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 on the plight of civilians caught in the Gaza cross-fire, US Secretary of State Antony Blinken told reporters on a visit to India on Friday: "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 Thursday 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.
"Israel is now launching a war on Gaza City hospitals," said Mohammad Abu Selmeyah, director of Al Shifa hospital.
He later said at least 25 people were killed in Israeli strikes on Al-Buraq school in Gaza City, where people whose homes had been destroyed were sheltering.
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.
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.
Gaza health ministry spokesman Ashraf Al-Qidra said Israel had bombed Shifa hospital buildings five times.
"One Palestinian was killed and several were wounded in the early morning attack," he said by phone. Videos verified by Reuters showed scenes of panic and people covered in blood.
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."
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.
