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Palestinian authorities have proposed a Red Cross-supervised evacuation of a hospital beset by fighting in Gaza, as health officials warn the only way to save three dozen newborns trapped there is to call a cease-fire and transport them out of the besieged territory.
After days of battles with Palestinian militants, Israeli forces have encircled al-Shifa Hospital, where hundreds of patients, medical staff and displaced people are trapped with dwindling supplies and without electricity to run incubators and other equipment.
Gaza's largest hospital has emerged as a symbol of Palestinian suffering in the war between Israel and Hamas that extends far beyond its walls.
Only one hospital in the territory's north is still capable of receiving patients, and about 200,000 Palestinians have streamed out of the area toward worsening conditions in the south in recent days, the UN humanitarian office said on Tuesday.
The war, now in its sixth week, was triggered by Hamas' surprise attack into Israel, in which militants killed hundreds of civilians and dragged some 240 hostages back to Gaza. The conflict has killed thousands of Palestinian civilians and wreaked widespread destruction on the impoverished enclave.
Hamas released a video late on Monday showing one of the hostages, who identifies herself as 19-year-old Noa Marciano, before and after she was killed in what Hamas said was an Israeli strike. The military later declared her a fallen soldier, without identifying a cause of death.
She is the first hostage confirmed to have died in captivity. Four were released by Hamas and a fifth was rescued by Israeli forces.
Plight of hospitals
Israel accuses Hamas of using hospitals as cover for its fighters, and alleged that the militants have set up their main command centre in and beneath Shifa. Israel says these claims are based on intelligence but has not provided visual evidence to support them.
Both Hamas and Shifa Hospital staff deny the allegations, and the Health Ministry in Hamas-ruled Gaza says it has invited international organisations to investigate the facility.
The ministry said 40 patients, including three babies, have died since the hospital's emergency generator ran out of fuel on Saturday. The military said it placed fuel several blocks from al-Shifa, but Hamas militants prevented staff from reaching it — an allegation the ministry denied, saying instead it was too dangerous for staff to venture out.
According to the ministry, 36 babies remain who are at risk of dying because there is no power for incubators.
The Israeli military said it had started an effort to transfer incubators to al-Shifa. But Christian Lindmeier, a spokesman for the World Health Organisation, said they would be useless without electricity and that the only way to save the newborns was to move them out of Gaza.
"Another hospital under siege or under attack is not a viable solution. Nowhere is safe in Gaza right now," he told The Associated Press.
He said an evacuation would require specialiased equipment and a ceasefire along the route.
Health Ministry spokesman Ashraf al-Qidra said it has proposed evacuating the hospital with the supervision of the International Committee of the Red Cross and transferring the patients to hospitals in Egypt, but has not received any response. He said 120 bodies will be buried in a mass grave inside the hospital because they are unable to safely transport them to cemeteries.
International law gives hospitals special protections during war. Hospitals can lose those protections if combatants use them to hide fighters or store weapons, but staff and patients must be given plenty of warning to evacuate, and the harm to civilians cannot be disproportionate to the military objective.
On Monday, the military released footage of a children's hospital that its forces entered over the weekend, showing weapons it said it found inside, as well as rooms in the basement where it believes militants were holding hostages. The video showed what appeared to be a hastily installed toilet and ventilation system in the basement.
The Health Ministry rejected the allegations, saying the area had been turned into a shelter for displaced people.
The Red Cross tried Monday to evacuate some 6000 people from another Gaza City hospital, Al-Quds, but said its convoy had to turn back because of shelling and fighting.
Deteriorating conditions in the south
Israel has urged civilians to evacuate Gaza City and surrounding areas in the north, but the southern part of the besieged territory is not much safer. Israel carries out frequent airstrikes throughout Gaza, hitting what it says are militant targets but often killing women and children.
Some 1.5 million Palestinians, more than two thirds of Gaza's population, have fled their homes, and UN-run shelters in the south are already severely overcrowded.
People stand in line for hours for scarce bread and brackish water. Trash is piling up, sewage is flooding the streets and taps run dry because there is no way to power water systems.
Israel has barred fuel imports since the start of the war, saying Hamas would use it for military purposes.
The onset of rainy, cold weather added to the misery. At a tent camp outside a hospital in the central town of Deir al-Balah, people trudged through mud as they stretched plastic tarps over flimsy tents.
"All of these tents collapsed because of the rain," said Iqbal Abu Saud, who had fled Gaza City with 30 of her relatives.
"How many days will we have to deal with this?"
The UN agency for Palestinian refugees, which is struggling to provide basic services to over 600,000 people sheltering in schools and other facilities in the south, said it may run out of fuel by Wednesday, forcing it to halt most aid operations.
It said it could no longer import limited supplies of food and medicine through Egypt's Rafah crossing, Gaza's only link to the outside world.
Regional tensions
As of Friday, more than 11,000 Palestinians, two-thirds of them women and minors, have been killed since the war began, according to the Health Ministry, which does not differentiate between civilian and militant deaths. About 2700 people have been reported missing.
At least 1200 people have died on the Israeli side, mostly civilians killed in the initial Hamas attack. The military says 46 soldiers have been killed in ground operations in Gaza, and that thousands of militants have been killed.
About 250,000 Israelis have evacuated from communities near Gaza, where Palestinian militants still fire barrages of rockets, and along the northern border, where Israel and Lebanon's Hezbollah militant group have repeatedly traded fire.
The war has also fuelled tensions in the Israeli-occupied West Bank, where at least seven Palestinian were killed overnight during an Israeli raid, the Palestinian Health Ministry said on Tuesday. There was no immediate comment from the army. More than 190 Palestinians have been killed in the West Bank since October 7.
