Palestinian officials said a baby died and dozens more patients were at risk from Israeli gunfire around Gaza's largest hospital on Saturday, while Israel said it had killed a Hamas militant who had stopped another hospital from being evacuated.
Israel says doctors, patients and thousands of evacuees who have taken refuge at hospitals in northern Gaza must leave so it can tackle Hamas gunmen who it says have placed command centres under and around them.
Hamas denies using hospitals in this way. Medical staff say patients could die if they are moved and Palestinian officials say Israeli fire makes it dangerous for others to leave.
"It's totally a war zone, it's a totally scary atmosphere here in the hospital," Ahmed al-Mokhallalati, a senior plastic surgeon at Al Shifa hospital, told Reuters.
"It's continuous bombardment for more than 24 hours now, nothing stopped, you know, it's all from the tanks, from the street, from the air strike."
Most of the hospital staff and people sheltering at the hospital had left, he said, but 500 patients were still there.
Surgeon at Al Shifa hospital says 500 patients still there
Israel says it is not shooting at hospital and people can leave
Palestinian Red Cross reports intense shooting at Al-Quds hospital
Islamic Jihad fighters say they are clashing with Israeli forces near hospitals
The Israeli military denied endangering the hospital.
"There are clashes between IDF (Israel Defense Forces) troops and Hamas terrorist operatives around the hospital. There is no shooting at the hospital and there is no siege," said Colonel Moshe Tetro, head of coordination and liaison at COGAT, the Israeli defence ministry body handling civil affairs in Gaza.
Tetro said he was in constant contact with the hospital's director. "I told him several times: we can coordinate for anyone who wants to leave the hospital safely."
Hospital director Mohammad Abu Selmeyah had said late on Friday that the hospital was subject to Israeli attacks and the wounded were in a dangerous situation.
A Palestinian health ministry spokesman said on Saturday that Israeli shelling had killed a patient in intensive care.
Ashraf Al-Qidra, who represents the health ministry in Hamas-controlledGaza, said Israeli army snipers on the rooftops of buildings near the hospital fired into the medical complex from time to time, limiting people's ability to move.
"We are besieged inside the Al Shifa Medical Complex, and the (Israeli) occupation has targeted most of the buildings inside," he told Reuters by phone.
The hospital suspended operations after fuel ran out, Qidra said, adding: "As a result, one newborn baby died inside the incubator, where there are 45 babies."
CLASHES ALL NIGHT
Residents said Israeli troops, who went to war to eliminate Hamas after it staged a bloody cross-border assault on Oct. 7, had been clashing with Hamas gunmen all night in and around Gaza City where the hospital is located.
The military wing of Hamas ally Islamic Jihad, the Al-Quds Brigades, posted on social media: "We are engaged in violent clashes in the vicinity of Al Shifa Medical Complex, Al-Nasr neighbourhood, and Al-Shati camp in Gaza."
The Al-Nasr neighbourhood is home to several major hospitals.
An Israeli military spokesperson was asked at a briefing if troops planned to enter Gaza hospitals at some point.
"The hospitals need to be evacuated in order to deal with Hamas," the spokesperson said. "We intend on dealing with Hamas who have turned hospitals into fortified positions."
Hamas says it does not use hospitals for its military purposes and has asked the United Nations and the International Committee of the Red Cross to send missions to Shifa to investigate the Israeli allegations.
Israel said earlier it had killed what it called a Hamas "terrorist" who it said had prevented the evacuation of another hospital in the north, which Palestinian officials have said is out of service and surrounded by tanks.
"(Ahmed) Siam held hostage approximately 1,000 Gazan residents at the Rantissi Hospital and prevented them from evacuating southwards for their safety," an Israeli military statement said.
It said Siam was killed along with other militants while hiding in the "al Buraq" school. Palestinian officials told Reuters on Friday at least 25 Palestinians had been killed in an Israeli strike at the school, which was packed with evacuees.
BABIES AT RISK IN HOSPITAL
Israel said rockets were still being fired from Gaza into southern Israel, where it has said about 1,200 people were killed and more than 200 taken hostage by Hamas militants last month. It reduced the death toll by 200 on Friday.
Palestinian officials said on Friday 11,078 Gaza residents had been killed in air and artillery strikes since Oct. 7, around 40% of them children.
Qidra, the Gaza health ministry spokesman, said there was no electricity at the Al Shifa hospital, putting the babies and other vulnerable patients at risk.
"We are working hard to keep them alive, but we are afraid we may lose them in the coming hours," he said.
At another hospital, Al-Quds, medical teams worked on patients by torchlight, according to video footage released by the Palestinian Red Crescent.
Israel said it had increased the number of places in which it said it would stop firing for several hours at a time so Gazans could move south and that many had done so.
"We have over the last three days seen a mass evacuation of at least 150,000 people," a military spokesman said. "And we have seen more people evacuating today as the humanitarian pause in Jabalya area has been implemented."
In London, at least 300,000 pro-Palestinian demonstrators marched through the city, with police arresting nearly 100 far-right counter-protesters to stop them ambushing the main rally. More than 20,000 people joined a pro-Palestinian rally in Brussels.
Meeting in Saudi Arabia, Muslim and Arab countries called for an immediate end to military operations in Gaza, rejecting Israel's justification of its actions against Palestinians as self-defence.