Doctors have described a situation so extreme in Gaza’s major hospitals that it has gone beyond a humanitarian catastrophe and become a “collective death sentence”.

Israel was accused on Sunday (AEDT) of striking Gaza’s largest hospital, Al Shifa, which it denied but acknowledged fighting was raging outside. Israel counter-accused Hamas of hiding its headquarters in the hospital’s basement.

In posts to X, international doctors’ groups operating in Gaza said the destruction and killing had reached an “unfathomable scale”.

Patients were dying as hospitals tried to function without power, water, or oxygen. In one example two premature babies died after the Al Shifa hospital’s last generator was hit, and another 37 premmies were at risk.

The Israeli military on Sunday (AEDT) said it would help evacuate babies from Al Shifa hospital’s paediatric department to “a safer hospital”.

United Nations (UN) humanitarian chief Martin Griffiths said what was happening in Gaza’s hospitals was “unconscionable, reprehensible, and must stop”.

In a post to X, Griffiths said “hospitals must be places of greater safety, not of war”.

“There can be no justification for acts of war in health care facilities, leaving them with no power, food or water, and shooting at patients and civilians trying to flee”.

His comments came as Doctors Without Borders said civilians and patients were being shot at when trying to leave the medical facility.

The group said hospitals in the Gaza Strip had been under “relentless bombardment” for the previous 24 hours

Physicians for Human Rights-Israel said all hope seemed lost after a month of aerial bombardment of civilian and medical infrastructure, a siege and a ban on the entry of critical equipment.

“The destruction and killing have reached an unfathomable scale. We demand an immediate ceasefire and an end to the assault in a last effort to prevent the further killing of thousands of civilians.

“Over the last few hours, we’ve received horrifying reports from Shifa Hospital. There’s no electricity, no water, no oxygen.

“Military bombardments have damaged the intensive care unit as well as the only generator that remained operational until now. As a result of the lack of electricity, we can report that the neonatal intensive care unit has stopped working.

“Two premature infants have died, and there is a real risk to the lives of 37 other premature infants. The hospital is besieged, with no option to bring in the corpses and injured people sprawled outside. There is no movement in or out of the hospital.

“The picture we are now seeing at Shifa is no longer of a humanitarian catastrophe – it is a collective death sentence.”

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Meanwhile the United States has expressed growing concern about the rising Palestinian death toll in the Gaza Strip, where health officials said the number killed in a five-week-old Israeli bombardment had topped 11,000.

In his strongest comments to date, US Secretary of State Antony Blinken told reporters: “Far too many Palestinians have been killed; far too many have suffered these past weeks.”

Blinken welcomed the four-hour humanitarian Israeli pauses that the White House announced on Friday (AEDT) but told reporters more action was needed to protect Gaza’s civilians.

Israel has faced growing calls for restraint in its month-long war with Hamas but says the militants, who attacked Israel on October 7 and took hostages, would exploit a truce to regroup.

Gaza officials said missiles landed in the courtyard of Al Shifa, the enclave’s biggest hospital, in the early hours, damaged the Indonesian Hospital and reportedly set fire to the Nasser Rantissi pediatric cancer hospital.

Israel’s military said later that a misfired projectile launched by Palestinian militants in Gaza had hit Shifa.

The hospitals are in northern Gaza, where Israel says the Hamas militants who attacked it last month are concentrated, and are full of displaced people as well as patients and doctors.

“Israel is now launching a war on Gaza City hospitals,” said Mohammad Abu Selmeyah, director of Al Shifa hospital.

Israeli government spokesman Eylon Levy said the Hamas headquarters was in Shifa hospital’s basement, which meant the hospital could lose its protected status and become a legitimate target.

Israel says Hamas hides weapons in tunnels under hospitals, charges Hamas denies.

Israeli tanks, which have been advancing through northern Gaza for almost two weeks, have taken up positions around the Nasser Rantissi cancer hospital as well as the Al-Quds hospital, medical staff said earlier, raising the alarm.

The hospitals in northern Gaza are full of displaced people as well as patients and doctors.

Gaza health ministry spokesman Ashraf Al-Qidra said Israel had bombed Shifa hospital buildings five times.

Palestinian officials said on Friday 11,078 Gaza residents had been killed in air and artillery strikes since October 7.

Israel had said 1400 people were killed, mostly civilians, and about 240 were taken hostage by Hamas on October 7, while 39 soldiers have been killed in combat since.

On Friday, Israel’s foreign ministry said a revised death toll from the attack was about 1200.

The Palestinian Red Cross said Israeli forces were shooting at Al-Quds hospital, and there were violent clashes, with one person killed and 28 wounded, most of them children.

Israeli army spokesman Lieutenant Colonel Richard Hecht said the army “does not fire on hospitals. If we see Hamas terrorists firing from hospitals we’ll do what we need to do. We’re aware of the sensitivity (of hospitals), but again, if we see Hamas terrorists, we’ll kill them.”

A man rushes a child into the Al-Shifa hospital after an Israeli bombardment hit a home in Gaza City’s Mansura neighbourhood. Photo: Getty

The White House said on Thursday that Israel agreed to pause military operations in parts of north Gaza for four hours a day, and the army said Palestinians on Friday were allowed to leave over seven hours along a road south, but there was no sign of a let-up in the fighting.

More than 100,000 residents had fled south in the past two days as Israeli forces operate “deep in Gaza City”, chief military spokesman Daniel Hagari said.

But evacuations from Gaza into Egypt for foreign passport holders and for Palestinians needing urgent treatment were suspended on Friday, sources said.

A Palestinian official and an Egyptian medical source blamed problems bringing medical evacuees to the Rafah border crossing from inside Gaza.

Sirens sounded in Tel Aviv and surrounding areas following Hamas rocket fire. Medics reported two women in Tel Aviv suffered shrapnel wounds from a salvo.

The armed wing of Hamas said it was still firing rockets and shells into Israel and fighting off troops in Gaza.