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Israel launched air strikes on or near at least three hospitals in Gaza on Friday including Al Shifa, the enclave's biggest hospital, officials and medical personnel said.
Al Shifa was struck again at about 10.30am local time, hospital director Mohammad Abu Silmeyye told The National.
"People have been killed and injured, but the teams are still working on attending to them. So we still don't have a tally.
"I've just been hearing constant bombardment. They hit the maternity ward overnight," he said.
Gaza Health Ministry spokesman Ashraf Al Qidra told Al Jazeera television that the Israeli military "launched simultaneous strikes on a number of hospitals during the past hours”.
Mr Al Qidra said Al Rantisi Paediatric Hospital and Al Nasr Children's Hospital were “witnessing a series of direct attacks and bombardments”.
He said strikes on the hospital grounds at Al Rantisi set vehicles on fire but they had been partly extinguished.
Footage shared by local journalists showed people in makeshift shelters on Al Shifa's grounds cowering in fear as the shelling got closer.
In one video, a man screams in pain as he sits in a pool of blood while clutching his severely wounded leg.
Besides patients, about 60,000 people are taking shelter at Al Shifa.
Dr Abu Silmeyye said it was "impossible" to evacuate the hospital.
"We have informed the Israelis that this is simply impossible because there's nowhere to take the 200 patients, and the injured and the people sheltering there," he said.
There was also shelling around Al Quds hospital in Tal Al Hawa, northern Gaza, the Palestinian Red Crescent said.
The hospital, which it runs, is providing shelter to more than 14,000 displaced people seeking refuge from the Israeli bombardment.
Spokesman Mohammad Abu Msabbah said “hours” remained before the hospital's main generator ran out of fuel.
“We are having to make difficult decisions on whether to continue working or evacuate the hospital,” he said.
He said the hospital had been cut off by Israeli forces.
“We [have been] surrounded by Israeli tanks from all sides, for the past six hours. They are coming closer and closer.”
The Hamas-run Health Ministry posted a video on its Facebook page in which doctors said children in critical condition probably had only hours to live as hospitals such as Al Shifa and others around the enclave ran of fuel.
Israel's military says Hamas is using Al Shifa and other hospitals such as the Indonesian Hospital to hide command posts and entry points to an extensive tunnel network under the enclave.
Palestinian officials said 10,812 Gaza residents had been killed as of Thursday, about 40 per cent of them children, in Israeli air and artillery strikes since October 7.
Israel launched its attacks after militants from Hamas and allied groups killed 1,400 people, mostly civilians, and took about 240 taken hostage in a surprise attack on southern Israel.
The Israeli retaliatory attacks have created a humanitarian catastrophe as supplies of food, water, fuel and medicine run low and about half the population is diplaced from their homes.
The ministry says 18 of the Palestinian enclave's 35 hospitals and 40 other health centres have been forced to close because of damage from Israeli strikes or a lack of fuel.
“With ongoing strikes and fighting nearby [Al Shifa], we are gravely concerned about the well-being of thousands of civilians there, many children among them, seeking medical care and shelter,” Human Rights Watch said on social media platform X, formerly known as Twitter, on Friday.
Israel's military advance on central Gaza City, which brought tanks within about 1.2 kilometres of Al Shifa according to residents, has raised questions about how the Israelis will interpret international laws on protecting medical centres and displaced people sheltering there.
Deadly air strikes on refugee camps, a medical convoy and near hospitals have already prompted fierce arguments among some of Israel's Western allies over its military's adherence to international law.