Medical charity Doctors without Borders (MSF) has been forced to suspend its work in Gaza city as Israeli forces push through the area. It follows attacks and the closure of several health centres across the city in recent days.
"We have been left with no choice but to stop our activities as our clinics are encircled by Israeli forces," said Jacob Granger, MSF's emergency co-ordinator in Gaza.
"This is the last thing we wanted, as the needs in Gaza city are enormous, with the most vulnerable people - infants in neo-natal care, those with severe injuries and life-threatening illnesses - unable to move and in grave danger."
At least 48 people were killed across Gaza on Saturday morning as Israeli forces continued intensive air strikes and the demolition of homes, official Palestinian media reported.
Among the victims was one person killed while waiting for humanitarian aid in the Netzarim area, the Wafa news agency said, citing medical sources.
MSF operates at four hospitals, two field hospitals, four basic healthcare centres and two clinics across Gaza, according to its website. Its teams offer surgical support, wound care, physiotherapy, maternity and paediatric care, vaccinations, malnutrition care and mental health services. But Israel’s blockade of Gaza has left hospitals without sufficient supplies, it says.
The group said its MSF staff were being exposed to an "unacceptable" level of risk due to air strikes and tanks within a kilometre of its centres.
"Although we have been forced to suspend our activities in Gaza city, we aim to continue supporting key services in Ministry of Health facilities, including Al Helou and Al Shifa hospitals, while they continue to function," it said.
This week, two Gaza city hospitals were closed due to damage caused by Israeli bombing, the Gaza Health Ministry said, as tanks advanced deeper into the territory.
The ministry said Al Rantisi Children's Hospital was badly damaged by Israeli bombardment. It also reported Israeli attacks in the vicinity of the nearby Eye Hospital, which forced it to suspend services as well.
"The occupation deliberately and systematically targets the healthcare system in the Gaza governorate as part of its genocidal policy against the Strip," the ministry said.
"None of the facilities or hospitals have safe access routes that allow patients and the wounded to reach them."
Israeli troops are attempting to take control of Gaza's largest urban centre, which Israeli leaders say is a Hamas stronghold. Israel says the area houses between 2,000 and 3,000 Hamas fighters and the military operation aims to neutralise the group's central command.
But the offensive has been widely condemned by the international community over fears it will worsen the humanitarian situation in Gaza, where the UN says more than half a million people are trapped in famine.
Israel has faced growing scrutiny over its conduct in the war. UN-supported investigators have accused the country of committing genocide in an effort to “destroy the Palestinians”. They also accuse Israeli Prime Minister Benjamin Netanyahu and other senior politicians of incitement to the cause.
Conditions in Gaza are dire, with the World Health Organisation last week saying hospitals in the north were on the “brink of collapse”.
The Palestinian Medical Relief Society said this week that Israel had destroyed its main health centre in Gaza city. It said an air strike reduced the six-storey building to rubble in the central Samer area.
Israel has repeatedly bombed and raided hospitals in Gaza, accusing Hamas of using medical centres for military purposes, but it has provided little evidence to support its claim.
