Three thousand people who survived missile attacks in other parts of Gaza had come to take refuge at al-Ahli, where they slept in the garden courtyard and in the upper floors of the hospital building.

Those who were not among the at least 500 people who were killed in Tuesday night’s attack walked around dazedly, collecting what belongings were still usable or helping retrieve dead bodies and body parts.

“What happened is a crime against humanity,” Mohammed al-Nageh, the hospital’s director of programmes and coordination told Al Jazeera.

“This hospital, which has functioned and delivered health services for more than 140 years, was attacked in the most brutal manner, massacring more than 500 souls.”

Ambulances and private cars rushed hundreds of casualties to al-Shifa Hospital, the largest medical complex in Gaza City which was already overwhelmed with wounded from other attacks amid Israel’s bombardment of the Gaza Strip, inside Israel on October 7.

Victims arrived with gruesome injuries, Gaza’s health ministry spokesperson Ashraf al-Qidra said. Some were decapitated, disembowelled or missing limbs.

Health officials said most of the victims of the attack were women and children and warned the death toll was expected to rise.

Ibtihal al-Raii was sitting on the hospital’s second floor with other families and children.

“We saw the light of the missile,” she said. “The next second, we were in hell. The broken glass rained down on us, and I threw myself over the children. We ran outside and saw mutilated bodies, burned bodies, body parts everywhere, underneath our feet. Where is the Arab world?” She cried.

Officials in Gaza said the blast at the hospital was caused by an Israeli air raid.

The health ministry said at least 3,300 people have been killed in Gaza and 11,000 wounded in Israeli air raids.

Another 1,200 people across Gaza are believed to be buried under the rubble, alive or dead, according to health authorities.