Palestinians trapped inside Gaza's biggest hospital were digging a mass grave on Tuesday to bury patients who died under Israeli encirclement and said no plan was in place to evacuate babies despite Israel announcing an offer to send portable incubators. 

Israeli forces have surrounded Gaza City's Al Shifa hospital, which they say sits above the underground headquarters of Hamas militants. 

Hamas, Gaza's ruling Islamist group, denies fighters are present and says 650 patients and 5,000-7,000 other displaced civilians are trapped inside the hospital grounds, under constant fire from snipers and drones. It says 40 patients have died in recent days, including three premature babies whose incubators were knocked out. A Hamas official in Beirut said 25 of Gaza's 35 hospitals were out of use because of Israel's assault. 

Five weeks after Israel swore to destroy Hamas in retaliation for a cross-border assault by militants, the fate of Al Shifa has become a focus of international alarm, including from Israel's closest ally, the United States. 

Ashraf Al-Qidra, Gaza's health ministry spokesman, said there were about 100 bodies decomposing inside and no way to get them out. 

"We are planning to bury them today in a mass grave inside the Al Shifa medical complex. It is going to be very dangerous as we don't have any cover or protection from the ICRC," he told Reuters, referring to the International Committee of the Red Cross/Crescent. 

Thirty-six babies are left from the neo-natal ward after three died. Without fuel for generators to power incubators, the babies were being kept as warm as possible, lined up eight to a bed. 

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Israel announced on Tuesday that it was offering portable, battery-powered incubators so the babies could be moved. But Qidra said that so far no arrangements had been established to carry out any such evacuation. 

"We have no objection to having the babies moved to any hospital, in Egypt, the West Bank or even to the occupation (Israeli) hospitals. What we care most about is the wellbeing and the lives of those babies," he said. "The occupation [Israeli army] is still besieging the hospital and they are firing into the yards from time to time." 

Israel denies the hospital is under siege and says its forces allow exit routes for those inside. Medics and officials inside the hospital deny this and say those trying to leave come under fire. Reuters news agency could not verify the situation independently. 

'Thousands trapped in hospitals' 

Medical charity Medecins Sans Frontieres said shots were fired on Tuesday at one of its bases near Al Shifa, where MSF staff and their families, more than 100 people in total, were sheltering. 

"They ran out of food last night," MSF said on X, formerly Twitter. "We have been trying to evacuate them for three days. MSF is asking the Israeli army and Hamas to provide safe passage... Thousands of civilians, medical personnel and patients are currently trapped inside hospitals and other sites under fire in Gaza City." 

Medical officials in Hamas-run Gaza say more than 11,000 people are confirmed dead from Israeli strikes, around 40 per cent of them children, and countless others trapped under rubble. Around two thirds of Gaza's 2.3 million people have been made homeless, unable to escape the territory where food, fuel, fresh water and medical supplies are running out. 

'It will take hours and hours to bury bodies' 

Ahmed El Mokhallalati, a surgeon, said the main risk now was from decomposing bodies. "We are sure that all kind of infections will be transmitted. Today we had a little bit of rain. It was really horrible, nobody could even open a window, or just walk around the corridors with a really bad smell," he said. 

"Burying 120 bodies needs a lot of equipment, it can't be by hand efforts and by single person efforts. It will take hours and hours to be able to bury all these bodies." 

Doctors performed surgery without any oxygen on Monday, he said, making general anesthesia impossible. 

Israel's military has released video and photos of what it said were weapons Hamas had stored in the basement of another hospital, Rantissi, specialising in cancer treatment for children. Hamas said the images were staged. 

The armed wing of Hamas said it was ready to free up to 70 women and children held in Gaza in exchange for a five-day ceasefire. Al-Qassam Brigade spokesman Abu Ubaida said Israel had asked for 100 to be freed. 

There was no immediate public response from Prime Minister Benjamin Netanyahu's office, which has generally avoided commenting on negotiations over the release of captives, possibly in a swap for security prisoners held by Israel. 

U.S. President Joe Biden said on Tuesday he believed a release of hostages was going to happen. "Hang in there, we're coming," he said at the White House. 

Israel's foreign minister said on Tuesday that United Nations Secretary-General Antonio Guterres was not fit to head the global body, saying he had not done enough to condemn militant group Hamas and was too close to Iran. "Guterres does not deserve to be the head of the United Nations," Eli Cohen said.

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