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Hundreds of people fled on foot Saturday after the director of Gaza's main hospital said Israel's army ordered evacuation of the facility where more than 2,000 patients, medics and displaced people were trapped by the war between Israel and Hamas.
Columns of sick and injured -- some of them amputees -- displaced people, doctors and nurses, were seen making their way out of Al-Shifa hospital towards the seafront without ambulances as loud explosions were heard around the facility.
On the way, an AFP journalist saw at least 15 bodies, some in advanced stages of decomposition, along a road lined by badly damaged shops and overturned vehicles as Israeli drones buzzed overhead.
The Hamas-run health ministry said 120 wounded, along with an unspecified number of premature babies, were still at Shifa hospital that has become the focus of the seven-week war sparked by Hamas's unprecedented October 7 attacks on Israel.
Israel has been pressing military operations inside the hospital, searching for the Hamas operations centre it says lies under the sprawling complex -- a charge Hamas denies.
Israel has vowed to destroy Hamas in response to the October 7 attacks which Israeli officials say killed about 1,200 people, most of them civilians in southern Israel, and saw about 240 people taken hostage.
The army's relentless air and ground campaign has since killed 12,000 people, including 5,000 children, according to the Hamas government which has ruled Gaza since 2007.
In Gaza City on Saturday morning, Israeli troops had ordered over loudspeakers the evacuation of Al-Shifa hospital "in the next hour", an AFP journalist at the scene reported.
They called the hospital's director, Mohammed Abu Salmiya, telling him to ensure "the evacuation of patients, wounded, the displaced and medical staff, and that they should move on foot towards the seafront", he said.
Israel's army denied ordering the evacuation, saying it had "acceded to the request of the director of the Shifa Hospital to enable additional Gazans who were in the hospital, and would like to evacuate, to do so".
The United Nations estimated 2,300 patients, staff and displaced Palestinians were sheltering at Al-Shifa before Israeli troops entered the facility on Wednesday.
- 'They are all dead' -
Israel has told Palestinians to move from the north of Gaza for their safety, but deadly air strikes continue to hit central and southern areas of the narrow coastal territory.
"They said the south was safer, so we moved," Azhar al-Rifi told AFP.
Her family was caught in a strike at the Nuseirat refugee camp on Friday, killing seven of her relatives including her five-year-old nephew. The same blast caught up Nada Abu Hiya, aged eight -- her third bombing of the war.
"There are bombings everywhere," she said. "My grandmother is dead, my mother is dead, my grandfather is dead, my uncle is dead, they destroyed our house. Our neighbours' house is also destroyed and they are all dead."
Israel has imposed a siege on Gaza, allowing just a trickle of aid in from Egypt but barring most shipments of fuel over concerns Hamas could divert supplies for military purposes.
A first consignment of fuel entered Gaza after Israel's war cabinet bowed to pressure from its ally the United States and agreed to allow two diesel tankers a day into the Palestinian territory.
"We took that decision to prevent the spread of epidemics," Israel's national security adviser Tzachi Hanegbi said.
- Raw sewage -
A two-day blackout caused by fuel shortages ended after a first delivery arrived from Egypt late Friday, but UN officials continued to plead for a ceasefire, warning no part of Gaza is safe.
The UN agency for Palestinian refugees (UNRWA) said 70 percent of residents have no access to clean water in south Gaza, where raw sewage has begun to flow on the streets.
UNRWA said Israel has agreed to allow in 60,000 litres (16,000 gallons) of fuel daily from Egypt starting Saturday, but warned it was little more than a third of what is needed to keep hospitals, water and sanitation facilities running.
Humanitarian chief Martin Griffiths told the UN General Assembly that fuel supplies to the agency so far were "a fraction of what is needed to meet the minimum of our humanitarian responsibilities", which the UN says have been hampered by a communications blackout.
The Hamas health ministry said 24 patients had died in 48 hours due to the lack of fuel for generators.
In Gaza, more than 1.6 million people have been internally displaced, and Israel's blockade has left civilians facing the "immediate possibility of starvation", according to World Food Programme head Cindy McCain.
More than half of Gaza's hospitals are no longer functional due to combat, damage or shortages, and people are waiting four to six hours for half the normal portion of bread.
In the latest bloodshed, a strike on a residential building in the southern city of Hamad killed 26 people, the director of the Nasser hospital in Khan Yunis said.
"I was asleep and we were surprised by the strike. At least 20 bombs were dropped," Imed al-Mubasher, 45, told AFP.
His wife Sabrin Mussa said: "All of a sudden, the house caught fire. I found myself with gravel in my mouth and I immediately looked for my husband and daughters.
"I saw human remains everywhere," and screamed for help, she said.
The Israeli military has yet to respond to a request for comment.
- Starvation risk -
Israel has come under scrutiny for targeting hospitals in northern Gaza, but says the facilities are being used by Hamas -- a claim rejected by the group and medical staff.
The military says it has found rifles, ammunition, explosives and the entrance to a tunnel shaft at the hospital complex, claims that cannot be independently verified.
Israel has not recovered hostages at the hospital but said it found the bodies of two kidnapped women including a woman soldier not far away.
Those held hostage range from infants to octogenarians, and there has been little information on their fate despite ongoing negotiations mediated by Qatar and Egypt to secure releases.
Waving Israeli flags and placards depicting the hostages, thousands of people approached Jerusalem Saturday on the fifth and final day of a march calling for their release.