Gaza's largest hospital has become a "death zone," the World Health Organization said Sunday, announcing plans to evacuate the facility, as Israel's army said it was expanding operations to destroy Hamas.
The assessment came after a visit by WHO and other UN officials to the hospital, which Israeli troops raided earlier this week.
Elsewhere, a Hamas health official said more than 80 people were killed Saturday in twin strikes on a northern Gaza refugee camp, including on a UN school sheltering displaced people.
Social media videos verified by AFP showed bodies covered in blood and dust on the floor of a building where mattresses had been wedged under school tables, in Jabalia, the Palestinian territory's biggest refugee camp.
Philippe Lazzarini, head of the UN agency for Palestinian refugees UNRWA, described "horrifying images" from the incident, while Egypt called the bombing a "war crime" and "a deliberate insult to the United Nations".
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A separate strike Saturday on another building in Jabalia camp killed 32 people from the same family, 19 of them children, Hamas health authorities said.
Without mentioning the strikes, the Israeli army said "an incident in the Jabalia region" was under review.
Israel has vowed to destroy Hamas in response to the October 7 attacks, which Israeli officials say killed about 1,200 people, most of them civilians, and saw about 240 people taken hostage.
The army's relentless air and ground campaign has since killed 12,300 people, more than 5,000 of them children, according to the Hamas government, which has ruled Gaza since 2007.
The UN says some 1.6 million people have been displaced inside the Gaza Strip by six weeks of fighting, and Israel said Saturday its military was now "expanding its operational activities in additional neighbourhoods in the area of the Gaza Strip".
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- 'Extreme suffering' -
Gaza's largest hospital, Al-Shifa, has been a key focus in recent days, with Israeli forces alleging Hamas uses it as a command centre -- a claim denied by the group and medical staff.
On Sunday, the WHO described the hospital as a "death zone", with a mass grave at the entrance and nearly 300 patients left inside with 25 health workers.
It said it was planning "the immediate evacuation of the remaining patients, staff and their families", warning, however, that nearby facilities were already overstretched and urging an immediate ceasefire given the "extreme suffering of the people of Gaza".
On Saturday, hundreds of people fled the hospital on foot on orders from the Israeli army, according to the facility's director.
Columns of sick and injured -- some of them amputees -- were seen leaving with displaced people, doctors, and nurses, as loud explosions were heard around the complex.
At least 15 bodies, some in advanced stages of decomposition, were strewn along the route, lined with heavily damaged shops and overturned vehicles, an AFP journalist there said.
NGO Doctors without Borders said a convoy carrying its staff and family members came under attack Saturday while evacuating from near Al-Shifa, despite coordinating with both sides. One person was killed.
Israeli forces denied ordering the evacuation of the hospital, saying it had "acceded to the request of the director" to allow more civilians to leave.
The WHO said 29 patients at the hospital with serious spinal injuries cannot move without medical assistance, and others have infected wounds due to lack of antibiotics.
There are also 32 babies in "extremely critical condition," WHO said.
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- 'Not normal' -
Israel's siege on Gaza has left food, water, medicine and fuel in short supply, with just a trickle of aid allowed in from Egypt.
Under US pressure, Israel permitted a first consignment of fuel to enter late Friday, allowing telecommunications to resume after a two-day blackout.
The UN said Israel had agreed to allow in 60,000 litres (16,000 gallons) of fuel a day from Saturday, but warned it only around a third of what is needed.
Israel has told Palestinians to move south for their safety, but deadly strikes continued there too. At least 26 people were killed in a residential building on Saturday, according to the director of the Nasser hospital in Khan Yunis.
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Al-Wafa Hospital director in in Israeli attack
The director of a Palestinian hospital was killed in an Israeli airstrike south of Gaza City late Friday, according to the official Palestinian WAFA news agency.
The attack targeted the Al-Wafa Hospital for the Elderly Care in the Al-Zahraa neighbourhood, killing director Midhad Mhaisen. Several doctors were also injured in the attack, said sources.
The airstrike was the latest in a series of Israeli attacks targeting hospitals in the Gaza Strip amid an ongoing military offensive following a cross-border attack by the Palestinian group, Hamas, on Oct. 7.
According to Palestinian authorities, Israeli attacks and fuel shortages have forced 26 hospitals out of service.
US says still pushing for deal
The United States said Saturday it was still working to secure a deal between Israel and Hamas after a reported tentative agreement to free women and children held hostage in Gaza in exchange for a pause in fighting.
"We have not reached a deal yet, but we continue to work hard to get to a deal," White House National Security Council spokeswoman Adrienne Watson said on X, formerly Twitter, in response to the Washington Post reporting a deal had been agreed.
The Post said a detailed, six-page agreement could mean hostage releases begin within days and could also lead to the first sustained pause in the conflict in Gaza.
Citing unnamed sources, the newspaper said all parties would halt combat operations for at least five days while some hostages were released in batches, with overhead surveillance monitoring movement to police the pause.
But the White House quickly responded on Saturday evening with its message on X to deny any major breakthrough.
Israel has vowed to destroy Hamas in response to the October 7 attacks, which Israeli officials say killed about 1,200 people, most of them civilians, and saw about 240 people taken hostage.
The army's relentless air and ground campaign has since killed 12,300 people, more than 5,000 of them children, according to the Hamas government which has ruled Gaza since 2007.
US President Joe Biden's main adviser on the Middle East said earlier Saturday there would be a "significant pause" in the war if hostages held by militants in Gaza were freed.
"The surge in humanitarian relief, the surge in fuel, the pause... will come when hostages are released," Brett McGurk told a security conference in Bahrain.
The release of a large number of hostages would result in "a significant pause... and a massive surge of humanitarian relief," he said.
McGurk said Biden had discussed the issue on Friday evening with the ruler of the Gulf nation of Qatar, which is leading mediation efforts toward a ceasefire and release of the captives.
This week Biden said he was "mildly hopeful" of reaching a deal to free the hostages, believed to include about 10 US citizens.
Israel has refused to heed calls for a ceasefire before all the hostages are released.
Gazans evacuate hospital
Columns of Palestinians, some sick, some wounded made their way out of Gaza's largest hospital Saturday, walking for hours through the debris of war as they sought a new refuge.
The Al-Shifa hospital in Gaza City had been the focus of an Israeli special forces operation for days, searching for the Hamas command centre Israel insists is concealed beneath. Both the militants and hospital managers deny any such base exists.
Instructions to evacuate were issued Saturday, prompting the exodus of hundreds of patients and displaced towards the supposedly safer south of the Palestinian territory.
"The streets were destroyed, there were bomb craters and a lot of decomposing bodies" near the hospital, said Samia al-Khatib, 45, who left Al-Shifa along with her husband and 15-year-old daughter.
"There were scenes of horror, a real massacre," she told AFP.
Some clutched makeshift white flags as they made their way between dead bodies and heavily armed Israeli soldiers flanked by tanks and armoured vehicles.
Along a road lined by destroyed buildings and charred vehicles, children walked barefoot, elderly men leant on canes and the few who could afford it used horse-drawn carts to move south, where Israel has urged civilians to go.
One man carried his disabled daughter on his back. Another carried his injured daughter in his arms, a plaster cast on her tiny leg.
- 'It was hell' -
The hospital director said the Israeli army ordered the emptying of the facility.
Israel's military denied any such instructions, saying instead it had "acceded to the request of the director" to allow more civilians to leave.
At 8:00 am, the loudspeakers blared and an Israeli soldier ordered everyone to evacuate "within an hour" or risk bombardment, said Rami Sharab, 24, who was stuck in the hospital for some 20 days.
"I was one of the first to come out," said Sharab, who had sought refuge in the hospital complex with his family after his neighbourhood in Gaza City was bombed.
"We heard shots in the air and artillery fire."
Israel accuses Hamas of mounting attacks from hideouts under the health complex, and its troops have been combing its buildings.
Israel has vowed to "crush" Hamas in response to the group's October 7 attack, when it broke through Gaza's militarised border to kill about 1,200 people, most of them civilians, and take around 240 hostage, according to Israeli officials.
The army's air and ground campaign has killed 12,300 people, including more than 5,000 children, according to Hamas, which has ruled Gaza since 2007.
In all, more than 1.6 million people have been displaced in Gaza, around two-thirds of the territory's population, according to the United Nations.
The United Nations estimated 2,300 patients, staff and displaced Palestinians were sheltering at Al-Shifa before Israeli troops moved in on Wednesday.
During the operation Israeli soldiers interrogated patients in the compound's courtyard, some left naked as soldiers checked them for weapons or explosives, witnesses said.
"It was hell," said Sharab. "They stripped us, searched us and beat us."