Israel on Saturday expanded its ground operation in Gaza, sending in tanks and infantry backed by massive strikes from the air and sea. Israel’s defense minister said that “the ground shook in Gaza” and that the war against the territory’s Hamas rulers had entered a new stage.

The bombardment, described by Gaza residents as the most intense of the war, also knocked out most communications in Gaza. This largely cut off the besieged enclave’s 2.3 million people from the world, while enabling the Israeli military to control the narrative in the new stage of fighting.

The military released grainy images Saturday showing tank columns moving slowly in open areas of Gaza, many apparently near the border, and said warplanes bombed dozens of Hamas tunnels and underground bunkers. The underground sites are a key target in Israel’s campaign to crush the territory’s ruling group after its bloody incursion into Israel three weeks ago.

“We moved to the next stage in the war,” Defense Minister Yoav Gallant said in remarks broadcast Saturday. “Last evening, the ground shook in Gaza. We attacked above ground and underground. … The instructions to the forces are clear. The campaign will continue until further notice.”

His comments signaled a gradual ramping up toward what is expected to evolve into an all-out ground offensive in northern Gaza.

Early in the war, Israel amassed hundreds of thousands of troops along the border. Until now, troops had conducted brief nightly ground incursions before returning to Israel.

The Palestinian death toll in Gaza on Saturday rose to just over 7,700 people since Oct. 7, with 377 deaths reported since late Friday, according to the territory’s Health Ministry. A majority of those killed have been women and minors, the ministry said.

Ministry spokesman Ashraf al-Qidra told reporters that the disruption of communications has “totally paralyzed” the health network. Residents had no way of calling ambulances, and emergency teams were chasing the sounds of artillery barrages and airstrikes to search for people in need.

Some civilians were using their bare hands to pull injured people from the rubble and loading them into personal cars or donkey carts to rush them to the hospital. In a video posted by local news media, Palestinians were sprinting down a ravaged street with a wounded man covered in the dust of a building’s collapse while he winced, eyes shut, on a stretcher. “Ambulance! Ambulance!” the men shouted as they shoved the stretcher into the back of a pickup truck and shouted at the driver, “Go! Go!”

Other residents traveled by foot or car to check on relatives and friends. “The bombs were everywhere, the building was shaking,” said Hind al-Khudary, a journalist in central Gaza and one of a few people with cellphone service. “We can’t reach anyone or contact anyone. I do not know where my family is.”

Israel says its strikes target Hamas fighters and infrastructure and that the militants operate from among civilians, putting them in danger.

The World Health Organization appealed to “the humanity in all those who have the power to do so to end the fighting now” in Gaza. “There are more wounded every hour. But ambulances cannot reach them in the communications blackout. Morgues are full. More than half of the dead are women and children,” it said in a statement, and it expressed “grave concerns” about reported bombardment near hospitals in the northern half of Gaza.

Palestinians say this war is robbing them not only of their loved ones but also of the funeral rites that long have offered mourners some dignity and closure in the midst of unbearable grief.

Across Gaza, terrified civilians were huddling in homes and shelters with food and water supplies running out. Electricity was knocked out by Israel in the early stages of the war.

More than 1.4 million people have fled their homes, nearly half crowding into U.N. schools and shelters. Humanitarian workers say the trickle of aid Israel has allowed to enter from Egypt in the past week is a tiny fraction of what is needed. Gaza hospitals have been scrounging for fuel to run emergency generators that power incubators and other life-saving equipment.

The U.N. agency for Palestinian refugees, which runs an extensive network of shelters and schools for nearly half the displaced Gaza residents, has lost contact with most of its staff, spokeswoman Juliette Touma said Saturday. She said that coordinating aid efforts was now “extremely challenging.”

The intensified air and ground campaign raised new concerns about dozens of hostages dragged into Gaza on Oct. 7. On Saturday, hundreds of relatives of hostages gathered in a square in downtown Tel Aviv, demanding to meet with Gallant and Prime Minister Benjamin Netanyahu.

Some in the group demanded that Israel push for the release of all hostages before proceeding with the campaign against Hamas. Protesters wore shirts emblazoned with the faces of their missing relatives under the word “kidnapped” and the words “Bring them back.”

The families “feel like they’re left behind and no one is really caring about them,” said Miki Haimovitz, a former lawmaker and spokesperson for the group. “No one is talking to them. No one is explaining what’s going on.”

Gallant later said he would meet with the families on Sunday.

In Cairo, Egyptian President Abdel Fattah el-Sissi said his government was working to de-escalate the conflict through its talks with the warring parties to release prisoners and hostages. He didn’t provide further details.

The Israeli army spokesman, Rear Adm. Daniel Hagari, said the confirmed number of hostages was 229, after four were released in recent days through mediation by Qatar and Egypt. He dismissed news reports about a possible cease-fire deal in exchange for the release of hostages, saying Hamas was engaged in a “cynical exploitation” of the anxieties of relatives of hostages.

More than 1,400 people were slain in Israel during Hamas’ Oct. 7 attack, according to the Israeli government. Among those killed were at least 311 soldiers, according to the military.

Palestinian militants have fired thousands of rockets into Israel over the past three weeks.

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The overall number of deaths in Gaza and Israel far exceeds the combined toll of all four previous Israel-Hamas wars, estimated at around 4,000.

Gallant said Friday that Israel expects a long and difficult ground offensive into Gaza soon. It “will take a long time” to dismantle Hamas’ vast network of tunnels, he said, adding that he expects a lengthy phase of lower-intensity fighting as Israel destroys “pockets of resistance.”

Israel has said it aims to crush Hamas’ rule in Gaza and its ability to threaten Israel. But how Hamas’ defeat will be measured and an invasion’s endgame remain unclear. Israel says it does not intend to rule the tiny territory but has not said who it expects will — even as Gallant suggested a long-term insurgency could ensue.

In Washington, the Pentagon said U.S. Defense Secretary Lloyd Austin spoke with Gallant on Friday and “underscored the importance of protecting civilians during the Israel Defense Forces’ operations and focusing on the urgency of humanitarian aid delivery for civilians in Gaza.” The Pentagon said Austin also brought up “the need for Hamas to release all of the hostages.”

The conflict has threatened to ignite a wider war across the region. Arab nations — including U.S. allies and ones that have reached peace deals or normalized ties with Israel — have raised increasing alarm over a potential ground invasion, likely to bring even higher casualties amid urban fighting.