KHAN YOUNIS, Gaza Strip (AP) — Israeli strikes hit near several hospitals in Gaza City early Friday as the military pushed deeper into dense urban neighborhoods in its battle with Hamas militants, prompting increasing numbers of civilians to flee toward the south of the besieged territory.

Israel has accused Hamas fighters of hiding in hospitals and using the Shifa Hospital complex as its main command center, which the militant group and hospital staff deny, saying Israel is creating a pretext to strike it.

Growing numbers of people have been living in and around Shifa Hospital, Gaza’s largest, hoping it will be safer than their homes or United Nations shelters in the north, several of which have been hit repeatedly. Israeli troops were around 3 kilometers (2 miles) from the hospital, according to its director.

Early Friday, Israel struck the Shifa courtyard and the obstetrics department, according to the head of the Hamas-run media office in Gaza, Salama Maarouf.

A video at the scene recorded the sound of incoming fire waking people up in their makeshift shelters in the courtyard, followed by screams for an ambulance.

Maarouf told the television network Al Jazeera that strikes were carried out near three hospitals in total, but gave no casualty figures. The Health Ministry in Hamas-run Gaza later said one person had been killed at Shifa Hospital and several were wounded.

Gaza’s largest city is the focus of Israel’s campaign to crush Hamas following its deadly Oct. 7 surprise incursion.

More than 10,800 Palestinians have been killed since the hostilities began, according to the Gaza Health Ministry, which does not not differentiate between civilian and militant deaths. Another 2,650 people have been reported missing and may be trapped or dead under the rubble.

Though United States President Joe Biden and others have challenged the figures from the Gaza Health Ministry as exaggerated, Assistant Secretary of State Barbara Leaf told lawmakers earlier in the week that it was “very possible” the numbers were actually even higher than reported.

More than 1,400 people have been killed in Israel, mainly in the initial Hamas attack, and over 30 Israeli soldiers have been killed in Gaza since the ground offensive began.

Israel’s military said Friday that it killed 19 Hamas militants overnight — including a company commander and a platoon commander who were involved in the Oct. 7 attack — and also destroyed a shipping container that held some 20 rocket launchers.

Since the start of the week, the Israeli military has set aside several hours a day to enable civilians to flee from the combat zone in northern Gaza to the south, along the territory’s main north-south road. More than 120,000 civilians fled between Sunday and Thursday, according to U.N. monitors.

On Thursday, crowds of Palestinian families stretching as far as the eye could see were walking south to escape Israeli airstrikes and the ground battle raging between Israeli troops and Hamas fighters.

The accelerating exodus to the south came as Israel agreed to start implementing a four-hour humanitarian pause each day and to open a second route for people to flee the north, the White House said.

Those fleeing to the south face the prospect of ongoing airstrikes there, and dire humanitarian conditions.

On Friday, U.N. expert for the Palestinian territories Francesca Albanese called the four-hour 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.”

Asked about the agreement in a Fox News interview that aired Thursday, Israeli Prime Minister Benjamin Netanyahu replied that “the fighting continues against the Hamas enemy, the Hamas terrorists, but in specific locations for a given period, a few hours here, a few hours there, we want to facilitate a safe passage of civilians away from the zone of fighting. And we’re doing that.”

While Netanyahu suggested earlier in the week that Israel would be responsible for security in Gaza for an indefinite period, he told Fox that Israel is not looking to occupy nor govern Gaza.

FIGHTING AROUND SHIFA HOSPITAL

As Israeli ground forces battle near Shifa, conditions for tens of thousands of people sheltering there have become catastrophic, said Wafaa Abu Hajjaj, a Palestinian journalist at the hospital.

She, as well as several people who left the hospital to go south, said families are sleeping in hospital rooms, emergency rooms, surgical theaters and the maternity ward — or on the streets outside. Daily food distributions helped a tiny number for a time, but there has been no bread for the past four days, they said. Water is scarce and usually polluted, and few people can bathe.

Still more families are arriving, believing it is safer than fleeing to the south, where airstrikes also continue — though some have started to leave because of nearby missile strikes and the sound of clashes between Israeli forces and Hamas fighters, Abu Hajjaj said.

The hospital has been overwhelmed with daily waves of wounded from airstrikes, while medical supplies have been running low and electricity was shut off in many wards. The U.N. delivered two truckloads of supplies Wednesday night, the second delivery since the war began — enough to last a few hours, according to the hospital director.

Aid deliveries into Gaza from Egypt have reached an average of 100 trucks a day, U.S. humanitarian envoy for the war David Satterfield said Thursday. Relief workers say that is still far below what is needed.

MORE CIVILIANS FLEEING

More than two-thirds of Gaza’s population of 2.3 million have fled their homes since the war began, with hundreds of thousands heeding Israeli orders to flee to the southern part of the enclave.

The U.N. said 50,000 people fled south on Gaza’s main highway Wednesday. Similar-sized crowds streamed out on Thursday, according to an Associated Press reporter on the scene as they arrived out of the northern zone. Shots rang out in the distance and smoke rose from blocks away as families made their way on foot with only what they could carry. Others rode on horse-drawn carts.

Palestinian militants have continued to fire rockets into Israel, and 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 writer Nick Perry in Wellington, New Zealand, contributed to this report. Mroue reported from Beirut and Rising from Bangkok.

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