Israeli strikes overnight into Saturday killed five people in Gaza City, according to Shifa Hospital, adding to a post-ceasefire toll that Gaza health authorities put at 1,439 Palestinians killed since Israel and Hamas reached a ceasefire nearly a year ago.1
The latest deaths underscore a central humanitarian assessment of the October 2025 deal: It has reduced the war’s intensity from its peak, but it has not created a stable operating environment for hospitals, aid convoys or patients seeking evacuation.
The World Health Organization told a United Nations briefing in Geneva on Oct. 2 that no hospital in Gaza is fully functional, citing chronic shortages of medicines and medical supplies. It said aid entry remains too slow, unpredictable and concentrated through too few access points.2
WHO’s Gaza metrics suggest the ceasefire should be measured less by whether trucks cross a border than by whether the right supplies, patients and health workers can move in time to prevent deaths.
The Associated Press reported that four women were among those killed in the overnight strikes and that a Christian mother and daughter were among the dead, according to Shifa Hospital. The hospital said people were still believed missing under debris after strikes tore into a multistory building. Israel’s military did not immediately comment on the incident, saying it was checking for information.1
Al Jazeera reported that the strike hit a residential apartment in Gaza City’s Remal neighborhood, an area crowded with displaced people, and that several others were severely wounded.7
The Gaza Health Ministry’s death figures do not distinguish between civilians and combatants, AP reported, but the ministry’s data is generally considered reliable by U.N. agencies and independent experts. Israel says it targets Hamas and other militants who pose threats and responds to ceasefire violations, including attacks.1
Aid access is the main test of the ceasefire
WHO’s Oct. 2 briefing framed Gaza’s humanitarian crisis as an access problem as much as a supply problem. Dr. Reinhilde Van De Weerdt, WHO representative in the occupied Palestinian territory, said that one year after the ceasefire announcement and three years after the conflict began, humanitarian aid was still not entering Gaza at the scale needed to restore health services.2
The most striking metric was time. WHO said large volumes of medical supplies wait a median of 74 days for Israeli approval before they can move toward Gaza. If a shipment is rejected, the process must start again. WHO also said entry requirements change regularly, often without clear explanation, adding uncertainty to humanitarian planning.2
That delay affects not only medicines but the basic infrastructure of medical care. WHO said standard health kits have the lowest approval rates among WHO and health-sector shipments, while X-ray machines, sterilization equipment, spare parts for CT scanners and laboratory supplies are frequently delayed or rejected. Forty percent of laboratory and diagnostic equipment remained pending approval, according to the U.N. briefing summary.2
Those bottlenecks have consequences beyond individual patients. WHO said weak laboratory and diagnostic capacity means Gaza’s health authorities cannot quickly detect circulating pathogens or respond in time to disease outbreaks. The agency said polio had been contained but warned of concern over cholera and other preventable diseases amid poor water, sanitation and shelter conditions.3
Prosthetics, diagnostics and ‘dual use’ denials
Aid agencies say some of the most important health supplies are still delayed under Israel’s “dual use” restrictions, which apply to items Israeli authorities consider potentially usable by armed groups. WHO disputed the classification of essential medical supplies, saying the affected items are standard equipment needed to run hospitals and clinics.3
In the past six months, WHO said, one shipment of prosthetics and assistive devices was rejected four times, delaying care for amputees and others waiting to regain mobility.2 The UN Geneva multimedia briefing also recorded WHO’s warning that medical equipment and assistive devices can be rejected even after initial approvals, leaving medicines closer to expiry and equipment at higher risk of damage before reaching patients.4
Medicines appear to move more readily than other health categories, but the overall picture remains uneven. UN News reported that medicines were approved at almost 87 percent and rejected at just over 1 percent, while prosthetics, diagnostic equipment and other hospital materials faced repeated obstacles.5 Al Jazeera reported the same WHO warning and said Van De Weerdt urged Israeli authorities to “release the pressure on medical supplies.”6
For humanitarian and security watchers, those approval rates matter because they provide a more detailed picture than aggregate truck counts. A ceasefire may reduce major combat operations while still allowing a health system to erode if diagnostic equipment, spare parts, prosthetics and sterilization tools remain stuck in approval pipelines.
Crossings and evacuations remain constrained
Access is also geographically constrained. UN News reported that approved aid can enter Gaza only through Kerem Shalom, at the southern tip of the enclave, while Rafah is open for limited movement of people, including patients needing treatment abroad. Four other main entry points — Kissufim, Gate 96, Erez and Erez West — remain closed to aid entry.5
WHO’s transcripted Geneva remarks described the Kerem Shalom process as a complicated security operation. To collect medical supplies from the Israeli military-controlled side, WHO said it needs armored vehicles, personal protective equipment and international staff, and must coordinate with Israeli authorities. The agency said there are often delays in receiving clearance. It described similar issues affecting medical evacuations as patients move through crossing procedures.3
Al Jazeera’s report on the Gaza City strike said Rafah is open only for limited movements, especially for patients requiring treatment abroad, and reported that many people are waiting to leave the Gaza Strip for medical reasons.7
WHO’s access warning means the evacuation pipeline cannot be assessed only by whether the crossing is technically open. The relevant humanitarian metric is whether wounded and chronically ill patients can obtain approvals, transport and onward treatment in time.
Winter raises the stakes
Aid agencies say the coming winter could turn logistical delays into broader public-health risks. WHO said almost 2 million people need shelter protection from cold and flooding, conditions that heighten the risk of respiratory infections, waterborne disease and other preventable illness.3
Al Jazeera, citing OCHA, reported concerns over solid waste accumulation in Gaza City, where sanitation gains remain fragile because of unreliable access to heavy machinery, engine oil, spare parts and fuel funding.6
The winterization challenge adds another layer to the ceasefire test. If shelter materials, sanitation equipment and medical supplies are delayed or rejected, aid groups warn that the deal may prevent a return to full-scale war while still failing to protect civilians from exposure, disease and delayed treatment.
Measuring whether the deal is working
WHO has urged a multi-crossing model, clear published entry rules and predictable access for health and humanitarian supplies at scale.2 It also called for a change in how success is measured: not by the number of trucks or tons delivered, but by whether the right supplies reach the people who need them in time.4
The latest casualty figures and supply metrics point in the same direction. The ceasefire has not ended lethal strikes, with five more deaths reported Saturday and 1,439 since the agreement, according to Gaza health authorities.1 It has not restored hospitals, with WHO saying none is fully functional.2 It has not normalized medical evacuations or aid routing, with WHO describing persistent delays, security procedures and reliance on Kerem Shalom.3
That makes verification central. For casualties, the key questions are who is being killed, where and under what claimed justification. For aid access, the key questions are which supplies are approved, which are rejected, how long approval takes, which crossings operate and whether patients can leave.
Nearly a year into the ceasefire, those metrics suggest a reduced-intensity conflict but not a reliable humanitarian operating environment.
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