Is­raeli troops bat­tled Pales­tin­ian mil­i­tants in an ur­ban refugee camp and out­side the gates of a near­by hos­pi­tal on Tues­day as the army ex­pand­ed op­er­a­tions across north­ern Gaza, where res­i­dents have been with­out elec­tric­i­ty, wa­ter or ac­cess to hu­man­i­tar­i­an aid for weeks.

The front line of the war, now in its sev­enth week, has shift­ed to the Ja­baliya camp, a dense war­ren of con­crete build­ings near Gaza City that hous­es refugees from the 1948 war sur­round­ing Is­rael’s cre­ation and their de­scen­dants. Is­rael has been bom­bard­ing the area for weeks, and the mil­i­tary said Hamas fight­ers have re­grouped there and in oth­er east­ern dis­tricts af­ter be­ing pushed out of much of Gaza City.

Fight­ing has al­so in­ten­si­fied out­side the In­done­sian Hos­pi­tal on the out­skirts of Ja­baliya, where a strike killed 12 peo­ple on Mon­day. Health of­fi­cials said Tues­day that hun­dreds of pa­tients and dis­placed peo­ple are trapped in­side with dwin­dling sup­plies af­ter some 200 were evac­u­at­ed the day be­fore.

The war sparked by Hamas’ sur­prise Oct. 7 at­tack in­to Is­rael has ex­act­ed a heavy toll on Pales­tin­ian civil­ians, par­tic­u­lar­ly those who re­main in the north af­ter Is­rael re­peat­ed­ly called on peo­ple to flee south.

It’s un­clear how many peo­ple re­main in the north, but the U.N. agency for Pales­tin­ian refugees es­ti­mates that some 160,000 peo­ple are still in its shel­ters there, even though it is no longer able to pro­vide ser­vices. Some 1.7 mil­lion Pales­tini­ans, about three-fourths of Gaza’s pop­u­la­tion, have fled their homes.

Hun­dreds of thou­sands of dis­placed peo­ple have packed in­to U.N.-run schools and oth­er fa­cil­i­ties across south­ern Gaza. As the shel­ters have over­flowed, peo­ple have been forced to sleep on the streets out­side, with lit­tle shel­ter from win­ter rains that have hit the re­gion in re­cent days.

Across Gaza, there are short­ages of food, wa­ter and fu­el for gen­er­a­tors to pow­er ba­sic in­fra­struc­ture. There has been a ter­ri­to­ry-wide black­out since Is­rael cut off fu­el im­ports at the start of the war.

Is­rael con­tin­ues to strike what it says are mil­i­tant tar­gets across Gaza, in­clud­ing in the south­ern evac­u­a­tion zone, of­ten killing women and chil­dren, and of­fi­cials have said it may soon ex­pand its op­er­a­tions in the south.

FIGHT­ING AROUND HOS­PI­TALS

Tens of thou­sands of Pales­tini­ans in the north had shel­tered in hos­pi­tals, but those have steadi­ly been emp­tied out as the fight­ing has reached their gates, and most are no longer op­er­a­tional.

Mar­wan Ab­dal­lah, a med­ical work­er at the In­done­sian Hos­pi­tal near Ja­baliya, said heavy fight­ing pre­vent­ed am­bu­lances from bring­ing wound­ed peo­ple in.

Mu­nir al-Boursh, a se­nior Health Min­istry of­fi­cial who said he was in­side the hos­pi­tal, told Al-Jazeera tele­vi­sion by phone that Is­raeli forces had be­sieged it, forc­ing health work­ers to bury 50 bod­ies in the court­yard. “The sit­u­a­tion is unimag­in­able,” he said. “We are trapped in­side the hos­pi­tal.”

There was no im­me­di­ate com­ment from the mil­i­tary.

Pales­tin­ian of­fi­cials said an Is­raeli shell struck the hos­pi­tal on Mon­day, killing 12 peo­ple. Is­rael de­nied shelling the hos­pi­tal, but said its troops re­turned fire on mil­i­tants who tar­get­ed them from in­side.

Some 200 wound­ed pa­tients and their com­pan­ions were evac­u­at­ed from the hos­pi­tal to south­ern Gaza on Mon­day, but up to 600 wound­ed peo­ple and some 2,000 dis­placed Pales­tini­ans re­main strand­ed there, ac­cord­ing to Gaza’s Health Min­istry.

A sim­i­lar stand­off has played out in re­cent days at Shi­fa Hos­pi­tal, Gaza’s largest, where over 250 pa­tients and med­ical work­ers are strand­ed af­ter the evac­u­a­tion of 31 pre­ma­ture ba­bies.

Is­rael has pro­vid­ed some ev­i­dence in re­cent days of a mil­i­tant pres­ence at Shi­fa, where its troops have been op­er­at­ing since last week. But it has yet to sub­stan­ti­ate its claims that Hamas had a ma­jor com­mand cen­tre be­neath the fa­cil­i­ty, al­le­ga­tions de­nied by Hamas and hos­pi­tal staff.

Michael Ryan, a se­nior World Health Or­ga­ni­za­tion of­fi­cial, said Mon­day that care for com­plex med­ical cas­es – in­clud­ing most can­cer and kid­ney dial­y­sis pa­tients – is no longer avail­able in Gaza and that re­main­ing hos­pi­tals would like­ly be over­whelmed by some 5,500 births ex­pect­ed in the next month.

“The hos­pi­tal sit­u­a­tion – the pri­ma­ry health care sys­tem sit­u­a­tion – in Gaza is cat­a­stroph­ic,” he said. In the north, “it is the worst you can imag­ine.”

RIS­ING TOLL

More than 12,700 Pales­tini­ans have been killed in Gaza, ac­cord­ing to the Pales­tin­ian Health Min­istry in the West Bank. Of­fi­cials there say an­oth­er 4,000 are miss­ing. Their counts do not dif­fer­en­ti­ate be­tween civil­ians and com­bat­ants. Is­rael says it has killed thou­sands of mil­i­tants.

The Pales­tin­ian Health Min­istry bases its count on in­for­ma­tion gath­ered by its coun­ter­part in Hamas-ruled Gaza, which has been un­able to ful­ly up­date ca­su­al­ty fig­ures for more than 10 days be­cause of the break­down in ser­vices and com­mu­ni­ca­tions in the north.

About 1,200 peo­ple have been killed on the Is­raeli side, main­ly civil­ians dur­ing the Oct. 7 at­tack, in which Hamas dragged some 240 cap­tives back in­to Gaza. The mil­i­tary says 68 Is­raeli sol­diers have been killed in Gaza ground op­er­a­tions.

The mil­i­tary said forces are “prepar­ing the bat­tle­field” in the area of Ja­baliya. It said they struck three tun­nel shafts where fight­ers were hid­ing and de­stroyed rock­et launch­ers. Footage re­leased by the mil­i­tary shows Is­raeli sol­diers pa­trolling on foot as gun­fire echoes around them.

Res­i­dents said there had been heavy fight­ing as Is­raeli forces tried to ad­vance un­der the cov­er of airstrikes. “The (Is­raeli) oc­cu­pa­tion is try­ing to be­siege the camp,” said Hamza Abu Man­sour, a uni­ver­si­ty stu­dent. “They are fac­ing stiff re­sis­tance.”

It was not pos­si­ble to in­de­pen­dent­ly con­firm de­tails of the fight­ing.

Mil­i­tary footage from oth­er ar­eas in the north in re­cent days has shown wide­spread de­struc­tion, with near­ly every build­ing ap­pear­ing to be dam­aged or de­stroyed.

TALKS ON HOSTAGES

Is­rael, the Unit­ed States and Qatar, which me­di­ates with Hamas, have been ne­go­ti­at­ing for weeks over a hostage re­lease that would be paired with a tem­po­rary cease-fire and the en­try of more hu­man­i­tar­i­an aid.

Iz­zat Rishq, a se­nior Hamas of­fi­cial, said Tues­day that an agree­ment could be reached “in the com­ing hours,” in which Hamas would re­lease cap­tives and Is­rael would re­lease Pales­tin­ian pris­on­ers. Hamas’ leader in ex­ile Is­mail Haniyeh al­so said they were close to a deal, but sim­i­lar pre­dic­tions in re­cent weeks have proven pre­ma­ture.

Is­rael’s three-mem­ber war Cab­i­net met with rep­re­sen­ta­tives of the hostages’ fam­i­lies Mon­day evening. Prime Min­is­ter Ben­jamin Ne­tanyahu told fam­i­lies the gov­ern­ment con­sid­ers the re­lease of hostages and the de­feat of Hamas to be equal­ly im­por­tant, ac­cord­ing to a fam­i­ly mem­ber who at­tend­ed.

Udi Goren, whose cousin Tal Chai­mi is in cap­tiv­i­ty in Gaza, said that was “in­cred­i­bly dis­ap­point­ing” for the fam­i­lies, as Is­rael has said it could take months to dis­man­tle the mil­i­tant group.

Magdy re­port­ed from Cairo. As­so­ci­at­ed Press writer Melanie Lid­man in Jerusalem con­tributed.

DEIR AL-BAL­AH, Gaza Strip (AP) —