By WAFAA SHURAFA, ISABEL DEBRE and JACK JEFFERY (Associated Press)

DEIR AL-BALAH, Gaza Strip (AP) — Thousands of Palestinians sheltering from the Israel-Hamas war at Gaza City’s main hospital fled south Friday after several reported strikes in and around the compound overnight. They joined a growing exodus of people escaping intense urban fighting in the north — including near other hospitals — as Gaza officials said the territory’s death toll surpassed 11,000.

The search for safety across the besieged Gaza Strip has grown desperate as Israel intensified its assault on the territory’s largest city. The Israel army says Hamas’ military infrastructure is nestled amid Gaza City’s hospitals and neighborhoods. Israel has vowed to destroy Hamas after its deadly Oct. 7 surprise incursion. Hamas has been designated as a terrorist organization by the United States, Canada and the European Union.

The tens of thousands of Palestinians who fled south in the past few days face the prospect of ongoing bombardment and dire conditions. Reported overnight strikes on or near at least four hospitals in northern Gaza underscored the danger for tens of thousands more who have crowded into the facilities, believing they will be safe.

BATTLES AROUND HOSPITALS

Early Friday, strikes hit the courtyard and the obstetrics department of Shifa Hospital, Gaza’s largest, where tens of thousands of people are sheltering, according to Ashraf al-Qidra, spokesperson at the Health Ministry in Hamas-run Gaza.

A video of the courtyard recorded the sound of incoming fire waking people in makeshift shelters, followed by shouts for an ambulance. In the blood-splattered courtyard, one man writhed screaming on the ground, his leg apparently severed.

Al-Qidra blamed the attack on Israel, a claim that could not be independently verified.

The Israeli army says Hamas hides in and under hospitals and that it has set up its main command center in and under Shifa — claims Hamas and hospital staff deny.

For weeks, tens of thousands of displaced Palestinians — reaching as many 60,000 this week, according to the Health Ministry — have been sheltering in the Shifa hospital complex, hoping it would be safe.

But the overnight strikes triggered a mass exodus of the displaced. At around 10 a.m., large numbers packed up their belongings and began streaming out, walking toward the south, five people who were among those who left told the AP.

It was not clear how many remained at Shifa, but they said the vast majority had left. Wafaa abu Hajajj, a journalist who had been sheltering at Shifa hospital and arrived Friday in the south, said mainly those who could not walk or did not know where to go remained.

“The strikes were hoping to scare people and it worked. It was too intense and it became too much,” said 32-year-old Haneen Abu Awda, who had been at Shifa being treated for wounds from an earlier strike on their house.

At the same time, Shifa has been overwhelmed by thousands of wounded, even as it operates with minimal power and medical supplies.

In video released Friday by the Gaza Health Ministry, bodies of limp children are seen laid on stretchers across blood-stained floors in the hospital, some dead, some barely breathing. Other patients were strewn around the floor, unable to be treated for lack of supplies. One man is seen gasping for air.

The director of Shifa said Israel demanded the facility be evacuated, but he said there was nowhere for such a large number of patients to go.

“Where are we going to evacuate them?” Director Mohammed Abu Selmia asked speaking to Al Jazeera television.

In all, Gaza health officials said strikes were carried out near four hospitals overnight and early Friday, all of which were packed with displaced people and patients.

The Health Ministry said one person had been killed at Shifa and several were wounded. A senior Israeli security official said initial findings indicated that one strike at Shifa was the result of a misfire by militants. The military is conducting a review. The official spoke on condition of anonymity because the investigation is ongoing.

Another strike near the Al-Nasr Medical Center killed two people, according to the ministry. The strike forced the shutdown of Nasr’s children’s hospital, the only remaining specialized pediatric care in north Gaza, said World Health Organization spokesperson Margaret Harris. She said it was not known what happened to patients there, including children receiving dialysis and on life support — “things that you cannot possibly evacuate them safely with.”

Al-Qidra, the health ministry spokesman, said ambulances could not reach Nasr hospital to evacuate patients because of Israeli strikes.

CIVILIANS FLEE SOUTH

Tens of thousands of new evacuees from the north, some coming from Shifa, flowed down Salah al-Din road — the central spine running the length of the Gaza Strip — and reached the central city of Deir al-Balah on Friday. With no fuel for vehicles, the crowds had walked for hours as explosions echoed a short distance away. Among them were wounded and older people.

They arrived hungry, exhausted and with a stew of emotions — relief, rage, and despair.

Reem Asant, 50, described winding through the streets on the way out of Gaza City, trying to avoid shelling.

“We’re talking about children killed in a hospital,” shouted one man, Abu Yousef, his voice rising with fury. “Hundreds of women killed every day. Houses collapsing on the heads of civilians … Where are human rights? Where is the United Nations? Where is the United States? Where is the International Criminal Court? Where is the entire world?”

The Israeli military announced an expanded six-hour window Friday for civilians to escape northern Gaza along Salah al-Din, the route used since last weekend. It also announced the opening of a second route, along the coastal road, after an agreement announced by the White House a day earlier.

The White House said Israel agreed to implement a brief humanitarian pause each day — in what appeared to be an effort to formalize and expand the process.

More than two-thirds of Gaza’s population of 2.3 million have fled their homes since the war began. Israel estimates that more than 850,000 of the 1.1 people in northern Gaza have left, according to military spokesman Jonathan Conricus. He called the pauses “quick humanitarian windows” that allow southward movement “while we are fighting.”

U.N. expert for the Palestinian territories Francesca Albanese called the pauses “cynical and cruel,” saying it was just enough “to let people breathe and remember what is the sound of life without bombing, before starting bombing them again.”

RISING DEATH TOLLS

More than 11,070 Palestinians, two-thirds of them women and minors, have been killed since the war began, according to the Gaza Health Ministry, which does not differentiate between civilian and militant deaths. Another 2,650 people have been reported missing.

U.S. Secretary of State Antony Blinken said Friday that “far too many” Palestinians have died and suffered and that while recent Israeli steps to try to minimize civilian harm are positive, they are not enough.

U.S.. Assistant Secretary of State Barbara Leaf told American lawmakers this week that it was “very possible” the death toll was even higher than the the Gaza Health Ministry has reported, despite suggestions by President Joe Biden and others that it was exaggerated.

More than 1,400 people have been killed in Israel, mainly in the initial Hamas attack, and 41 Israeli soldiers have been killed in Gaza since the ground offensive began.

Palestinian militants have continued to fire rockets into Israel, and an attack on Tel Aviv wounded at least two people Friday, said Yossi Elkabetz, a paramedic with Israel’s rescue services. Hamas claimed credit.

Some 250,000 Israelis have been forced to evacuate from communities near Gaza and along the northern border with Lebanon, where Israeli forces and Hezbollah militants have traded fire repeatedly.

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Associated Press writers Bassem Mroue and Sarah El Deeb in Beirut, David Rising in Bangkok, Lee Keath in Cairo, and Julia Frankel and Josef Federman in Jerusalem, contributed to this report. Debre reported from Jerusalem, and Jeffery from Cairo.

Full AP coverage at https://apnews.com/hub/israel-hamas-war.