation’s safety policies.

The pattern repeats in emergencies from Gaza to Sudan and Afghanistan: While international workers can be quickly evacuated, the same levers aren’t available to local staff and their families.

“The localisation agenda was driven out of a development and disaster response perspective, and had not really considered the conflict situations,” said Wille of Insecurity Insight. “As a sector, we haven’t thought through how we can extend the security risk management to local staff.”

The spillover

The record death toll for aid workers is a part of the extreme violence faced by all civilians in Gaza.

Experts warn that the military tactics unleashed on Gaza could worsen humanitarian insecurity elsewhere, as the international community turns a blind eye to collateral damage, airstrikes on urban areas, and hospitals as targets.

“Over the past decade, direct attacks on hospitals have gone from relatively rare and met with shock and outrage, to sickeningly common and met with ever more muted reactions.”

“The fear is that with each successive conflict where international humanitarian law is massively violated, it progressively weakens the norm and numbs people to the suffering,” Stoddard said.

“For example, over the past decade, direct attacks on hospitals have gone from relatively rare and met with shock and outrage, to sickeningly common and met with ever more muted reactions.”

For the Palestinian aid workers trying to survive while helping their communities in Gaza, life is a matter of day-to-day survival.

Farah, the MSF doctor who narrowly survived an airstrike last month, spent the next day cleaning debris and fixing the plastic windows in her family’s shelter.

Their refuge had just been bombed, but they had nowhere else to go.

“I am a doctor. My husband is a doctor,” she told her colleagues in a voice note. “And we are suffering since day one of this war.”

*Farah is a pseudonym used to protect the aid worker’s identity.

Edited by Irwin Loy.

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