Israeli air strikes hit three Gaza hospitals and a school on Friday, killing at least 27 people, and a ground battle was under way at another hospital, Palestinian officials said, as the US voiced fresh disquiet at the war's mounting death toll.
In his strongest comments to date on civilian suffering, US Secretary of State Antony Blinken denounced the number of Palestinians killed - put by Gaza authorities at more than 11,000.
Blinken welcomed the four-hour humanitarian Israeli pauses that the White House announced on Thursday but told reporters more action was needed to protect Gaza's civilians.
"Far too many Palestinians have been killed; far too many have suffered these past weeks," he said on a visit to India.
Israel has faced growing calls for restraint in its month-long war with Hamas but says the militants, who attacked Israel on Oct. 7 and took hostages, would exploit a truce to regroup. It says Hamas uses civilians as human shields and hides weapons in tunnels under hospitals, charges Hamas denies.
Director of Gaza's Al Shifa Hospital 25 are killed in an Israeli strike on a Gaza City school
US Secretary of State Antony Blinken denounces the soaring number of Palestinians killed, saying more needs to be done to protect civilians
More than 100 UN employees have been killed since the Israel-Hamas war began in Gaza, the UN Palestinian refugee agency (UNRWA) says, making it the deadliest conflict ever for the UN in such a short period of time
The International Committee of the Red Cross calls for the respect and protection of medical facilities, patients and healthcare workers in Gaza, saying the healthcare system in Gaza has reached a 'point of no return'
Gaza officials said missiles landed in the courtyard of the enclave's biggest hospital, Al-Shifa, in the early hours, damaged the Indonesian Hospital and reportedly set fire to the Nasser Rantissi paediatric cancer hospital.
The hospitals are in northern Gaza, where Israel says the Hamas militants who attacked it last month are concentrated, and are full of displaced people as well as patients and doctors.
Israeli tanks, which have been advancing through northern Gaza for almost two weeks, have taken up positions around the Nasser Rantissi, Children's and Eye hospitals as well as the Al-Quds hospital, medical staff said earlier, raising the alarm.
"Israel is now launching a war on Gaza City hospitals," Mohammad Abu Selmeyah, director of Shifa hospital, which was struck by a missiles early on Friday, told Reuters.
Gaza health ministry spokesman Ashraf Al-Qidra said Israel had bombed Shifa hospital buildings five times. "One Palestinian was killed and several were wounded in the early morning attack," he said by phone. Videos verified by Reuters showed scenes of panic and people covered in blood.
Selmeyah said later that at least 25 people were killed in Israeli strikes on Al-Buraq school in Gaza City, where people whose homes had been destroyed were sheltering.
The Palestinian Red Cross said Israeli forces were shooting at Al-Quds hospital, and there were violent clashes, with one person killed and 28 wounded, most of them children.
Israeli army spokesperson Lieutenant Colonel Richard Hecht told an evening briefing the army "does not fire on hospitals. If we see Hamas terrorists firing from hospitals we'll do what we need to do. We're aware of the sensitivity (of hospitals), but again, if we see Hamas terrorists, we'll kill them."
Israeli government spokesperson Eylon Levy said the Hamas headquarters was in Shifa hospital's basement, which meant the hospital could lose its protected status and become a legitimate target.
Qidra said clearing out the hospitals was impossible.
"We are talking about 45 babies in incubators, 52 children in intensive care units, hundreds of wounded and patients, and tens of thousands of displaced people," he said.
The White House said on Thursday that Israel agreed to pause military operations in parts of north Gaza for four hours a day, and the army said Palestinians on Friday were allowed to leave over seven hours along a road south, but there was no sign of a let-up in the fighting that has devastated the seaside enclave.
Palestinians said an Israeli missile struck the road used by people to flee south and Hamas-run media said three people were killed.
Sirens sounded in Tel Aviv and surrounding areas to alert people to Hamas rocket fire. Medics reported two women in Tel Aviv suffered shrapnel wounds from a salvo.
The armed wing of Hamas said on Friday it was still firing rockets and shells into Israel and fighting off troops in Gaza.
Gaza's hospitals were struggling to cope, even before the conflict closed in on them, with medical supplies, clean water and fuel to power generators running out.
In the wake of the blast at Shifa hospital, many people fled. Ayman Al-Masri, wounded early in the war, told Reuters he had taken shelter there with his mother and sister 10 days ago.
"We want a truce, we want a solution, a political solution. Tens of our children are killed every day," he said.
Palestinian officials said 11,078 Gaza residents had been killed as of Thursday in air and artillery strikes.
Israel says 1,400 people were killed, mostly civilians, and about 240 were taken hostage by Hamas on Oct. 7, while 39 soldiers have been killed in combat since.
The World Health Organization said colleagues had reported "intense violence" at Shifa hospital and "significant bombardment" on Rantissi hospital. The Palestinian health ministry said later that Rantissi hospital was reported to be on fire after suffering a direct hit.
"Israel ... targeted at dawn a number of hospitals in the Gaza Strip," Palestinian Health Minister Mai Alkaila said. A person who said they were a member of staff of Nasser Children's Hospital posted an appeal on social media saying they were surrounded.
Indonesia said parts of the Indonesian Hospital in northern Gaza had been damaged in overnight explosions nearby.
The International Committee of the Red Cross (ICRC) on Friday called for the respect and protection of medical facilities, patients and healthcare workers in Gaza, saying the healthcare system in Gaza had reached a “point of no return.”
More than 100 United Nations employees have been killed since the Israel-Hamas war began in Gaza, the UN Palestinian refugee agency (UNRWA) said on Friday, making it the deadliest conflict ever for the UN in such a short period of time.