The Palestinian Red Crescent accused Israel of firing on Friday at a hospital in Khan Younis, as a major advance in the main city in the southern Gaza Strip threatened the few healthcare facilities still open.
The Red Crescent said displaced people were injured "due to intense gunfire from the Israeli drones targeting citizens at Al-Amal Hospital" as well as the rescue agency's base.
Nearby in the same city, Israeli tanks were also approaching Gaza's biggest remaining functioning hospital, Nasser, where people reported hearing shellfire from the west. Residents also reported fierce gun battles to the south.
Israel has launched a major new advance in Khan Younis this week to capture the city, which it says is now the primary base of the Hamas fighters who attacked Israeli towns on Oct. 7, precipitating a war that has devastated the Gaza Strip.
The Gaza health ministry said 142 Palestinians had been killed and 278 injured in the previous 24 hours, taking the Palestinian death toll from more than three months of war to 24,762.
Around 85% of Gaza's 2.3 million people are now sheltering in the south of the enclave, most penned into the small cities of Rafah just south of Khan Younis and Deir al-Balah just north of it.
Two-thirds of the enclave's hospitals have ceased functioning altogether, and those that remain are receiving hundreds of wounded a day, crammed into wards and treated on the floors.
Israeli officials have accused Hamas fighters of operating from hospitals, including Nasser, which staff deny.
In the north, where Israel says it has started pulling out troops and shifting to smaller scale operations, 12 people were killed in Israeli strikes on a residential building near the largely non-functioning Al Shifa Hospital in Gaza City, Palestinian health officials said.
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Israel's onslaught on Gaza was triggered by Hamas attacks in which around 1,200 people were killed and 253 taken hostage, of whom about half are still in Gaza, according to Israeli tallies.
Washington has had scant success in persuading its ally to alleviate the plight of an increasingly desperate civilian population, deprived since October of most of the regular aid on which they had depended, let alone of adequate medical care for the more than 62,000 people who have been wounded.
Israel says it will fight on until Hamas is eradicated, an aim Palestinians call unachievable because of the group's diffuse structure and deep roots in an enclave it has run since 2007.
Diplomats were dealing on Friday with the repercussions after Israeli Prime Minister Benjamin Netanyahu appeared to rule out an independent Palestinian state, rejecting a long-standing pillar of US strategy in the Middle East.
"Israel must have security control over the entire territory west of the Jordan River," Netanyahu told a briefing in Tel Aviv on Thursday. "It clashes with the principle of sovereignty, but what can you do?"
US State Department spokesperson Matthew Miller responded at a news briefing that the establishment of a Palestinian state was the only way to provide lasting security to Israel itself, along with reconstruction, governance and security for Gaza.
Hani Bseiso, a doctor, recounted to Reuters how he was forced a month ago to amputate his 18-year-old niece A'Hed's leg below the knee, with a pair of scissors, gauze and sewing thread but no anesthetic, at home after her house was hit. Israeli tanks had blocked the way to the nearest hospital, he said.
"The choice was that I either let the girl die or I try to the best of my abilities."
Thousands of children in Gaza have undergone amputations amid poor hygiene and shortages of medicine.
Israel has detained large numbers of Palestinians in Gaza since the war began, on suspicion of militant activity.
Ajith Sunghay, a UN human rights official in Gaza, said he had just met men who had described being held for weeks, beaten and blindfolded, with some released into the cold wearing only diapers.
"These are men who were detained by the Israeli security forces in unknown locations for between 30 to 55 days," he told reporters in Geneva by video link.
Israel's military said detainees were treated "in accordance with international law" and released if suspicions proved unfounded.
It also said suspects were required to hand over their clothes to be searched, and given their clothing back "when possible".
Apart from Gaza, Israel has also carried out raids in the occupied West Bank, which has seen the worst violence in many years. Residents of the West Bank city of Tulkarm were reeling on Friday from a two-day Israeli military raid, of the kind that Israel says target suspects accused of carrying out or planning attacks against Israelis.
"They destroyed everything, the roads, infrastructure, the water and electricity. They entered houses, broke the doors and bombed them, as you can see," said resident Majida Abu Mariam.
"They demolished the house, they didn't leave anything in it - but what can we do?"
