Humanitarian Scorecard Gaza Ceasefire by Oxfam Canada

APRIL 2026

HUMANITARIAN SCORECARD

Six Months In, Gaza Ceasefire is Failing

Introduction

This scorecard evaluates the performance of the ceasefire agreement outlined in the Trump administration’s 20-point Gaza plan, as endorsed by UN Security Council Resolution 2803. It assesses progress against the plan’s stated objectives related to civilian protection, humanitarian access, reconstruction and economic development, and freedom of movement.

The ceasefire agreement was presented not simply as a mechanism to pause the fighting, but as the foundation for a fundamentally improved reality in Gaza—one that would deliver stability, humanitarian relief, and the beginnings of recovery. It received the full weight of Security Council endorsement, and the backing of a broader group of UN Member States—all of whom committed to improving the conditions for Palestinians in Gaza. The agreement itself was the result of intensive diplomacy and generated hope among policymakers and affected communities alike that it could mark a turning point.

Six months on, that hopeful promise remains largely unfulfilled. While the agreement secured the release of Israeli hostages and some Palestinian detainees and reduced the intensity of hostilities, attacks have continued and the broader framework has failed to address Gaza’s overlapping displacement and humanitarian crises in a meaningful and sustained fashion.

Key provisions intended to underpin a ceasefire—including consistent aid delivery, restoration of basic services, civilian protection, and a clear pathway toward governance and security arrangements—have been only partially implemented or have failed to materialize altogether. In the few areas in which progress has been made against the agreement’s humanitarian benchmarks, it has generally required sustained diplomatic pressure at the highest levels, particularly from the United States. That pressure, however, has not been applied consistently or at the scale needed to secure full implementation.

For civilians in Gaza, the consequences have been stark. While restrictions on commercial access have been partially relaxed, humanitarian access remains severely constrained, and markets remain volatile. Much of what enters through commercial channels is neither sufficient nor appropriate to meet large-scale humanitarian needs. As a result, most of the population is unable to access affordable, nutritious food and remains without sufficient water, sanitation, shelter, or healthcare. At least 1.7 million people remain in displacement sites, with many sheltering in deteriorating tents, lacking sanitation and repeatedly subject to flooding.

In recent weeks, conditions have deteriorated further amid regional escalation, including the U.S.-Israel-led war with Iran, with crossings repeatedly shut and medical evacuations stalled. During the first two weeks of March 2026, trucks entering Gaza declined by 80 percent, and the price of basic goods increased dramatically—fueling renewed fears of hunger.

UNSCR 2803 also established a temporary governance framework to facilitate an administrative transition in Gaza. However, the absence of a clearly defined and fully empowered governance framework has also complicated efforts to advance both immediate relief and longer-term recovery. The institutional architecture supporting Gaza under the ceasefire remains in an early and evolving stage. Bodies such as the Gaza Executive Board, the National Committee for Administrative Governance (NCAG), and related technocratic arrangements have yet to be given consistent authority or demonstrate a clear impact on conditions inside Gaza.

The ceasefire now faces a new set of difficult medium- and longer-term challenges. If it is to survive and begin to live up to its promise, an essential first step is to make meaningful progress on the humanitarian situation and the recovery of Gaza. The recommendations that follow are intended as practical measures to help do that.

Recommendations

• Take measures to enforce a definitive ceasefire across the whole of Gaza, including by setting up an independent UNmandated mechanism to monitor, verify, and report violations of the agreement.

• Ensure an independent, transparent system is in place to process and verify humanitarian goods at Gaza’s border crossings— one that eliminates current barriers that block aid delivery—under the mandate of UN Security Council Resolution 2803.

• Ensure all the crossing points into Gaza are fully and consistently opened and facilitate the predictable flow of goods, with a minimum of 600 humanitarian aid trucks a day, and without any arbitrary limits on the range and volume of goods.

• Restore the medical corridor between Gaza and the West Bank, including East Jerusalem, so that patients can access urgent medical care within the Palestinian territory.

• Immediately restore freedom of movement for Palestinians into and out of Gaza, including for urgent medical evacuations, ensuring access is not subject to arbitrary delay, denial, or quotas.

• Lift the new Israeli restrictions for INGO registration and ensure that international organizations with Palestinian Authority registration are permitted to operate freely across Gaza and the West Bank, including sending staff and supplies into Gaza.

• Member States that endorsed the New York Declaration should now translate their political commitments into tangible, coordinated action in support of Gaza’s recovery and reconstruction.

• Ensure recovery plans do not contribute to the confinement of Palestinians or coerce further displacement and social disintegration, and instead guarantee full freedom of movement across Gaza, including access to property.

Methodology

These findings are based on the observations and experience of humanitarian organizations on the ground in Gaza and on available public data and secondary sources. The evaluation provides an independent, objective, and transparent assessment of the U.S.-led 20-point Gaza peace plan and the UN Security Council Resolution 2803, supporting it. The benchmarks assessed here are those set by the plan itself—largely input-based measures rather than conditions experienced by civilians on the ground. This differs from the standards humanitarian organizations typically apply, which measure direct impact on people. It is also worth noting that humanitarian assistance should never be conditioned on political negotiations. Under international humanitarian law, all civilians in conflict have the right to access aid, regardless of the political context. The following is an assessment (A–D categories) against the plan’s own stated benchmarks, not independent humanitarian standards.

The scorecard uses a simple three-tier grading system for each indicator: green means full or significant progress and earns 2 points, yellow means partial or inconsistent implementation and earns 1 point, and red means non-compliance, significant delays, or backtracking and earns 0 points. Each metric is connected to a particular point in the 20-point plan and UNSCR 2803 as detailed in the table below. Indicator scores based on those metrics are then added up by section and across the full scorecard. The percentage of points earned determines the overall rating: 80–100 percent is “functional,” 50–79 percent is “fragile,” and anything below 50 percent is “failing.”

SCORECARD

Assessment of Trump 20-Point Plan endorsed by UNSCR 2803 | April 2026

SCORING: Green = Full or significant progress (2 pts) Yellow = Partial or inconsistent implementation (1 pt) Red = Non-compliance, significant delays, or backtracking (0 pts) OVERALL: 80–100% = FUNCTIONAL 50–79% = FRAGILE <50% = FAILING

Indicator

A. CEASEFIRE & CIVILIAN PROTECTION

A-1

Cessation of Hostilities and Civilian Protection

20-Point Plan #3: “all military operations, including aerial and artillery bombardment, will be suspended, and battle lines will remain frozen until conditions are met for the complete staged withdrawal.”

20-Point Plan #4-5: “Within 72 hours of Israel publicly accepting this agreement, all hostages, alive and deceased, will be returned. 5.

Once all hostages are released, Israel will release 250 life sentence prisoners plus 1700 Gazans who were detained after October 7th 2023, including all women and children detained in that context.

For every Israeli hostage whose remains are released, Israel will release the remains of 15 deceased Gazans.”

UNSCR OP1: “Endorses the Comprehensive Plan…and calls on all parties to implement it in its entirety, including maintenance of the ceasefire, in good faith and without delay;”

No airstrikes or artillery fire; positions stable; all hostages and detainees returned within 72 hours

Isolated/disputed incidents; corrective steps underway; most hostages and detainees returned

Sustained bombardment inconsistent with ceasefire; no hostages or detainees returned; ground operations to take more territory

Ongoing airstrikes post-October 2025 ceasefire; more than 700 Palestinians killed, including at least 180 children as of April 3, 2026; 4 Israeli soldiers killed in the same period.

Buffer zones expanded; positions moved; 224 Palestinians killed near the line, including women and children; inability to rebuild humanitarian services in areas beyond the shifting Yellow Line.

All hostages and 1,950 Palestinian detainees and prisoners in the agreement returned.

A-2

No Occupation or Annexation

20-Point Plan #16: “Israel will not occupy or annex Gaza.”

UNSCR OP7: “As the ISF establishes control and stability, the Israel Defense Forces (IDF) will withdraw from the Gaza Strip based on standards, milestones, and timeframes linked to demilitarization that will be agreed between the IDF, ISF, the guarantors, and the United States, save for a security perimeter presence that will remain until Gaza is properly secure from any resurgent terror threat.”

No legal/ administrative/ physical indicators of permanence

Ambiguous signals; no definitive permanence steps

Formal annexation steps; permanent structures established

Some construction indicators, including military outposts with roads connecting them to each other and Israel. While there have been no formal annexation announcements, facts on the ground are beginning to mimic other areas where de facto annexation has taken place.

B-1

Aid Volume, Rehabilitation, and Reconstruction

20-Point Plan #7: “Upon acceptance of this agreement, full aid will be immediately sent into the Gaza Strip. At a minimum, aid quantities will be consistent with what was included in the January 19, 2025, agreement regarding humanitarian aid, including rehabilitation of infrastructure (water, electricity, sewage), rehabilitation of hospitals and bakeries, and entry of necessary equipment to remove rubble and open roads.”

UNSCR OP3: “full resumption of humanitarian aid in cooperation with the BoP into the Gaza Strip in a manner consistent with relevant international legal principles and through cooperating organizations”

600+ UNcoordinated aid trucks/day; consistent with Jan 19, 2025 agreement minimums, including a substantial number of humanitarian trucks; reconstruction of infrastructure ongoing; rubble being cleared

300–400 UNcoordinated aid trucks/ day (below minimum but steady); some infrastructure rehabilitation and clearance underway

<200 UNcoordinated aid trucks/day (severe shortfall); little to no infrastructure rehabilitation and clearance of rubble

~100 UN-coordinated humanitarian trucks/day; little infrastructure repair or rubble clearance in populated areas is possible given restrictions on the entry of critical supplies and equipment.

Section A Total: FRAGILE

B. HUMANITARIAN AID ACCESS

B-2 Border Crossings Operational

20-Point Plan #8 and UNSCR

OP8: “Opening the Rafah crossing in both directions will be subject to the same mechanism implemented under the January 19, 2025 agreement.”

B-3 No Interference by Parties with Aid Distribution

B-4 Infrastructure Rehabilitation

20-Point Plan #8 and UNSCR OP8: “Entry of distribution and aid in the Gaza Strip will proceed without interference from the two parties through the United Nations and its agencies, and the Red Crescent, in addition to other international institutions not associated in any manner with either party. Opening the Rafah crossing in both directions will be subject to the same mechanism implemented under the January 19, 2025 agreement.”

20-Point Plan #7 and UNSCR

OP7: “At a minimum, aid quantities will be consistent with what was included in the January 19, 2025, agreement regarding humanitarian aid, including rehabilitation of infrastructure (water, electricity, sewage), rehabilitation of hospitals and bakeries, and entry of necessary equipment to remove rubble and open roads.” UNSCR OP4: mentions the need to facilitate “the reconstruction of Gaza and of economic recovery programs” and “the coordination and supporting of and delivery of public services and humanitarian assistance in Gaza.”

All major crossings open daily; 12+ hours

Limited hours or 1–2 crossings operational

UN, ICRC, Red Crescent, major NGOs operate freely; no diversions reported Recurring friction; partial remediation underway

Most crossings closed or severely restricted Rafah and Jordan border crossings still effectively closed for aid; Israeli crossings restricted with only Kerem Shalom open for aid as of March 30, 2026. 0/2

Systematic impediments prevent aid flows

NGOs largely barred from bringing supplies into Gaza; other agencies severely restricted from bringing in necessary supplies and personnel for the humanitarian response. 0/2

Hospitals, basic services, & bakeries restored; rubble removal underway Partial restoration; equipment entering

No restoration; essential equipment unable to enter

Fuel severely restricted; temporary shelters banned; no fully functioning hospitals; safe water for drinking and hygiene below emergency thresholds; infestation and rising disease rates resulting from lack of appropriate shelters, sanitation, and sewage systems

0/2

B-5

Dual-Use Restrictions Policy Transparency

UNSCR OP7: “At a minimum, aid quantities will be consistent with what was included in the January 19, 2025, agreement regarding humanitarian aid, including rehabilitation of infrastructure (water, electricity, sewage), rehabilitation of hospitals and bakeries, and entry of necessary equipment to remove rubble and open roads.”

Published, consistent policy; appeals mechanism available Uneven enforcement; list partially disclosed

C. RECONSTRUCTION & ECONOMIC DEVELOPMENT

C-1

Trump Economic Development Plan Convened and Special Economic Zone (SEZ) Established

20-Point Plan #2: “Gaza will be redeveloped for the benefit of the people of Gaza, who have suffered more than enough.”

20-Point Plan #10: “A Trump economic development plan to rebuild and energize Gaza will be created by convening a panel of experts who have helped birth some of the thriving modern miracle cities in the Middle East.”

20-Point Plan #11: “A special economic zone will be established with preferred tariff and access rates to be negotiated with participating countries.”

UNSCR OP6: “Calls upon the World Bank and other financial institutions to facilitate and provide financial resources to support the reconstruction and development of Gaza, including through the establishment of a dedicated trust fund for this purpose and governed by donors.”

Classified list; item rejected without reasonable explanation

Dual use list continues to be opaque and include unreasonable items such as hygiene products, as well as critical medical and shelter supplies.

Expert panel convened; development framework drafted; SEZ framework and preferred tariff rates negotiated

Consultations underway; no formal plan yet

No expert panel; no development plan

No formal development plan convened; no SEZ framework established; World Bank created a new Financial Intermediary Fund (FIF) called the Gaza Reconstruction and Development (GRAD) fund in coordination with the Board of Peace, but its role is only as a limited trustee, with no responsibility for how funds are spent.

C-2

Market

Conditions & Price Stability

C-3

Commercial Trucks Allowed to Enter as a Complement to Humanitarian Aid

20-Point Plan #10: “Many thoughtful investment proposals and exciting development ideas have been crafted by wellmeaning international groups, and will be considered to synthesize the security and governance frameworks to attract and facilitate these investments that will create jobs, opportunity, and hope for future Gaza.”

UNSCR OP8: “Entry of distribution and aid in the Gaza Strip will proceed without interference from the two parties through the United Nations and its agencies, and the Red Crescent, in addition to other international institutions not associated in any manner with either party. Opening the Rafah crossing in both directions will be subject to the same mechanism implemented under the January 19, 2025 agreement.”

20-Point Plan #8: “Entry of distribution and aid in the Gaza Strip will proceed without interference from the two parties through the United Nations and its agencies, and the Red Crescent, in addition to other international institutions not associated in any manner with either party.”

UNSCR OP3: Underscores the importance of the full resumption of humanitarian aid in cooperation with the BoP into the Gaza Strip in a manner consistent with relevant international legal principles and through cooperating organizations, including the United Nations, the International Committee of the Red Cross, and the Red Crescent

Stable/affordable prices; no extreme inflation Volatile; moderate inflation (50–100%)

Extreme inflation (>300%); with chronic shortages

Commercial flows have been unable to meet the needs of the population and virtually no private sector investment has taken place to alleviate conditions. Israel allows only a handful of traders to import supplies and goods (including those on the dual use list) to Gaza and requires exorbitant “coordination fees” for every truck. This has led to volatile and exceedingly high prices on vital goods and supplies. Food items remain higher than pre-crisis levels (September 2023), by 3 to 233 percent. Other critical needs for electricity and WASH are even higher.

Unobstructed commercial and humanitarian access Commercial entries partly displace humanitarian imports Commercial entries substantially displace humanitarian imports

70-80%+ of the trucks authorized by Israel to enter Gaza are commercial, often prioritized ahead of waiting humanitarian trucks. Limited commercial trucking has brought down the cost of some essential goods compared to the height of the famine. However, there is little transparency on their contents, some of which are non-essential and should not take precedence over humanitarian deliveries.

Limited traders, high import fees, supply chain disruptions, and insufficient humanitarian supplies for vulnerable individuals mean that commercial flows are not a viable substitute.

D. FREEDOM OF MOVEMENT & RETURN

D-1

No Forced Displacement Out of Gaza

D-2

Right to Movement & Civilian Access to Rebuild Gaza

20-Point Plan #12 and UNSCR

OP12: “No one will be forced to leave Gaza, and those who wish to leave will be free to do so and free to return. We will encourage people to stay and offer them the opportunity to build a better Gaza.”

20-Point Plan #12 and UNSCR

20-Point Plan #16: “Israel will not occupy or annex Gaza.”

D-3

Medical Evacuations

20-Point Plan #12 and UNSCR

OP12: ”No one will be forced to leave Gaza, and those who wish to leave will be free to do so and free to return.“

No forced displacement out of Gaza; People are are free to leave and return and stay in their areas to rebuild

Gazans displaced by the war can return to homes freely

No forced displacement orders issued, but coercive conditions remain and reentry restricted Palestinians forcibly removed from Gaza; coercive evacuation orders active

Partial return; some restricted zones Return blocked; no return allowed beyond restricted lines; majority of Gaza inaccessible

50+ per day; transparent criteria; no backlog 100–200 per week; sporadic approvals <100 per week; major backlog; people dying waiting

Barely livable conditions create pressure that forces people to leave, though few are leaving Gaza due to restricted movement. Some Palestinians have re-entered Gaza with the limited reopening of Rafah in recent weeks, however numbers remain low.

Returns not permitted beyond Yellow Line; most of the population still displaced; most unable to leave or return. 0/2

Major backlog of people; Rafah restricted; people dying while waiting. 0/2

1/6

A. Ceasefire & Civilian Protection (A-1 to A-2)

1. Cessation of Hostilities and Civilian Protection

The ceasefire has succeeded in reducing the intensity of hostilities and securing the release of all Israeli hostages, along with agreed numbers of Palestinian detainees. However, there have still been a number of violations leading to civilian harm since the ceasefire took effect. Israeli air strikes, artillery shelling, and drone attacks have continued to occur on residential buildings and makeshift tents where displaced families shelter, killing at least 700 Palestinians, including more than 180 children and several healthcare workers, and injuring at least 1,600 Palestinians, including at least 151 children. Israel has reported four soldiers killed in the same period.

Even with regards to the release of prisoners, international humanitarian law continues to be violated. While the Palestinian detainees specified in the agreement were released, Israel continues to arbitrarily detain at least 309 healthcare workers. As of March 2026, Israel holds an estimated 3,442 Palestinian administrative detainees from across the Occupied Palestinian Territories without trial.

In March 2026, Israeli authorities also extended the militarized buffer zone beyond the previous “Yellow Line,” designating the expanded area the “Orange Line.” The areas along the line constitute active firing zones, where at least 200 Palestinians have been killed. The expansion has had significant consequences for humanitarian operations. As of late January 2026, more than 14,000 households were estimated to live in the zone, with more in its immediate proximity—raising concerns about displacement, access to services, and exposure to Israeli military operations. At least 10 UN installations—including collective shelters—now fall within the Israeli-controlled area and are effectively inaccessible to Palestinians. The expansion has also prevented UNRWA from opening a medical facility in North Gaza, where there is not a single even partially functioning hospital, according to the World Health Organization (WHO). Additionally, dozens of Water, Sanitation, and Hygiene (WASH) facilities also fall within the Israeli declared “coordination corridor,” requiring Israeli approval for access—approval that is often delayed or denied.

2. No Occupation or Annexation

Satellite imagery examined by Haaretz shows at least 32 IDF outposts in the buffer zone, including at least seven new outposts built since the ceasefire agreement was enacted. Though there have been no formal announcements for plans to annex or occupy the areas east of the Yellow Line, the Israeli government appears to be creating facts on the ground that could lead to de facto annexation.

B. Humanitarian Aid Access (B-1 to B-5)

1. Aid Volume, Rehabilitation, and Reconstruction

The 20-point plan and UN resolution call for immediate “full” aid with minimum quantities consistent with levels agreed to during the January 2025 ceasefire (+600 trucks per day). While Israeli authorities have cited up to 600 trucks entering daily, these numbers have not been sustained, and only a small percentage of these are UN-coordinated humanitarian aid shipments. Overall, in the 172 days between the day after the announcement of the ceasefire on October 11, 2025, and April 1, 2026, aid trucks delivered to Gaza averaged fewer than 100 aid trucks a day coordinated by the UN under the 2720 mechanism. This mechanism was created in 2023 by the United Nations Security Council under UN Security Council Resolution 2720, specifically to speed up humanitarian aid into Gaza by appointing a UN coordinator to verify shipments and facilitate their delivery while addressing Israeli security concerns. The rest are commercial goods and bilateral aid convoys that are not independently tracked or monitored.

Commercial shipments are not a substitute for humanitarian aid. According to WFP, a “sizeable” proportion of commercial shipments are of “high monetary value but low nutritional value.” In the meantime, shelter and medical supplies and water, sanitation, and hygiene equipment (WASH) are in short supply. Together, these trends show that restrictions on aid are not only limiting the provision of services and care but are also accelerating the spread of preventable illness and worsening the effects of current illnesses and injuries—deepening an already severe and systemic crisis in Gaza.

During the final months of 2025, organizations not approved under the new Israeli registration criteria were routinely denied entry of their own supplies—and, in some cases, their personnel—into Gaza. The December–February period shows fewer aid requests submitted alongside a higher rate of rejections—suggesting that organizations may already be self-censoring, avoiding requests they anticipate will be denied.

Since February 2026, regional escalation curbed access further. According to figures held by the U.S.-run Civil Military Coordination Center (CMCC), the number of trucks entering Gaza fell by 80 percent in the first two weeks of the war against Iran, which started on February 28, 2026. The reduction in goods entering since the regional escalation has driven sharp price increases in March, effectively doubling the cost of living for families compared to pre-escalation levels. This volatility shows how vulnerable Palestinians in Gaza still are to any shocks within and outside the territory.

According to OCHA reporting in early April citing the Gaza Chamber of Commerce, the level of commercial supplies collected within Gaza had sharply declined, from an average of 900 trucks a week in January and February to less than 400 per week in March, with humanitarian aid levels considerably lower even than these. While these figures may not be exhaustive, they are reflective of the overall volumes allowed in recent months and access trends since the start of the war with Iran.

Despite being described as a ceasefire, healthcare services in Gaza remain under extreme strain, largely due to the continued restrictions on aid entry and access for personnel. There are still no fully functional hospitals operating in the territory. Roughly half of all hospitals are still entirely non-operational. The number of partially functioning hospitals in Gaza has risen only slightly from 14 in October 2025 to 19 by March 2026.

Medical shortages are equally severe, with around 46 percent of essential medical items, 66 percent of medical consumables, and 64 percent of cancer medications completely out of stock. Medical teams in Gaza report severe and worsening shortages of essential supplies due to continued restrictions on aid entry. Since January 2026, Médecins Sans Frontières (MSF) has been unable to bring in new medical supplies, leaving nearly 50 percent of essential medications for chronic diseases—such as diabetes, hypertension, and respiratory conditions—at critically low levels. Hospitals are rationing care, limiting treatment to existing patients, and beginning to face acute shortages of basic materials like sterile dressings, increasing the risk of infection among trauma and burn patients. At the same time, the inability to import medical equipment or spare parts is leading to surgical delays and equipment failures, further undermining care in an already overwhelmed system.

These constraints are driving a broader public health crisis. There are more patients because of the conditions in Gaza, but without sufficient medical care or supplies to meet their needs. According to UNICEF, as of February 2026, respiratory infections are among the most common illnesses in Gaza and are increasing, including severe cases requiring hospitalization. This rise over time is directly linked to overcrowded displacement sites, exposure to cold and inadequate shelter, and the collapse of water, sanitation, and hygiene systems, which together create conditions for rapid disease transmission.

The situation is also dire for cancer patients: approximately 68 percent of chemotherapy drugs are unavailable, significantly undermining treatment and survival prospects. Screening and treatment services for cervical and breast cancer have been largely suspended since October 2023. These shortages extend across the healthcare system, with nearly 70 percent of medical laboratories no longer functioning due to lack of supplies, further crippling diagnostic and treatment capacity. High patient caseloads continued to overwhelm hospital capacity as of late March 2026, with particular strain driven by high needs for trauma and limb reconstruction cases.

A third of pregnancies are high-risk and 70 percent of newborn babies are born underweight, often sharing single incubators, significantly increasing mortality risks. Women requiring c-sections are discharged hours after their operations due to overcrowding in over-stretched hospitals. Additionally, over 500,000 women and girls face shortages of menstrual hygiene materials and access to clean water.

Malnutrition

Despite some improvement after famine conditions were partially pushed back in 2025, the situation in March 2026 remains highly fragile, according to the Integrated Food Security Phase Classification. Much of the population continues to face crisis or emergency levels of food insecurity, driven by restricted humanitarian access, mass displacement, and the near-total disruption of local food production and markets. While full food rations were provided in January 2026 to 1.6 million people, reductions in aid entering Gaza and stock depletions meant humanitarian organizations were only able to provide half rations in February and March, covering only 50 percent of caloric needs. This lack of sufficient and sustained food access perpetuates a malnutrition crisis in Gaza.

Initial improvements in aid flows after the ceasefire led to an increase in the number of children and pregnant and lactating women reached for malnutrition treatment, leading to drops in the number of malnourished children enrolled in treatment programs in late 2025. But as of March 2026, the malnutrition crisis in Gaza remains widespread, with the most recent updates from UNICEF indicating persistently high levels of acute malnutrition among vulnerable populations. Over 60,000 children under five are in need of life-saving acute malnutrition treatment and more than 290,000 children under five are estimated to be in need of supplements because their daily intake of nutrition is inadequate. In addition, roughly 37,000 pregnant and breastfeeding women require urgent nutritional support, reflecting the broader impact of the crisis.

These outcomes are closely linked to the continued collapse of Gaza’s healthcare system, with hospitals overwhelmed, shortages of essential medicines and therapeutic foods, and limited access to clean water—all of which significantly increase the risk and severity of malnutrition.

Shelter Conditions

Between October 2023 and October 2025, estimates indicated that at least 92 percent of Gaza’s housing units were either fully destroyed or damaged, and over 90 percent of the population was displaced. In March 2026, the Shelter Cluster reported that shelter stocks had been “severely depleted” over the previous month as a result of restrictions. Although 900,000 people were assessed as needing emergency shelter items such as tents and tarpaulins in February 2026, only 2,000 tents and roughly 38,000 tarpaulins were delivered to Gaza during the month. During harsh winter months, timber, tent poles, and tools—critical to supporting shelter—were restricted from entering due to restrictions on what Israeli authorities consider “dual-use” items. As a result of persistent obstructions to providing shelters, families were left to deal with winter conditions without any means to protect themselves from the elements. Families were flooded out of their makeshift tents made of cloth and rags, exposing them further to disease and infections. By February, at least 39 Palestinians, 22 of them children, died due to insufficient shelter with 25 killed by structures collapsing and 14 dying of hypothermia.

Today, at least 1.7 million people are currently sheltering in some 1,600 displacement sites in Gaza, with living conditions affected by vermin and parasite infestations, and skin rashes transmitted by pests. Some 40 percent of the overall population is still currently living in areas prone to flooding, a risk made more pronounced due to the lack of proper sanitation and presence of open sewage in many displacement sites. As of late March, an estimated 5,000 families are assessed to be living in the open air with no shelter at all.

In March, aid officials reported that, at the current pace of deliveries, it would take about 15 to 17 months to move all of the shelter supplies waiting in Jordan into Gaza. That is because only around 100 trucks carrying shelter and basic household items are getting through each month, while the total backlog amounts to roughly 1,780 truckloads.

Water, Sanitation, and Hygiene

Despite the ceasefire, the UN reports that residents continued to survive on less than the emergency standard of six liters of water per person per day and hygiene and sanitation conditions remain abysmal.

Water quality continues to pose serious health risks. Recent monitoring shows that over three-quarters of water samples fail basic health standards, with widespread contamination including fecal coliform and E. coli. Only 1.5 percent of water quality samples from health care facilities met recommended standards in February. The public health consequences are severe. In late February, the UN reported a sharp increase in skin infections including scabies and head lice, along with waterborne diseases. The report cited that this was driven by overcrowding, degraded tent fabric, and insufficient WASH facilities. With sanitation systems damaged after two years of Israeli military bombardment, rainwater has mixed with human and animal sewage leading to outbreaks of diseases such as hepatitis, diarrhea and gastroenteritis. According to Save the Children, conditions like malnutrition make these diseases life-threatening for children.

Over 80 percent of Gaza’s WASH facilities have been destroyed, while sewage and wastewater management and solid waste mechanisms are mostly dysfunctional due to damage, inaccessibility, and denial of necessary items for repair and rehabilitation. Late-2025 assessments found no functioning wastewater treatment facilities and no safe landfill sites for ordinary or medical waste. Other more recent surveys point to widespread exposure to sewage near homes, limited access to basic sanitation, and unsanitary living conditions across many sites, including visible pests, waste accumulation, standing water, and signs of open defecation. Residents fear rodent and insect infestation leading to disease. Humanitarians are trying to scale up the distribution of hygiene kits, but stocks are limited and there is an urgent need for pest control materials and chemicals.

Additionally, the private sector faces significant restrictions on importing hygiene items, making it nearly impossible for people to afford these items themselves. These factors heighten reliance on the humanitarian system for basic hygiene items.

Affected supplies include soap, dish washing liquid, shampoo, sanitary products, laundry powder, and plastic bags for domestic waste. Arbitrary restrictions on the overall volume of pallets into Gaza also creates constraints on the range and number of items humanitarian actors are able to import.

Education

School-aged children in Gaza are now missing formal schooling for a third year in a row. Currently more than 637,000 schoolaged children are out of school. Over 90 percent of school buildings remain destroyed or rendered inoperable with no sign of being rebuilt. Temporary learning sites have been set up across Gaza. However these are informal and often lacking even the most basic materials—chairs, tents, sanitation facilities, and teaching tools—due to severe restrictions on the entry of supplies and prohibitively high local prices. More than 60 percent of school-aged children in Gaza do not have access to any form of in-person learning. Although the Ministry of Education continues to provide accredited informal programs, learning is often disrupted by cuts in electricity and weak internet.

2. Border Crossings Operational

The Kerem Shalom crossing remains the only operational crossing through which humanitarian and commercial cargo can enter Gaza, and access through even that crossing is inconsistent and limited. The Rafah crossing remains effectively closed for cargo.

3. No Interference by Parties with Aid Distribution

Of the dozens of humanitarian organizations with decades of experience operating in Gaza, many have struggled to bring in their own supplies since the beginning of the war. These challenges intensified since March 2025, with approvals for basic items often denied or delayed by Israeli authorities. By the end of 2025, 37 NGOs were ordered by Israeli authorities to cease operations in the occupied Palestinian territory by the end of February 2026 under revised Israeli registration rules, severely constraining their ability to continue operating. This includes organizations that have deployed hundreds of international doctors and medical teams, saving countless lives over the past two and a half years.

Their work spans all major sectors: food, water, health, nutrition, protection, shelter, education, livelihoods, legal aid, and mine action. It also includes coordination and planning that enables an effective humanitarian response. UN agencies rely on INGO partners for delivery and augmented capacity, while Palestinian NGOs rely on INGOs for funding and technical expertise, as well as supplies and fuel. Collectively, international NGOs support or implement the delivery of more than half of all food assistance in Gaza, 60 percent of field hospitals’ operations, nearly 75 percent of shelter and non-food item activities, all inpatient treatment

for children suffering severe acute malnutrition, and 30 percent of emergency education services, in addition to funding over half of explosive hazard clearance, among other services.

The humanitarian needs in Gaza are far beyond the capacity of a few humanitarian actors to address. These organizations have the operational capacity and technical expertise essential to respond quickly and at scale. The deregistration of these NGOs makes delivering these lifesaving services more challenging, and in many cases, critical gaps remain unmet.

Though Israeli authorities have frequently cited looting and interference by Hamas as a reason to restrict aid, the data shows that this is not a significant issue. Between the announcement of the ceasefire on October 10, 2025, and April 6, 2026, less than .4 percent of pallets of humanitarian cargo were looted—a number that includes those intercepted peacefully by hungry people because of the lack of aid entering Gaza.

4. Infrastructure Rehabilitation

Basic service systems in Gaza remain in a state of near-total collapse, with little meaningful rehabilitation across food production, energy, and water infrastructure. Nearly 87 percent of cropland has been damaged. More than 85 percent of agricultural facilities and water wells have been affected. In addition, the livestock sector has been largely devastated, leaving Gaza structurally dependent on imports. Energy systems are similarly degraded: no cooking gas entered Gaza for 10 consecutive days between late February and early March 2026. Even after limited resumption, supply remains far below needs. As a result, 48 percent of households report relying on burning waste for cooking, posing severe health risks.

Water and sanitation systems—closely tied to energy availability—also remain critically impaired. Damage to wells, desalination plants, and pumping stations, combined with fuel shortages, has sharply reduced access to safe water. Repairs to the crucial Mekorot water supply line have stalled because the infrastructure lies east of the so-called “Yellow Line,” which demarcates Gaza territory under Israeli military control. These overlapping failures underscore that Gaza’s crisis is not only one of access, but of systemic collapse: without restoration of infrastructure, basic services cannot recover.

5. “Dual Use” Restrictions Policy Transparency

Despite the 20-point plan’s prohibition of arbitrary aid restrictions, the Israeli government has denied a wide range of essential and life-saving household products into Gaza through broad, ambiguous, and inconsistent “dual use” restrictions. This allows Israeli authorities to systematically block the entry of basic supplies into the besieged enclave on vaguely defined security grounds and without regard to international standards. At the same time, Israel does allow a select number of private traders to bring dual-use items into Gaza for exorbitant fees.

So-called “dual-use” items are goods, technologies, or materials that have both civilian and military applications. In other words, they can be used for legitimate, everyday purposes but may also be repurposed to support military activities, weapons development, or security operations. As a point of reference, the Wassenaar Arrangement on Export Controls for Conventional Arms and Dual-Use Goods and Technologies—the multilateral export control regime with 42 member countries (including the United States)—includes items like sensors and lasers and navigation and avionics equipment, such as specialized inertial navigation systems.

Israel has not provided a comprehensive dual use list to humanitarian organizations, but organizations have built an understanding of the classifications as items are rejected for being dual use. Israeli classified dual-use items have included basic medical supplies and shelter materials, such as non-electric wheelchairs, tarpaulins, sleeping bags, and portable toilets. At times, they have included items such as bandages, diapers, shampoo, and poles for tents. Israel also classifies many basic components needed to repair water and sanitation systems as “dual-use” items. Ongoing restrictions on critical medical equipment such as ultrasound machines, incubators, ventilators, and mobile maternity units significantly limit the ability of partners to scale up maternal and newborn health services across Gaza, undermining safe antenatal, obstetric, and postnatal care.

The ambiguous dual-use restrictions are also hindering efforts to prevent the spread of diseases. As temperatures rise, vector control is emerging as an increasingly urgent public health concern. As mentioned, reports of rodent and insect infestations are mounting across displacement camps, yet Gaza currently has no available rodenticides or insecticides due to ongoing Israeli entry restrictions. Without the entry of these materials, the risk of vector-borne disease will escalate sharply as summer approaches—adding another preventable and compounding health crisis to an already catastrophic situation.

C. Reconstruction & Economic Development (C-1 to C-3)

1. Trump Economic Development Plan Convened and Special Economic Zone (SEZ) Established

The 20-point plan outlined an ambitious transition from war to recovery, including large-scale reconstruction, private investment, and the creation of special economic zones. Yet by March 2026, there is no meaningful evidence that these components have materialized. The plan’s second phase—focused on redevelopment—has effectively stalled amid continued military entrenchment, lack of a clear withdrawal mechanism, and unresolved political conditions. The proposed governance structures meant to oversee reconstruction have struggled to establish themselves, while no major infrastructure projects, industrial zones, or sustained investment flows have taken shape. Instead, Gaza remains in a humanitarian emergency, with restricted aid access, collapsed services, and widespread dependence on emergency relief rather than recovery.

Though the World Bank created a new Financial Intermediary Fund (FIF) called the Gaza Reconstruction and Development (GRAD) fund in coordination with the Board of Peace, its role is only as a limited trustee, with no responsibility for how funds are spent. Unlike previous reconstruction funds, GRAD is separate from Palestinian Authority plans and oversight, meaning it does not represent real progress on an economic development plan for Gaza. The GRAD fund only allows the World Bank to transfer money to third parties without traditional oversight. This contrasts with previous FIFs for Ukraine and Haiti, where the World Bank maintained fiduciary oversight and reconstruction was guided by the affected country’s own plans.

Where private sector involvement has emerged, it has not resembled the kind of development envisioned in the plan that would lead to recovery for ordinary Palestinians. Rather than channeling funds through established humanitarian actors, there has been a shift toward opaque contracting structures tied to U.S.-linked firms. Reporting by the Guardian highlights proposals for logistics and aid delivery contracts with profit margins reportedly reaching up to 300 percent, raising serious concerns about profiteering in a humanitarian context. This shift not only undermines the neutrality and efficiency associated with organizations like the UN and major NGOs, but also reflects a broader distortion of the recovery agenda—away from public goods like infrastructure, water systems, and housing, and toward fragmented, profit-driven companies that do not respond to the needs of people where they are.

2 & 3. Market Conditions & Price Stability; Commercial Trucks Allowed to Enter as a Complement to Humanitarian Aid

Despite more goods entering Gaza after the ceasefire, commercial flows fail to provide all essential items needed, and most people still cannot afford what is commercially available. Moreover, the scale of commercial goods has fallen in recent weeks, with the UN reporting a drop from an average of 900 truckloads per week in January and February down to under 400 per week by March 2026.

The UN has also reported that since October 2025, more than 30 percent of private sector trucks carried “non-essential items” such as soda, while items like shelter or hygiene supplies are scarce in this pipeline.

According to the WFP Gaza market monitoring, most prices for the majority of food items remain higher than pre-crisis levels (September 2023), in some items by 3 to 233 percent, straining a population already suffering from 80 percent unemployment. On average, households now eat two meals a day (up from one), yet one in five people still eat only once daily. At the same time, according to the Danish Refugee Council (DRC), essential items remain expensive (e.g., a lighting unit rising from about $40 to more than $200).

Volatile market conditions highlight why commercial flows cannot substitute for humanitarian aid. In early March, the temporary closure of crossings triggered panic buying and sharp price spikes, with tomatoes reaching 35 NIS ($12) per kilogram, the highest recorded during the war. Wheat flour prices surged from 40 NIS (~$13) to 130 NIS (~$41) for a 25-kg bag before partially stabilizing at a price still above pre-crisis levels. These fluctuations reflect Gaza’s extreme import dependence: even small disruptions in supply chains rapidly translate into reduced affordability and access. As of March 2026, cash shortages and severe cooking gas scarcity left nearly half the population burning waste to cook.

Market functionality itself remains deeply constrained. According to a recent WFP analysis, by March 2026, only 28 percent of households reported improved access to food (down from 49 percent in February), while 37 percent reported worsening conditions, largely due to rising prices and reduced commercial inflows. Retailers face mounting challenges, with 70 percent reporting below-normal stock levels and 81 percent citing price volatility as a major barrier to restocking. Meanwhile, shortages of cooking gas have driven black market prices as high as 80–130 NIS ($25-41) per kilogram, further straining household budgets. In this context, the presence of goods in markets does not equate to access. Widespread poverty, liquidity constraints, and price instability mean that commercial supply cannot replace coordinated humanitarian aid designed to reach the most vulnerable populations.

This kind of price volatility underscores the limits of relying on commercial deliveries. Aid agencies have repeatedly stressed that commercial supply chains cannot replace organized aid delivery, which is designed to reach the most vulnerable populations free of charge.

The insights of Palestinians confirm these numbers. According to residents in Gaza, certain fresh produce has more than doubled in price—far beyond the means of Palestinians to buy. Potatoes have more than tripled in price. Cleaning supplies have increased by anywhere from 60 percent to 100 percent. Residents worry that flour will not only increase further in price but that it will become completely unavailable. Many Palestinians also rely on solar for electricity because of the severe fuel shortages but the price per wattage of this source of energy has also doubled. As one resident told a humanitarian INGO, “we are living in name only but not in reality.”

Reflecting growing concern, European diplomats are reportedly reconsidering their participation in the U.S.-led Civil-Military Coordination Center in southern Israel, citing the lack of any meaningful increase in humanitarian access and the overreliance on commercial shipments. Together, these trends highlight a critical reality: in a context of widespread poverty, displacement, and market dysfunction, commercial goods are not a substitute for humanitarian aid—they are often simply out of reach.

D. Freedom of Movement & Return (D-1 to D-4)

1. No Forced Displacement Out of Gaza

The vast majority of Gaza’s population remains displaced, with no immediate prospect of return. Nearly the entire population is now confined to less than 50 percent of Gaza, as over 50 percent of the territory—demarcated by the “Yellow Line”—remains under Israeli military control and largely off-limits to civilians. The “Yellow Line” effectively bisects large areas of Khan Younis, Rafah, Gaza City, and North Gaza, preventing families from returning to their homes or accessing private property. In the absence of clear timelines or guarantees for return, this sustained restriction raises serious concerns about the risk of permanent displacement and the forcible transfer of the population, though forced displacement outside of Gaza or forced evacuation orders have not yet occurred.

As displacement becomes more protracted with more than half of Gaza outside the hands of Palestinians and nearly 80 percent of structures damaged or destroyed, rumors of plans for so-called “Alternative Safe Communities” (ASC) in the Israeli controlled areas east of the Yellow Line continue to circulate. These plans for Gaza reportedly envision concentrating vetted civilians into tightly controlled, demilitarized zones where aid can be delivered while military operations continue elsewhere. In practice, it risks legitimizing mass displacement and containment, offering the appearance of protection while leaving civilians overcrowded, dependent, and still exposed to violence in a devastated infrastructure environment. These operations would almost certainly occur in a coercive environment, with continued deprivation in areas of current displacement used to pressure civilians to move, which may amount to forcible transfer.

2. Right to Movement & Civilian Access to Rebuild Gaza

A Haaretz investigation finds that what was initially presented as a temporary ceasefire boundary—the “Yellow Line”—is increasingly becoming a de facto permanent border inside Gaza. Rather than preparing for withdrawal, the Israeli military has expanded and entrenched its presence, constructing at least seven new outposts since late 2025, bringing the total to over 30 positions across Gaza. Satellite imagery shows significant infrastructure development, including paved bases, communications systems, and a growing physical barrier stretching more than 17 kilometers. The line currently leaves roughly 54 percent of Gaza under Israeli control, with further encroachment reducing Palestinian-held territory even more. As a result, Gaza’s 2.1 million people are now confined to less than half the territory they previously inhabited, many living in tents or damaged buildings. The fact that Israeli-controlled areas are essentially the breadbasket of Gaza also severely threatens food security and livelihoods for Palestinians.

The Yellow Line also seems to move and interfere with plans for humanitarian assistance and recovery. The establishment of a new medical facility in Beit Lahia, in the North Gaza area, despite advanced preparations, was unable to proceed due to the recent expansion of the Israeli-militarised zone of control and worsening security conditions in the area.

This consolidation has had severe humanitarian consequences. The areas surrounding the Yellow Line have effectively become active combat zones, with frequent airstrikes, artillery fire, and shootings. According to UN data, at least 224 Palestinians have been killed near the line, many of them civilians, including women and children. Human rights observers describe a pattern of people being targeted simply for being close to the line, which is often unmarked and shifts over time, putting civilians at constant risk—even while performing daily tasks like collecting water or returning home. When expanding their presence, Israeli forces have unilaterally shifted the yellow blocks further west into Gaza, razing areas, destroying hundreds of buildings, and displacing residents—actions that amount to violations of the ceasefire. Despite ceasefire language and international proposals for phased withdrawal, the IDF is deepening its hold on Gaza, while no clear mechanism exists for de-escalation or territorial rollback.

3. Medical Evacuations

Since the ceasefire came into effect, just under 700 patients have been medically evacuated from Gaza—including just over 260 since Rafah crossing was partially reopened, according to the UN. These figures fall short of even the restricted quotas Israeli authorities announced they would implement upon reopening the crossing. Medical evacuations from Gaza continue to be denied and obstructed with devastating consequences for patients unable to access the treatment they urgently need.

More than 18,500 critically ill individuals still require medical evacuation outside the territory, including around 4,000 children, according to the World Health Organization.

The human toll of these delays is acute and ongoing. Between six and ten Palestinians are reportedly dying each day while awaiting evacuation, according to local health authorities. Since October 2023, more than 1,400 patients have died due to lack of access to evacuation and necessary treatment.

Beyond emergency evacuations, the medical corridor that once allowed Palestinians from Gaza to access treatment for critical illnesses—including cancer and congenital heart problems—remains suspended, despite existing capacity, expertise, and infrastructure capable of absorbing such cases.