Israeli troops have raided the compound of Gaza's Al-Shifa Hospital in an operation that Palestinian health authorities say has caused multiple casualties and set off a fierce fire in one of the buildings.
The Israeli military said soldiers conducted a "precise operation" early on Monday and were fired upon when they entered the compound.
"The troops responded with live fire and hits were identified. Our troops are continuing to operate in the area of the hospital," it said in a statement.
The operation was based on intelligence information which indicated the hospital was being used by senior Hamas leaders, the military said.
"Suddenly, we started to hear sounds of explosions, several bombings, and soon tanks started to roll, they came from the western road and headed toward Al Shifa, then sounds of gunfire and explosions increased," Mohammad Ali, 32, a father of two, who lives around one kilometre from the hospital, told Reuters via a chat app.
"We don't know what is happening, but it looked as if it was a re-invasion of the Gaza City," he said, adding the military activities began about 1am.
Gaza's Hamas-run health ministry said a fire broke out at the entrance of the complex, causing cases of suffocation among displaced women and children in the hospital.
It said communication had been cut off, with people trapped inside the surgery and emergency units of one of the buildings.
The Israeli military issued grainy drone footage of the operation which it said showed troops coming under fire from a number of buildings in the hospital complex.
It said troops had been instructed on the importance of operating cautiously as well as on measures to be taken to avoid harm to patients, civilians, medical staff and medical equipment and said patients were not required to evacuate.
Hamas said the Israeli military had committed a new crime by directly targeting the hospital buildings without caring about patients, medical staff or displaced people in it.
Israel came under fierce criticism in 2023 when troops first raided the hospital, where they uncovered underground tunnels they said were used as command and control centres by Hamas.
The hospital in Gaza City is one of the few remaining health facilities left in the besieged enclave and the Israeli military has long accused the Islamist movement Hamas of using it as a base for its fighters.
Hamas and hospital officials have denied the accusation and the hospital has been at the centre of accusations of war crimes on both sides, with Palestinians accusing Israel of targeting hospitals and Israel saying the sites were being used to shelter armed fighters.
The assault came after Israeli Prime Minister Benjamin Netanyahu said he would keep on with the military campaign against Hamas in Gaza.
Netanyahu told a cabinet meeting on Sunday that Israel would push into Rafah, the last relatively safe place in the Gaza enclave after more than five months of war, despite international pressure for Israel to avoid civilian casualties.
"We will operate in Rafah. This will take several weeks, and it will happen," he said, without clarifying if he meant the assault would last for weeks or would begin in weeks.
Netanyahu later said after meeting German Chancellor Olaf Scholz in Jerusalem that Israel would not leave civilians trapped in Rafah when its forces begin their assault.
Israel's allies have piled pressure on Netanyahu not to attack Rafah, where more than a million displaced people have sought shelter, without a plan to protect civilians.
In Washington, US President Joe Biden stressed the need to increase humanitarian aid to Gaza and get a ceasefire deal that brought Hamas-led hostages home.
Biden said a move towards a two-state solution was "the only path for lasting peace and security".
Hamas fighters killed 1200 people and seized 253 hostages in the October 7 attack according to Israeli tallies, triggering a massive assault on Gaza.
Israel's air and ground campaign since has killed more than 31,700 people say health authorities in Hamas-run Gaza.
A source familiar with truce talks in Qatar told Reuters the head of Israel's Mossad intelligence agency would join the delegation attending the negotiations with Qatari, Egyptian and US mediators.
