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The morgues at European Hospital and Abu Yousef Al Najjar Hospital in southern Gaza are full, with bodies left lying on hospital floors, after overnight Israeli strikes on Rafah killed more than 93 people, Palestinian Health Ministry spokesman Dr Ashraf Al Qudra told The National.
"Every square kilometre in Rafah contains between 25,000 to 27,000 people, which means a military operation would be catastrophic," he said, speaking from the Al Helal Emirati Maternity Hospital in Rafah.
He said triage was being performed on incoming patients as the number of casualties from the strikes exceeds the capacity of the small hospitals, and that emergency units were still pulling people out of the rubble.
The strikes came after US President Joe Biden urged Israel's Prime Minister Benjamin Netanyahu to shield civilians from any military operation in Gaza's southernmost city. Israel should not proceed without a “credible and executable plan” for their safety and support, he said.
Video of the overnight strikes posted by the Palestinian news agency Wafa shows smoke filling the night sky amid the sound of bombardment.
The Israeli military later said a “series of strikes” it conducted on southern Gaza were “concluded”.
The heavy bombardment caused widespread panic in Rafah because many people were asleep when the strikes started. Some feared Israel had begun its anticipated ground offensive on the city.
Some people in Rafah have considered moving north towards Deir Al Balah in central Gaza but that area is still a frequent target of Israeli air strikes.
"So, where should we go? They want us to only think about going towards the border to go to Sinai, but we will not go to Sinai," Ola Handoqa, 39, told The National from Rafah.
She said she would prefer to "die in her own land".
Yousef Barak from Rafah's Al Shabora neighbourhood said he had seen the carnage wrought by the Israeli strikes.
"My uncle owns the house that was targeted," he said. "So I went to see the damage. I found bodies of martyrs scattered everywhere." In total, Mr Barak counted eight bodies "belonging to women and children".
"These are civilians who were sleeping peacefully."
Currently, about 1.4 million Palestinians are crowded into Rafah, with many living in tents, with food, water and medicine becoming increasingly scarce, the UN said.
Aid agencies say an assault on Rafah would be catastrophic. It is the last relatively safe place in the devastated enclave.
On Monday, Dr Al Qudra said food had run out for staff, patients and displaced people in the besieged Al Nasser Hospital in Khan Younis. The shelling surrounding the medical complex had also caused "the ceilings in the housing units and operations department to fall", he said in a statement.
"Nobody is able to move in the complex's yard as Israeli snipers are stationed nearby," Dr Al Qudra said. At least seven civilians were killed, and 14 staff and displaced people were injured inside the complex as a result of Israeli attacks, he said.
The shelling also caused damage to the hospital complex's sewage system, causing sewage to seep into the facility. Dr Al Qudra said it was an urgent need for a technical team to be allowed to safely move around the complex's buildings to fix the damage.
Israeli strikes on Gaza have killed 28,340 Palestinians and wounded 67,984 since October 7, the Health Ministry in Gaza said on Monday.
The army usually orders civilians to leave their homes and towns without any specific evacuation plans before they conduct strikes.
Hamas said the Rafah strikes were a continuation of the “genocidal war” that Israel has waged against the Palestinian people. It accused Israel of attempting forced displacement in Gaza.
Mr Netanyahu has ordered his army to prepare a ground offensive on Rafah, Gaza's last major population centre that troops have yet to enter after Hamas's October 7 attacks sparked the war.
Israel says Hamas militants killed about 1,200 people in southern Israel and abducted at least 250 in their attacks.
Mr Netanyahu said on Sunday that “enough” of the 132 remaining Israeli hostages held in Gaza were alive to justify Israel's war in the region.