Columns of Palestinians, some sick, some wounded made their way out of Gaza's largest hospital, 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 said.
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.
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 8am, 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.
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."
