Israel renewed its military operation at Al Shifa Hospital on Thursday a day after it launched a raid on Gaza's largest medical facility, targeting what it says was a Hamas command center hidden beneath thousands of patients, medics and displaced people.

"Tonight we conducted a targeted operation into Shifa hospital," said Major General Yaron Finkelman, the head of army operations in Gaza. "We continue to move forward." Both Israel and its ally the United States claim Hamas has built tunnels below the Al Shifa complex, something Gaza's governing body and the directors of the hospital have strongly denied.

The enclave's health ministry said on Thursday that Israeli armored bulldozers had "destroyed parts of the southern entrance" of the hospital after it raided the site, interrogating patients and staff. Before Israel first sent troops into the hospital complex on Wednesday, UN agencies estimated that 2,300 patients, staff and displaced civilians were sheltering at Al Shifa.

"All men 16 years and above, raise your hands," a soldier shouted in accented Arabic through a loudspeaker at those inside seeking refuge inside the hospital on Wednesday. "Exit the building towards the courtyard and surrender," the soldier ordered, a journalist trapped inside because of the fighting told AFP.

About 1,000 male Palestinians, their hands above their heads, were soon led into the vast hospital courtyard, some of them stripped to their underwear by Israeli soldiers checking them for weapons or explosives, the journalist said. Hours later, some 200 remained in their underwear, forced to stand beside tanks used in the military incursion into the medical facility.

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The plight of the hospital had drawn international alarm, with patients and displaced civilians trapped inside without fuel, oxygen or basic supplies. Medics said dozens of patients had died in recent as a result of Israel's siege, including three newborn babies in incubators that lost power.

The Israeli army has labelled the raid a "precise and targeted" operation against Hamas, which launched a deadly attack on southern Israel on October 7. Israel has vowed to destroy Hamas in retaliation for the strikes, which killed 1,200 people. Meanwhile, Gaza's health ministry said the death toll from the Israeli assault has now topped 11,500, including thousands of children, as calls for a ceasefire mounted.

'Urgent' pauses

The UN Security Council on Wednesday set aside deep divisions over the conflict to agree a resolution calling for "urgent and extended humanitarian pauses" in fighting. The resolution - which passed thanks to abstentions from the U.S., Britain and Russia - called on Hamas and Israel to protect civilians, "especially children".

Israel has agreed to temporary localized pauses in fighting, but has rejected calls for a broader ceasefire. "The UN Security Council's resolution is disconnected from reality and is meaningless," Israel's Ambassador to the United Nations, Gilad Erdan, wrote on X, formerly Twitter. "Israel will continue to act until Hamas is destroyed and the hostages are returned," he added.

The Israeli foreign ministry in response called on the Security Council and the international community to "stand firm on the prompt release" of all the kidnapped. "Extended humanitarian pauses are untenable as long as 239 abductees remain in the hands of Hamas terrorists," it said. 

Israel's army claimed an initial raid in Al Shifa had uncovered military equipment, weapons and what spokesman Daniel Hagari described as "an operational headquarters with comms equipment". A video narrated by another Israeli army spokesman showed rifles, ammunition and ammunition magazines inside an area he identified as Al Shifa's MRI scanner building.

Hamas said the video was staged. Other Palestinians said that even on its face it depicted nothing like the vast underground militant headquarters complex that Israel had claimed was inside the compound. Kenneth Roth, former head of Human Rights Watch, said on social media platform X: "Israel will have to come up with a lot more than a handful of 'grab and go' rifles to justify shutting down northern Gaza's hospitals with its enormous cost for a civilian population with urgent medical needs."

The U.S. did not give Israel any kind of green light for its raid, the White House said on Wednesday, adding that such decisions were for the Israeli military. U.S. President Joe Biden later said Hamas had committed a war crime by housing "their headquarters, their military hidden under a hospital." But he warned Israel to be "incredibly careful" of harming civilians during the operation.

Witnesses have described conditions inside the site as horrific, with medical procedures performed without anesthetic, families with scant food or water living in corridors, and the smell of decomposing corpses filling the air. "The protection of newborns, patients, medical staff and all civilians must override all other concerns," UN humanitarian chief Martin Griffiths said. "Hospitals are not battlegrounds."

Evacuation order in south Gaza

Israel ordered civilians to leave four towns in the southern part of the Gaza Strip on Thursday, raising fears its war could spread to areas it had told people were safe.

Leaflets dropped overnight from aircraft told civilians to leave the towns of Bani Shuhaila, Khuzaa, Abassan and Qarara, on the eastern edge of Khan Younis, Gaza's main southern city. The towns, collectively home to more than 100,000 people before Israel's assault on the Strip, are now sheltering tens of thousands more who fled other areas.

"The acts of Hamas terrorist group require the defense forces to act against them in the areas of your residence," the leaflets said. "For your safety, you need to evacuate your places of residence immediately and head to known shelters." Residents said the area came under heavy bombardment overnight.

Israel has already ordered the evacuation of the entire northern half of Gaza before sending in its ground forces at the end of October. Long processions of people clutching just a few possessions have made their way south each day under the eyes of Israeli soldiers during six-hour "tactical pauses" to allow residents to leave. The UN says around two-thirds of Gaza's 2.3 million people have been made homeless, most of them sheltering in towns in the south.

Home front

Polls in Israel show public support for military action against Hamas following the October 7 attacks, the worst in the country's history.

Prime Minister Benjamin Netanyahu on Wednesday boasted there was no safe place for Hamas and "no place in Gaza" the army would not reach. "They told us we wouldn't reach the outskirts of Gaza City and we did, they told us we wouldn't enter Al Shifa and we did," he said. 

But Netanyahu, who has led Israel on-and-off for 16 years, is under intense domestic pressure to account for political and security failings surrounding the attack. Protesters have taken to the streets demanding more be done to release the hostages.

Once the war in Gaza has concluded, a political reckoning is expected. Israeli opposition leader Yair Lapid on Wednesday called for that reckoning to come even sooner, demanding that Netanyahu step down. 

"Netanyahu should leave immediately," he told Israel's N12 channel. "We need change, Netanyahu cannot remain prime minister," he added. "We cannot allow ourselves to carry out a long campaign under a prime minister who has lost the people's trust."

Qatar, which hosts a Hamas political office and also has behind-the-scenes diplomatic links with Israel, has meanwhile led negotiations for the release of the hostages. Speaking to reporters on Wednesday, Biden said he was "mildly hopeful" there would be a deal. "I don't want to get ahead of myself here because I don't know what's happened in the last four hours, but we have gotten great cooperation from the Qataris," he said when asked about progress on freeing the hostages.

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