Major breakthrough in push to help desperate civilians flee Gaza

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The White House says Israel has agreed to put in place four-hour daily humanitarian pauses in its assault on Hamas in northern Gaza, as the Biden administration says it has secured a second pathway for civilians to flee fighting.

President Joe Biden had asked Israeli Prime Minister Benjamin Netanyahu to institute the daily pauses during a Monday call.

US National Security Council spokesman John Kirby said that the first humanitarian pause would be announced on Thursday (Friday AEDT) and that the Israelis had committed to announcing each four-hour window at least three hours in advance.

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Biden also told reporters that he had asked the Israelis for a "pause longer than three days" during negotiations over the release of some hostages held by Hamas, though he ruled out the chances of a general cease-fire.

US Secretary of State Antony Blinken had warned Israel last week that it risked destroying an eventual possibility for peace unless it acted swiftly to improve humanitarian conditions in Gaza for Palestinian civilians as it intensifies its war against Hamas.

In a blunt call for Israel to pause military operations in the territory to allow for the immediate and increased delivery of assistance, Blinken said the situation would drive Palestinians toward further radicalism and effectively end prospects for any eventual resumption of peace talks to end the conflict.

French President Emmanuel Macron opened a Gaza aid conference on Thursday with an appeal for Israel to protect civilians, saying that "all lives have equal worth" and that fighting terrorism "can never be carried out without rules".

Israeli strikes pound Gaza City, which tens of thousands have fled in recent days

Israeli strikes pounded Gaza City overnight into Thursday as ground forces battled Hamas militants in dense urban neighbourhoods from which tens of thousands have fled in recent days.

Israeli troops were around 3 kilometres from Shifa Hospital in the heart of downtown, the hospital's director said. Israel has been vague on troop movements, but officials say Gaza's largest city is the focus of their campaign to crush Hamas following its deadly October 7 assault inside Israel.

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Netanyahu had said any temporary cease-fire would have to be accompanied by the release of hostages. Israel has said around 240 hostages are currently held in Gaza. Their plight has galvanised Israeli support for the war despite growing international concerns.

Western and Arab officials gathered in Paris on Thursday to discuss ways of providing more aid to civilians in Gaza, a day after the Group of Seven wealthy democracies, which includes close allies of Israel, called for the "unimpeded" delivery of food, water, medicine and fuel, and for "humanitarian pauses" in the fighting.

The cease-fire deal was being brokered by the United States, Egypt and Qatar, a Persian Gulf country that mediates with Hamas.

A senior US official said the Biden administration had suggested Israel tie the length of a pause to a certain number of hostages being released in a formula that could be used for additional pauses. All the officials spoke on condition of anonymity for fear of impacting the delicate, ongoing negotiations.

Israeli Foreign Minister Eli Cohen declined to elaborate on any emerging deal in an interview with Israel's army radio, saying "I'd recommend not talking about what we've agreed to — it hurts the negotiations."

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Battles near Shifa Hospital

Meanwhile, Israeli ground forces battled near Gaza's largest hospital, Shifa, where tens of thousands are sheltering alongside patients, according to the hospital's general director, Mohammed Abu Selmia.

The Israeli military says Hamas' main command centre is located in and under the hospital complex and that senior leaders are hiding there, using the facility as a shield. Hamas and hospital staff deny the claims and say the military is creating a pretext to strike it.

Scores of wounded people were rushed to Shifa overnight, Abu Selmia told The Associated Press on Thursday. "At dawn, a shell landed very close to the hospital, but thank God only a few people had minor injuries," he said.

"The conditions here are disastrous in every sense of the word," he said. "We're short on medicine and equipment, and the doctors and nurses are exhausted. … We're unable to do much for the patients."

International journalists who entered the north on a tour led by the Israeli military on Wednesday saw heavily damaged buildings, fields of rubble and toppled trees along the Mediterranean shoreline.

Increasingly dire conditions in Gaza

The trickle of aid entering Gaza from the south is largely barred from going north, which has been without running water for weeks. The UN aid office said all the bakeries there have shut down for lack of fuel, water and flour. Hospitals running low on supplies are performing surgeries without anaesthesia.

More than two-thirds of Gaza's population of 2.3 million have fled their homes since the war began, with many heeding Israeli orders to flee to the southern part of the besieged enclave.

But the conditions there are also dire. Israel has continued to strike what it says are militant targets all across the territory. New arrivals from the north are squeezing into homes with extended family, or into UN schools-turned-shelters where hundreds of thousands are taking refuge.

Still, the exodus from Gaza City and surrounding areas in the north has accelerated in recent days. The UN Office for the Coordination of Humanitarian Affairs said 50,000 people fled south on Gaza's main highway on Wednesday during a daily, hours-long window announced by the Israeli military.

There are clashes and shelling near the road, and evacuees reported seeing corpses alongside it, the UN office said. Most are traveling on foot with only what they can carry, many holding children or pushing older relatives in carts.

The Hamas-run Interior Ministry, which has urged Palestinians to stay in their homes, has told media outlets not to circulate footage of people fleeing.

A month of relentless bombardment in Gaza since the Hamas attack has killed more than 10,500 Palestinians — two-thirds of them women and minors, according to the Health Ministry in the Hamas-run territory. More than 2300 others are believed to have been buried by strikes that in some cases have demolished entire city blocks.

Israeli officials say thousands of Palestinian militants have been killed, and blame civilian deaths on Hamas, accusing it of operating in residential areas and using Palestinian civilians as human shields. Gaza's Health Ministry does not distinguish between civilians and combatants in its casualty reports.

More than 1400 people have died in Israel since the start of the war, most of them civilians killed by Hamas militants during their initial incursion. Israel says 32 of its soldiers have been killed in Gaza since the ground offensive began.

Palestinian militants have continued to fire rockets into Israel, and some 250,000 Israelis have been forced to evacuate from communities near Gaza and along the northern border with Lebanon, where Israeli forces and Hezbollah militants have traded fire repeatedly.