Heavy fighting has erupted around a hospital in northern Gaza where thousands of patients and displaced people have been sheltering for weeks, as Israeli forces focus on clearing out medical facilities that they say Hamas militants are using for cover.

A shell has struck the second floor of the Indonesian Hospital, killing at least 12 people, according to the health ministry in Hamas-ruled Gaza and a medical worker inside the facility.

The northern advance came a day after the World Health Organisation evacuated 31 premature babies from Shifa Hospital. At least 28 were transported to Egypt on Monday.

They were among more than 250 critically ill or injured patients stranded at the hospital days after Israeli forces entered the compound.

Egypt’s state-run media later confirmed that babies evacuated from Shifa have arrived in the country.

The Palestinian Red Crescent rescue service said it was transporting 28 premature babies from a hospital in southern Gaza to another across the border to Egypt.

Gaza graphic
(PA Graphics)

Egypt’s Al-Qahera satellite channel broadcast images of the babies inside Egyptian ambulances, without specifying how many had arrived.

The plight of Gaza’s hospitals is at the focus of a battle of narratives over the war’s brutal toll on Palestinian civilians, thousands of whom have been killed or buried in rubble since the six-week-old war was sparked by Hamas’ rampage into southern Israel on October 7.

Israel says Hamas uses civilians as human shields, while critics say Israel’s siege and relentless aerial bombardment amounts to collective punishment of the territory’s 2.3 million Palestinians.

Marwan Abdallah, a medical worker at the Indonesian Hospital, said Israeli tanks were visible from the windows. He said: “You can see them moving around and firing.

Army flare over Gaza
An Israeli army flare is seen over the Gaza Strip (AP)

“Women and children are terrified. There are constant sounds of explosions and gunfire.”

Mr Abdallah said the hospital had received dozens of dead and wounded in air strikes and shelling overnight. He said medical staff and displaced people fear Israel will besiege the hospital and force its evacuation.

Health ministry spokesman Ashraf al-Qidra said Israeli forces struck the hospital, killing at least 12 people. It was not possible to independently confirm the report.

Palestinian babies
A nurse cares for prematurely born Palestinian babies that were brought from Shifa Hospital in Gaza City to another hospital in Rafah, Gaza Strip (AP)

He said some 600 patients, 200 healthcare workers and 2,000 displaced people are sheltering there.

The Israeli military, which rarely publicises troop movements, had no immediate comment.

UN bodies were able to safely evacuate the babies, who were in critical condition, from Shifa to a hospital in southern Gaza, and plan to transport them to a hospital in neighbouring Egypt. Four other babies died in the two days before the evacuation, according to Mohamed Zaqout, the director of Gaza hospitals.

More than 250 patients with severely infected wounds and other urgent conditions remain in Shifa, which could no longer provide most treatment after it ran out of water, medical supplies and fuel for emergency generators amid a territory-wide blackout. Israeli forces battled Palestinian militants outside its gates for days before entering the facility last Wednesday.

Israel’s army said it had strong evidence supporting its claims that Hamas maintained a sprawling command post inside and under the hospital’s 20-acre complex, which includes several buildings, garages and a plaza.

The military released a video showing what it said was a tunnel discovered at the hospital, 60 yards long and about 33ft below ground. It said the tunnel included a staircase and a firing hole that could be used by gunmen, and ended at a blast-proof door that troops have not yet opened.

Israel has repeatedly ordered Palestinians to leave northern Gaza and seek refuge in the south, which has also been under aerial bombardment since the start of the war. Some 1.7 million people, nearly three quarters of Gaza’s population, have been displaced, with 900,000 packing into crowded UN-run shelters, according to the UN.

Boys in the West Bank
Palestinian boys scramble up a hill in a tense area near several Israeli outposts on the edge of the Palestinian village of Qaryout in the northern West Bank (AP)

Aid group Doctors Without Borders said 70 people were killed and at least 52 injured, including children, in strikes in the southern town of Khan Younis on Saturday. It said it was performing 10 burn surgeries a day at the town’s overwhelmed Nasser Hospital, where hundreds of people who need such procedures must wait for care.

More than 11,500 Palestinians have been killed in Gaza, according to Palestinian health authorities. Another 2,700 have been reported missing, believed buried in rubble. The count does not differentiate between civilians and combatants, and Israel says it has killed thousands of militants.

About 1,200 people have been killed on the Israeli side, mainly civilians during the October 7 attack, in which Hamas dragged around 240 captives back into Gaza. The military said 65 Israeli soldiers have been killed in Gaza ground operations.

Hamas has released four hostages, Israel has rescued one, and the bodies of two were found near Shifa.

Israel, the United States and Qatar, which mediates with Hamas, have been negotiating a much larger hostage release for weeks. Israel’s three-member war cabinet is scheduled to meet representatives of the hostages’ families on Monday evening.