Palestinians ride on an animal-drawn cart as people flee north Gaza towards the south on Thursday. Reuters

Israeli forces battled Hamas fighters through shell-blasted buildings in Gaza City on Thursday as some 80 countries and organisations met in Paris to coordinate humanitarian aid and find ways to help wounded civilians escape the siege.

A conference in Paris on Thursday, attended by Arab nations, Western powers, G20 members and NGO groups such as Doctors Without Borders will discuss measures to alleviate the suffering in Gaza, but without a pause in fighting expectations are low. "The object is really to work with all the participants and also with Israel ... to allow improved access," a French presidential official told reporters ahead of the conference.

 Palestinian Authority Prime Minister Mohammad Shtayyeh arrives for an international humanitarian conference for civilians in Gaza, at the Elysee Presidential Palace, in Paris, on Thursday. AP

Among the options discussed will be setting up a maritime corridor to use sea lanes to ship humanitarian aid into Gaza and see how ships could be used to help evacuate the wounded. Thousands of Palestinian civilians trudged in a forlorn procession out of the north of Gaza on Wednesday seeking refuge from Israeli air strikes and fierce ground fighting between Israeli troops and Hamas fighters.

The exodus took place during a four-hour window announced by Israel, which has told residents to evacuate encircled northern parts of Gaza or risk being trapped in the violence. But the central and southern parts of the enclave also came under fire again. Infectious diseases spread in Gaza due to deaths, injuries Huge numbers of displaced people from among Gaza's 2.3 million population are already crammed into schools, hospitals and other sites in the south.

 Minister of Foreign Affairs of Egypt Sameh Shoukry arrives for the Paris meet. AFP

Thousands of others remain in the north, including at Gaza City's main Al Shifa hospital. Israel has blamed Hamas for civilian deaths in Gaza, saying that it is using them as human shields and hiding arms and operations centres in residential areas.

"As deaths and injuries in Gaza continue to rise due to intensified hostilities, intense overcrowding and disrupted health, water, and sanitation systems pose an added danger: the rapid spread of infectious diseases," the World Health Organisation warned on Wednesday. WHO said that more than 33,551 cases of diarrhoea had been reported since mid-October, the bulk of which was among children aged under five.

Reuters