Gaza City’s hospitals were increasingly under siege on Friday, with hundreds of seriously ill and wounded patients and thousands of displaced people stranded on hospital grounds as intense, close-quarters combat between Israeli troops and Hamas fighters raged around them.
The precarity of the hospitals was made clear early on Friday when projectiles struck inside the Al Shifa complex, Gaza’s largest hospital, and a video appeared to show people being turned back by gunfire as they tried to evacuate another hospital.
Israeli tanks and troops have surrounded several hospitals in Gaza, hospital administrators and the Gazan Health Ministry said on Friday. A spokesman for the Israeli military said of the hospitals, “we’re slowly closing in on them” and urged people to leave them.
Israel has long maintained that Hamas uses the hospitals as shields, operating from within them, while thousands of Palestinian civilians have taken refuge on their grounds.
The chief of Al Shifa Hospital said it was struck four times on Friday, killing seven people, with several others wounded. The sources of the strikes and the extent of the damage were not immediately known.
In what appeared to be his strongest comments to date on the dire state of Gazan civilians, Secretary of State Antony J. Blinken said on Friday that “far too many Palestinians have been killed.” His remarks edged as close as he has come so far to criticizing Israel’s conduct of the five-week-old war.
“Much more needs to be done to protect civilians and to make sure that humanitarian assistance reaches them,” Mr. Blinken told reporters in New Delhi after a diplomatic tour through Middle Eastern and Asian nations. “Far too many have suffered these past weeks. And we want to do everything possible to prevent harm to them and to maximize the assistance that gets to them.”
The overall death toll in Gaza, as reported by the health authorities, part of the Hamas-run government, surpassed 11,000 on Friday. Last month, President Biden cautioned against accepting figures from Gazan officials, but on Wednesday a senior State Department official told Congress that the true toll numbers could be “even higher than are being cited.”
Among those killed are more than 100 staff members of a United Nations agency supporting Palestinian refugees, UNRWA, and at least 39 journalists and other media workers, according to the Committee to Protect Journalists. The rate of journalist fatalities is the highest for any conflict since it began tracking such deaths in 1992, the committee said.
The Gazan authorities have not said how many of those killed have been leaders and fighters of Hamas, Israel’s stated target, but they say the highest toll has been on the most vulnerable. More than 4,500 Gazan children and 3,000 women have been killed since the conflict began, they reported, and close to 27,500 people have been wounded.
The Israeli Foreign Ministry on Friday revised the government’s estimate of people killed by the Hamas-led assault on Israel on Oct. 7 from more than 1,400 to about 1,200.
Not long after the Oct. 7 raid and the Israeli retaliation began, hospital compounds in Gaza became makeshift refugee centers. Al Shifa, in particular, harbored thousands of displaced Gazans whose homes had been damaged or who simply thought Israeli forces would be less likely to attack a hospital than their neighborhoods.
Gazan hospitals have come to symbolize the extraordinary perils of prosecuting a war in a territory where tens of thousands of combatants live among — and in tunnels beneath — the more than 2 million tightly packed residents. In one of the deadliest incidents of the war, a projectile exploded between buildings at the Ahli Arab Hospital on Oct. 17, possibly killing hundreds of people sheltering there. Hamas blamed Israel, while the Israelis and Western governments said it was a malfunctioning rocket fired by Palestinians at Israel. A video analysis by The New York Times found that evidence cited by Israel was misinterpreted, leaving it unclear what caused the blast.
The Israeli military has repeatedly singled out Al Shifa in statements in recent weeks, saying that the hospital conceals a major Hamas military compound, with the group’s leaders and fighters operating from within the facility, including in a network of command posts, supply depots and passageways hidden beneath it.
Hamas denies operating within the hospital or under it, as does the hospital director, Mohammad Abu Salmiya.
The Gaza health ministry on Friday released a graphic video of conditions inside Al Shifa Hospital, where there are not nearly enough beds, doctors or nurses for the flood of patients. It showed injured people, both living and apparently dead, lying on stretchers on bloodstained floors.
“At this point, there’s just so little we can do for the wounded we receive, only the bare minimum,” Dr. Abu Salmiya said in a telephone interview. “There are people who need complex operations, but we can’t provide them, because we simply don’t have the capacity or the medication.”
He said the hospital complex had been hit four times on Friday, including two strikes on the obstetrics ward.
Videos verified by The New York Times show a projectile streaking out of the predawn darkness and into the hospital complex. It was not clear what kind of weapon was involved, who fired it or what damage it did.
A video from the grounds of Al-Nasr Hospital, posted on X, shows scores of women, men and children waving white cloths above their heads walking out a gate, stopping at the sound of a gunshot, and then running back through the gate as more shots are fired. It was not clear from the video who was shooting, or if anyone was hit.
“We’re aware of the sensitivity of the hospitals,” a military spokesman, Lt. Col. Hecht, told reporters on Friday night, adding that was why the troops were moving in “slowly.” He said that Israel wants people to leave the hospitals and join the exodus to southern Gaza, and “we’ve seen people leaving some of the hospitals.”
The Israeli military “does not fire on hospitals,” Colonel Hecht said, but add
ed, “if we see Hamas terrorists firing from hospitals, we’ll do what we need to do.”
On Thursday, Israeli troops fought ground battles “near the Shifa hospital,” according to the Israeli military, raiding what it said were Hamas command centers. “The terrorists located in the basements of Shifa tonight can hear the thundering sound of our tanks and bulldozers,” Israel’s defense minister, Yoav Gallant, said on Thursday night.
As Israel’s aerial bombardments intensified in October, more than 60,000 displaced people were sheltering at Al Shifa. But since the ground invasion began two weeks ago, many Gazans left the compound as it grew clearer that the Israeli military regarded Al Shifa as a possible threat, and perhaps a target.
These fears have turned on Israeli assertions that Al Shifa has ties to Hamas militants. Last week, an Israeli airstrike destroyed an ambulance near the hospital that the Israeli military said was being used to transport Hamas fighters. The hospital chief said 13 people were killed.
Late last month, for the first time, the Israeli military publicly laid out where it said specific installations were hidden in Al Shifa, based on what it said was intelligence. The military’s chief spokesman, Rear Adm. Daniel Hagari, told reporters that Hamas “does its command and control in different departments of the hospital,” a statement that raised fears that Israeli forces were preparing the groundwork for an attack on Al Shifa.
The Israeli authorities have also released videos that they say show Palestinian prisoners who were involved in the Oct. 7 attack on Israel speaking about Hamas’s use of Al Shifa.
Inside the hospital on Friday, staff members were preparing for the worst, including a potential Israeli ground raid into the hospital, Dr. Abu Salmiya said. They have no immediate plans to totally evacuate the complex, he added.
“We will stay with our patients,” he said.
Reporting was contributed by Alan Yuhas, Gaya Gupta, Iyad Abuheweila, Raja Abdulrahim and Edward Wong.