Palestinian medics have said they are increasingly afraid for the lives of hundreds of patients and medical staff at Gaza's biggest hospital, cut off from all links to the outside world for more than a day after Israeli forces entered.
Israel said its commandos were still searching through Al Shifa hospital today, more than a day after they entered its grounds as part of an offensive Israel says aims to wipe out Hamas militants in the Palestinian enclave.
"The operation is shaped by our understanding that there is well-hidden terrorist infrastructure in the complex," an Israeli official said, declining to be identified.
Israel has so far released pictures of what it says were rifles and flak jackets found on the premises, but no evidence of a vast underground Hamas command headquarters it said was operating in tunnels beneath it.
Human Rights Watch cautioned that hospitals have special protections under international humanitarian law.
"Hospitals only lose those protections if it can be shown that harmful acts have been carried out from the premises," the watchdog's UN Director Louis Charbonneau told Reuters.
"The Israeli government hasn't provided any evidence of that," he said.
The director of Al Shifa Complex, Muhammad Abu Salamiya, said the hospital was "under occupation authority for 48 hours and every minute that passes" more patients will die.
"We are waiting for slow death," he told Al Jazeera TV.
Israeli forces brought a BBC film crew into the hospital overnight and showed it some rifles they said were found there, but the broadcaster said Israeli escorts had barred its team from interacting with patients or staff.
Gaza's health ministry said Israeli soldiers had removed bodies from the hospital grounds and destroyed cars parked there, but they were not letting staff or patients leave.
Ministry spokesman Ashraf Al-Qidra said there was no water, food or baby milk in Shifa, which was packed with 650 patients and about 7,000 people displaced by weeks of Israeli air strikes and artillery bombardments.
"Medical teams, patients and displaced people are fighting death due to the lack of any basic life necessities. The occupation forces are now present in the complex, but they did not provide any fuel for the hospital to continue work," he said in a statement.
He demanded that the Israeli troops leave. Medics have previously said dozens of patients including three premature babies had died from of a lack of fuel and basic supplies during a days-long siege.
Humanitarian bodies issued some of their direst warnings about the harm Israel's military campaign in Gaza was causing to civilians since it began retaliation against Hamas for a deadly 7 October rampage in southern Israeli towns.
The World Food Programme (WFP) said Gaza faced widespread hunger, with supplies of food and water almost exhausted.
"With winter fast approaching, unsafe and overcrowded shelters, and the lack of clean water, civilians are facing the immediate possibility of starvation," said WFP Executive Director Cindy McCain.
The head of the UN Palestinian refugee agency (UNRWA) said he believed there was a deliberate attempt to "strangle" its humanitarian work in Gaza, warning the agency may have to entirely suspend its operations due to a lack of fuel.
Israel refuses fuel imports, saying they could be used by Hamas for military purposes.
"If the fuel does not come in, people will start to die because of the lack of fuel. Exactly as from when, I don't know. But it will be sooner rather than later," said UNRWA Commissioner-General Philippe Lazzarini.
Gaza communications down as 'energy runs out'
Gaza's main telecommunications companies Paltel and Jawwal said all telecom services in Gaza had gone down, as all energy sources supplying the network had run out.
Reuters journalists have been unable to reach anyone inside Shifa hospital for more than 24 hours.
The World Health Organization said it was trying to arrange a medical evacuation of patients from Shifa, but was hindered by security concerns and the inability to communicate with anyone there.
WHO officials understood around 600 patients were still inside, including 27 in critical condition.
All hospitals in northern Gaza have effectively been shut down by Israeli forces, who have ordered the evacuation of the entire northern part of the enclave, home to more than half its 2.3 million people.
At the Indonesian Hospital in Gaza, about 45 patients who need urgent surgery have been left in the reception area, hospital chief Atef al-Kahlout told al Jazeera.
Israel maintains that Hamas fighters were operating a command headquarters in a complex of tunnels under Shifa, a claim backed by Washington.
Yesterday, Israel released a video in which a soldier toured a hospital building, showing three bags with guns and flak jackets he said had been found stashed there, as well as several other rifles in a closet and a laptop computer, but no tunnels.
"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," Kenneth Roth, a former head of Human Rights Watch who now works as a visiting professor at Princeton, said on social media platform X.
Hamas said the Israeli video was staged.
Elsewhere, Israel ordered civilians to leave four towns in the southern part of Gaza on Thursday, raising fears war could spread to areas where it had told people they would be safe.
Israeli Defence Minister Yoav Gallant said in a statement Israeli forces had cleared the entire west part of Gaza City and that the "next stage has begun".
The United Nations said around two-thirds of Gaza's population have been made homeless, most of them sheltering in towns in the south.
Hamas militants burst through the fence around Gaza on 7 October in an assault that Israel says killed 1,200 people in the deadliest day in its history.
Around 240 hostages were taken back to Gaza.
Israel has pounded Gaza with air strikes and cut off food and fuel.
Gaza health authorities deemed reliable by the UN say more than 11,000 people have been confirmed killed, more than 40% of them children.
Meanwhile, Israeli President Isaac Herzog said a "very strong force" may need to remain in Gaza for the near future to prevent Hamas re-emerging after the war, but US President Biden warned that occupying Gaza would be "a big mistake".
"If we pull back, then who will take over? We can't leave a vacuum. We have to think about what will be the mechanism; there are many ideas that are thrown in the air," Mr Herzog said.
"But no one will want to turn this place, Gaza, into a terror base again", he added.
Mr Herzog told the Financial Times newspaper that Israel's government was discussing many ideas about how Gaza would be run once the war ends and added that he assumed that the United States and "our neighbours in the region" would have some involvement in the post-conflict order.
Mr Biden said that he had made it clear to Israeli Prime Minister Benjamin Netanyahu that a two-state solution was the only way to resolve the Israel-Palestinian conflict and that occupying Gaza would be "a big mistake".
The Palestinian Authority (PA), which exercises limited self-rule in parts of the Israeli-occupied West Bank, says Gaza, where Hamas has ruled since 2007, is an integral part of what it envisions for a future Palestinian state.
Mr Biden told reporters he was doing everything in his power to free hostages held by Hamas militants, but that did not mean sending in the US military.
Washington has boosted its military presence in the Middle East, sending two aircraft carriers and support ships to the region, to prevent the conflict spreading and to deter Iran, along-time backer of Hamas, from getting involved.
Iran's supreme leader told the head of Hamas when they met in Tehran in early November, according to three senior officials: "You gave us no warning of your 7 October attack on Israel and we will not enter the war on your behalf".
Read more:
Three more Irish citizens cross from Gaza into Egypt, Tánaiste says
Father informed that children will not leave Gaza today after administrative error
Follow live updates from the Israel-Hamas war
Ayatollah Ali Khamenei told Ismail Haniyeh that Iran would continue to lend Hamas political and moral support, but would not intervene directly, said the Iranian and Hamas officials with knowledge of the discussions who asked to remain anonymous to speak freely.
Jordan yesterday condemned in the "toughest of terms" Israel's shelling around the Jordanian field hospital in Gaza which injured seven staff, and said it would await the results of an army investigation before taking legal and political steps to hold Israel accountable for the "crime".
First fuel truck arrives in Gaza
Retaliating against the 7 October attack by Hamas, Israel has enforced a strict blockade of Gaza, and conducted an aerial bombardment and armoured ground offensive that Palestinian authorities say has killed around 11,500 people, around 40% of them children, with many more dead buried under the rubble.
Israel has ordered the evacuation of the entire northern half of Gaza, and around two-thirds of its 2.3 million residents are now homeless.
The first truck carrying fuel into Gaza since the start of the war crossed from Egypt yesterday to deliver diesel to the United Nations, though it will do little to alleviate shortages that have hampered relief operations.
The United Nations Security Council yesterday called for urgent and extended humanitarian pauses in fighting for a "sufficient number of days" to allow aid access.
It also called, in a resolution, for the immediate and unconditional release of all hostages held by Hamas.
Israel has so far rejected calls for a ceasefire, which it says would benefit Hamas. A pause in fighting has been discussed, however, in negotiations mediated by Qatar.
Qatari mediators were seeking a deal that would include a three-day truce, with Hamas releasing 50 of its captives and Israel to release some women and minors from among its security detainees, an official briefed on the negotiations said.
