Israeli forces entered Gaza's largest hospital Wednesday, targeting a Hamas command centre they say is located below thousands of ailing and sheltering civilians.
Israeli and Palestinian officials said military operations were taking place at Gaza City's Al-Shifa hospital, which has been the focal point of days of fighting and nearby aerial bombardments.
The Israel Defense Forces said its troops were carrying out "a precise and targeted operation against Hamas in a specified area" of the facility.
Youssef Abul Reesh, an official from the Hamas-run health ministry who is inside the hospital, told AFP he could see tanks inside the complex and "dozens of soldiers and commandos inside the emergency and reception buildings."
Thousands of patients, staff and displaced civilians are believed to be inside the hospital complex, according to local officials.
Witnesses have described conditions as horrific, with medical procedures taking place without anaesthetic, families with scant food or water living in corridors, and the stench of decomposing corpses filling the air.
"There are bodies littered in the hospital complex and there is no longer electricity at the morgues," said hospital director Mohammad Abu Salmiya.
Israel has repeatedly claimed that Hamas uses the hospital as cover for a command post and weapons stores, a claim Hamas denies.
That use "jeopardises" the hospital's "protected status under international law", the military said, a claim that many international human rights lawyers refute.
Israel has vowed to destroy Hamas in response to attacks on October 7, which killed an estimated 1,200 people, mostly civilians, and saw 240 hostages being taken to Gaza.
The Palestinian militant group accused US President Joe Biden of being "wholly responsible" for the Israeli assault on Al-Shifa.
The Palestinian Authority, historically the representative body for the Palestinians but which has no authority in Gaza, warned "against a massacre being carried out inside the hospital."
Anticipating a fierce backlash against the hospital raid, the Israel Defense Forces said it had given authorities in Hamas-run Gaza 12 hours' notice that any military operation inside must cease.
"Unfortunately, it did not," the Israeli military said, again calling on "all Hamas terrorists present in the hospital to surrender".
Israeli army ground teams were said to include medics and Arabic speakers "who have undergone specified training to prepare for this complex and sensitive environment".
The "intent" was that "no harm is caused to the civilians being used by Hamas as human shields", the Israeli military added.
Abul Reesh, from Gaza's health ministry, called on "the international community and the United Nations to intervene immediately and urgently to stop the Israeli storming operation."
He urged both to protect what he said were "20,000 people inside the hospital including medical staff and 650 ailing people and thousands of injured people."
The White House on Tuesday said that US intelligence sources had corroborated Israel's claim that Hamas has buried an operational centre under the hospital.
Hamas and another Palestinian militant group, Islamic Jihad, "operate a command and control node from Al-Shifa in Gaza City", National Security Council spokesman John Kirby told reporters.
"They have stored weapons there and they're prepared to respond to an Israeli military operation against that facility."
The situation in Gaza's other hospitals is also dire, with the UN saying 22 of 36 are not functional due to lack of generator fuel, damage and combat.
"The 14 hospitals remaining open have barely enough supplies to sustain critical and life-saving surgeries and provide inpatient care, including intensive care," said the World Health Organization.
The health ministry in Hamas-run Gaza says Israel's offensive has killed 11,320 people, mostly civilians, including thousands of children.
The humanitarian crisis in the territory also includes the hundreds of thousands of people who have fled southwards at Israel's urging to get away from the most intense fighting.
Even escaping the fighting is dangerous. Wounded Palestinians told AFP how they were hit by a strike on their way south.
"I walked around three to four kilometres (around two miles) while I was bleeding," said Hasan Baker, whose head and left hand were bandaged. "There was no possibility for any ambulance to enter the area."
Israeli leaders have so far insisted there will be no ceasefire in the five-week-old war until hostages are released.
Abu Obeida, a spokesman for Hamas's military wing, said Monday that Israel asked for the release of 100 hostages while the militants want 200 Palestinian children and 75 women freed from Israeli prisons.
"We informed the mediators we could release the hostages if we obtained five days of truce... and passage of aid to all of our people throughout the Gaza Strip, but the enemy is procrastinating," Abu Obeida said in an audio statement.
Qatari foreign ministry spokesman Majed bin Mohammed Al-Ansari told a news conference in Doha that the "deteriorating" situation in Gaza was hampering efforts to find a deal.
"We believe that there is no other chance for both sides other than for this mediation to take place," he said.
With pressure building on the Israeli government, Prime Minister Benjamin Netanyahu said he was "working relentlessly" to get the hostages out.
Relatives of the hostages set out Tuesday on a five-day protest march from Tel Aviv to the prime minister's office in Jerusalem to call for the captives' release, the Hostages and Missing Families Forum said.
The families group later demanded the government "approve a deal tonight to bring home all hostages from Gaza".
The Israeli army said it had captured Gaza's parliament, the government building, the police headquarters and other government institutions run by Hamas in Gaza City, as its forces deepened their offensive in the Palestinian territory.
In the occupied West Bank, eight Palestinians were killed in clashes with Israeli troops, seven during an army raid on the northern city of Tulkarem and one near the southern city of Hebron, the Palestinian health ministry said on Tuesday.
At least 180 Palestinians and three Israelis have been killed across the West Bank since October 7, according to officials on both sides.
