Palestinians said deadly strikes on Friday hit hospitals and a school where desperate civilians in Gaza City have sought refuge from intense combat that has sent thousands of others fleeing.

The Israeli army has repeatedly accused Palestinian militant group Hamas of using hospitals, particularly Al-Shifa, to coordinate their attacks and also as hideouts for its commanders. Hamas authorities deny the accusations.

The fighting in the urban areas of the Gaza Strip has reached critical levels, as the Israeli occupation forces are pushing forward and deeper. Now the Israeli troops are stationed in the Tel al-Hawa neighbourhood and even in the eastern areas of Gaza as they are trying to infiltrate more into the central and main centres of Gaza City. The IDF claimed Al-Shati taking over what it described as the main stronghold in the camp. Al-Shati, the third largest refugee camp in the Gaza Strip, has seen some of the heaviest Israeli bombardments throughout the war,

Eyewitnesses have told the BBC that Israeli forces are close to Al-Shifa, Al-Quds and the Indonesian Hospital – and there have been reports of explosions inside or near them. Footage has emerged of Israeli tanks positioned outside Al-Rantisi Paediatric Hospital in Gaza City. Witnesses said troops had been using loudhailers to order anyone who wasn’t medical staff or a patient to leave.

“There is no safe place left. The army hit Al-Shifa. I don’t know what to do,” said 32-year-old Abu Mohammad, who was among those seeking refuge at the hospital. “There is a shooting… at the hospital. We are afraid to go out.”

Al-Shifa’s director and Gaza’s Hamas government, which reported a death toll of 13, blamed Israeli forces for a strike on the hospital. The hospital received the bodies of another 50 people killed in a strike on Gaza City’s Al-Buraq school, the Al-Shifa director said. BBC Verify investigated and confirmed a video posted on social media showing a projectile attack in the vicinity of the Al-Shifa hosital – the largest in Gaza – where people have been seeking shelter.

The Palestinian Red Crescent Society said Israeli snipers had also shot at Al-Quds hospital, killing at least one person. AFP could not immediately confirm the tolls.

Israeli forces would “kill” Hamas militants if they saw them “firing from hospitals”, military spokesman Richard Hecht said. Heavy fighting was raging near Al-Shifa hospital, with Israel saying it had killed dozens of militants and destroyed tunnels that are key to Hamas’s capacity to fight.

Israel launched an offensive in Gaza after Hamas fighters poured across the heavily militarised border on October 7, killing 1,400 people, mostly civilians, and taking around 240 hostages. Vowing to destroy the militants, Israel retaliated with bombardment and a ground campaign that the health ministry in the Hamas-run Gaza Strip says has killed more than 11,000 people, mostly civilians and many of them children.

Witnesses told AFP that hundreds of people sheltering at Gaza City’s Al-Rantisi hospital fled on instruction from the Israeli military, which was surrounding it with armoured vehicles.

Amid the fighting, the International Committee of the Red Cross warned the health system in the Gaza Strip had “reached a point of no return”.

In Israel, medical services reported two women were wounded in rocket attacks in Tel Aviv. Hamas’s military wing said it had targeted the Israeli commercial hub.

The war in the densely populated coastal territory has prompted repeated calls for a ceasefire to protect civilian lives and allow in more humanitarian aid. There have been no reports of a lull in fighting in northern Gaza, despite the US announcements that Israel had agreed to begin four-hour daily military pauses. US Secretary of State Antony Blinken wrapped up a marathon diplomatic push Friday, saying Israel’s pauses in its Gaza offensive would “save lives” but more was needed.

“Far too many Palestinians have been killed,” Blinken said in New Delhi, his last stop before heading home, where he repeated US support for ally Israel but was firm that more aid had to reach civilians in Gaza. Tens of thousands of people have fled to the south of the territory in recent days, often on foot and with only the things they could carry.

The United Nations called for an end to the “carnage” in Gaza, saying “razing entire neighbourhoods to the ground is not an answer for the egregious crimes committed by Hamas”. “To the contrary, it is creating a new generation of aggrieved Palestinians who are likely to continue the cycle of violence. The carnage simply must stop,” UNRWA chief Philippe Lazzarini wrote in an opinion piece. Lazzarini also said on social media that over 100 UNRWA colleagues were confirmed killed in one month of war, noting the figure included parents, teachers, nurses, doctors and support staff.

Complicating Israel’s military push is the fate of the hostages abducted on October 7.. The conflict has also stoked regional tensions, with cross-border exchanges between the Israeli army and Lebanon’s Hezbollah, and Yemen’s Iran-backed Huthi rebels saying they launched “ballistic missiles” at southern Israel.

Iran’s Foreign Minister Hossein Amir-Abdollahian said the expansion of the Israel-Hamas war has become “inevitable”.

Saudi Arabia’s Crown Prince Mohammed bin Salman denounced the conduct of Israeli forces in Gaza, saying “we stress the necessity of stopping this war and forced displacement”.

Israel must stop killing babies and women in Gaza, French President Emmanuel Macron has told the BBC.”De facto – today, civilians are bombed – de facto. These babies, these ladies, these old people are bombed and killed. So there is no reason for that and no legitimacy. So we do urge Israel to stop.”

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