Israeli forces are raiding Gaza's largest hospital, targeting what they say is a Hamas command center in tunnels beneath thousands of patients and civilians seeking refuge from intense combat, a move that has "appalled" the U.N.

The operation at Gaza City's Al-Shifa hospital brings to a head weeks of growing concern for the people trapped inside in grim conditions, as dozens of Israeli soldiers, some wearing face masks and shooting in the air, ordered people to surrender in what the army called a "precise and targeted" operation at the facility. Youssef Abu Rish, an official from the Gaza health ministry who was in the hospital, told AFP he could see tanks inside the complex and "dozens of soldiers and commandos inside the emergency and reception buildings." 

The Israeli army described it as "a precise and targeted operation against Hamas in a specified area" of the facility, despite Hamas officials repeatedly denying there was any such base at the hospital. After sharp warnings from the U.S. and others that Al-Shifa must be protected, Israel said the raid was being executed based on "an operational necessity."

The U.N. has said it estimates that at least 2,300 people - patients, staff and displaced civilians - are inside and may be unable to escape because of fierce fighting. The body's aid chief Martin Griffiths said he was "appalled" by the raid, stating that the protection of civilians "must override all other concerns."

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"Reports of military incursion into Al-Shifa hospital are deeply concerning," WHO Director-General Tedros Adhanom Ghebreyesus wrote on social media platform X. "We've lost touch again with health personnel at the hospital. We're extremely worried for their and their patients' safety."

Witnesses have described conditions inside the hospital as horrific, with medical procedures taking place without anasthetics, families with little food or water living in corridors and the smell of decomposing corpses filling the air. "There are bodies littered in the hospital complex and there is no longer electricity at the morgues," hospital director Mohammad Abu Salmiya said on Tuesday, before the Israeli raid.

A UK-based doctor who recently returned from working at Gaza's Al Shifa Hospital told CGTN Europe on Tuesday that during his ten years going regularly to the medical facility, he saw no signs that the building was a Hamas headquarters, as Israel has claimed.

Meanwhile, the first truck to deliver fuel to the Gaza Strip since Israel imposed a total siege on the enclave began crossing from Egypt on Wednesday, two Egyptian security sources said. Limited deliveries of humanitarian aid have been crossing from Egypt into Gaza since October 21, but Israel had refused to let fuel enter, leading to hospitals having to switch off life support machines for the terminally ill and prematurely born babies. 

Prime Minister Benjamin Netanyahu has vowed to destroy Hamas in response to its attacks on October 7, which killed an estimated 1,200 people, and saw 240 hostages taken to Gaza. The Hamas-run health ministry in Gaza says Israel's ensuing aerial bombardment and ground offensive have killed 11,320 people, mostly civilians, including more than 4,000 children.

Anticipating a fierce backlash against the operation, the Israeli military claimed it had provided evacuation routes for civilians and 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."

The Israeli army said its ground teams included 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" allegedly being used by Hamas as "human shields," it added.

White House warnings

Gaza's health ministry has called on "the international community and the United Nations to intervene immediately and urgently to stop the Israeli storming operation." 

The U.S. reiterated its concerns for the safety of civilians shortly after the raid began, with a National Security Council spokesperson saying: "We do not support striking a hospital from the air and we don't want to see a firefight in a hospital." The official added that there should not be a situation in which "innocent people, helpless people, sick people trying to get medical care they deserve are caught in the crossfire."

Despite the statement, the White House had said earlier that U.S. intelligence sources corroborated Israel's claim that Hamas and another Palestinian resistance group, Islamic Jihad, had buried an operational "command and control node" under Al-Shifa. Hamas, which has repeatedly denied the claims, said U.S. President Joe Biden was "wholly responsible" for the assault, accusing his administration of giving Israel "the green light... to commit more massacres against civilians."

Citing the Gaza's health ministry, UN humanitarian agency OCHA said 40 patients had died in Al-Shifa on Tuesday, while hospital director Abu Salmiya said 179 bodies had been interred in a mass grave inside the complex.

The situation in Gaza's other hospitals is also dire, with the World Health Organization saying 22 of 36 are not functional due to a lack of generator fuel, damage or combat. "The 14 hospitals remaining open have barely enough supplies to sustain critical and life-saving surgeries and provide inpatient care, including intensive care," the U.N. agency said.

The WHO "has warned that the evacuation of hospitals in the north, as demanded by the Israeli military, would be a 'death sentence' for some patients, because operational hospitals in the south cannot admit more patients", according to an update from OCHA. The humanitarian crisis also includes 1.5 million people who, according to the U.N., have fled southwards after Israel told them to leave the northern half of the territory.

Even escaping the fighting is dangerous. Wounded Palestinians described how they were hit by a strike on their way south. "I walked around three to four kilometers 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."

Hostage talks

Israeli leaders have so far rejected calls for a ceasefire in the five-week-old war until hostages are released. Abu Obeida, spokesman for Hamas's military wing, said on Monday that Israel had 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, who is helping oversee talks on a hostage deal, said the "deteriorating" situation in Gaza was hampering efforts to find agreement.  

With pressure building on the Israeli government, Netanyahu said he was "working relentlessly" to get the hostages out. Relatives of the hostages set out on 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 group later demanded the government "approve a deal tonight to bring home all hostages from Gaza."

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