Palestinians transport the body of a relative killed in Israeli attack from the morgue of the Al-Shifa hospital. AFP

Explosions and shootings shook the Gaza Strip’s biggest hospital and surrounding neighbourhoods as Israeli forces stormed through the facility for a second day Tuesday. The military said it had killed 50 Hamas fighters in the hospital, but it could not be independently confirmed that the dead were combatants.

The raid was a new blow to the Shifa medical complex, which had only partially resumed operations after a destructive Israeli raid in November. Thousands of Palestinian patients, medical staff and displaced people were trapped inside the sprawling complex Tuesday as heavy fighting between troops and Hamas fighters raged in nearby districts.

"It’s very hard right now. There’s heavy bombardment in the area of Shifa, and buildings are being hit. The sound of tank and artillery fire is continuous,” Emy Shaheen, who lives near the hospital, said in a voice message with repeated booms of shelling audible in the background. She said a large fire had been raging for hours near the hospital.

The Israeli military said it raided Shifa early Monday because Hamas fighters had grouped in the hospital and were directing attacks from inside.

Palestinians identify relatives killed in Israeli bombardment at Al-Shifa hospital in Gaza City. AFP

The claim could not be confirmed, and the Hamas media office said all those killed in the assault were civilians. But the surge in fighting in Gaza City underscored Hamas’ continued presence in northern Gaza months after Israeli ground troops claimed they largely had control over the area.

Israel launched its offensive in Gaza vowing to destroy Hamas after the group’s Oct. 7 attack on southern Israel. More than 31,800 Palestinians have been killed in the bombardment and offensive since. Much of northern Gaza has been leveled, and an international authority on hunger crises warned on Monday that 70% of the people there were experiencing catastrophic hunger and that famine was imminent.

The mayhem in the north came as Israeli Prime Minister Benjamin Netanyahu repeated his determination to invade Gaza’s southernmost town, Rafah - one of the last major towns not targeted by a ground assault.

Palestinian women mourn their relatives killed in Israeli attack in front of the Al-Shifa hospital in Gaza. AFP

A day earlier, in their first phone call in a month, US President Joe Biden urged Netanyahu not to carry out a Rafah operation, urging "an alternative approach” to more precisely target Hamas fighters there.

The United States, Israel’s closest ally, has expressed concern over attacking Rafah because some 1.4 million people from across Gaza have crowded into the area. UN officials have warned of a massive death toll and the potential collapse of the humanitarian aid effort if troops moved into Rafah.

Associated Press