Besieged for days by Israel’s military, doctors inside the hospital reiterated on Monday that the lack of fuel for electricity generators is leaving them unable to save patients. Israel has refused to back down, claiming that the hospital hides a Hamas base.

Fighting has been concentrated in a tightening circle around the Gaza Strip’s largest hospital, where thousands of civilians have sought shelter.

The Israeli military, whose ground forces entered the Strip in late October and quickly encircled the north’s main settlement Gaza City, has said that al-Shifa is the primary target in its battle to seize control of the northern half of the enclave.

Israel says that Hamas fighters have an underground headquarters in tunnels beneath the hospital and are deliberately using its patients as a shield, a claim that Hamas denies.

Reports on Monday suggested that thousands of people have fled the hospital. But huge numbers also remain trapped within.

At least 650 patients remain, as well as staff, said Gaza’s Ministry of Health spokesperson Ashraf al-Qudra, who was inside al-Shifa Hospital in Gaza City

He said an Israel tank was stationed at the hospital gate.

“The tank is outside the gate of the outpatient clinic department, this is how the situation looks this morning,” al-Qudra told the Reuters news agency by phone.

Israeli snipers and drones were firing into the hospital, making it impossible for medics and patients to move around, he added.

“We are besieged and are inside a circle of death,” he said.

The official said that 32 patients had died in the past three days, including three newborn babies, as a result of the siege of the hospital and the cut-off of its power.

Nowhere to go

Israel has told civilians to leave and medics to send patients elsewhere.

It was unclear where they would go. Several hospitals and clinics in Gaza have been forced to shut down, while others are already working at full capacity with dwindling supplies. Meanwhile, Israeli forces have surrounded the facility.

Israel also claimed that it attempted to evacuate babies from al-Shifa’s neonatal ward and left 300 litres (79 gallons) of fuel to power emergency generators at the hospital entrance, but that Hamas blocked the offer and prevented the hospital from using the fuel.

The Health Ministry spokesperson denied rejecting the fuel, adding that 300 litres would power the hospital for just half an hour.

Al-Shifa needed 8,000-10,000 litres (2,113-2,641 gallons) of fuel per day, which must be delivered by the Red Cross or an international aid agency, he told Reuters.

Medical Aid for Palestinians, a UK-based charity that has supported al-Shifa’s neonatal intensive care unit, said transferring critically ill infants is complex.

“With ambulances unable to reach the hospital … and no hospital with capacity to receive them, there is no indication of how this can be done safely,” CEO Melanie Ward said. She said the only option was to pause the fighting and allow in fuel.

The Gaza Health Ministry said that of 45 babies in incubators at al-Shifa, six had died as of Monday. Al-Qudra had no immediate update.

World Health Organization chief Tedros Adhanom Ghebreyesus said in a post on X that al-Shifa was “not functioning as a hospital anymore”.

.@WHO has managed to get in touch with health professionals at the Al-Shifa hospital in #Gaza.

The situation is dire and perilous.

It’s been 3 days without electricity, without water and with very poor internet which has severely impacted our ability to provide essential…

— Tedros Adhanom Ghebreyesus (@DrTedros) November 12, 2023

“Tragically, the number of patient fatalities has increased significantly,” he said. “The world cannot stand silent while hospitals, which should be safe havens, are transformed into scenes of death, devastation, and despair.”

Dr Alice Rothchild, from Jewish Voice for Peace, told Al Jazeera that diseases are “running rampant” inside Gaza’s hospitals.

“A modern 21st-century hospital needs electricity and power to use all of its instruments and equipment. Without fuel, even the electric generators and ambulances cannot work,” she said.

“Think about the hospital personnel. The staff is exhausted, traumatised. Many of them are getting sick because there are contagious diseases that are now running rampant,” Dr Rothchild said.

“What’s going to happen is that people are going to suffer, and some of them are going to die. They could die slowly with sepsis, infection or gangrene. And some are going to die suddenly when their respirator stops working,” she added.

Weeks of conflict

The more than monthlong conflict has polarised the world, with many countries saying that even the shocking brutality of the Hamas attacks on October 7 did not justify an Israeli response that has killed so many civilians in a crowded territory under siege.

Israel says it must destroy Hamas, the group that rules Gaza, and the blame for harm to civilians falls on fighters who intentionally hide among them.

It has rejected demands for a ceasefire, which it says would only prolong the suffering by giving Hamas a chance to regroup, a position supported by Washington, which nevertheless says it is pressing its ally to protect civilians.

“The United States does not want to see firefights in hospitals where innocent people, patients receiving medical care, are caught in the crossfire and we’ve had active consultations with the [Israeli army] on this,” White House National Security Adviser Jake Sullivan told CBS News broadcaster.

Hundreds of thousands of civilians are believed to remain in the northern part of Gaza where the fighting is focused, despite Israel’s order to leave. Israel has also regularly bombed the south, leaving Gaza Palestinians saying they have nowhere safe to go.

The order to leave the north amounted to a choice “whether to stay in your home, where your memories are and where you were born, and go to nowhere or be bombed”, said Ahmed, 42, reached by phone in the Jabalia refugee camp in northern Gaza.

“Most of the people in Jabalia didn’t leave and they don’t want to leave. Israel doesn’t differentiate between north and south,” he said.

In the south, Israeli planes bombed several houses in Khan Younis. In one strike, health officials said seven people were killed and several wounded.

At Nasser hospital, people in private cars brought casualties including children to the emergency department.

“There are dead bodies under the rubble, we need ambulances,” one of the men cried.