Gaza officials said Israel launched air strikes on or near at least three hospitals on Friday, further endangering a health system swamped with thousands of casualties and people displaced by Israel's war against Hamas in the Palestinian enclave.

“The Israeli occupation launched simultaneous strikes on a number of hospitals during the past hours,” Gaza Ministry of Health spokesman Ashraf Al-Qidra told Al Jazeera television.

Qidra said Israel targeted the courtyard of Al Shifa, the biggest hospital in Gaza City, and there were casualties, but he did not provide details. Israel said Hamas has hidden command centres and tunnels beneath Al Shifa, allegations Hamas denies.

Israel’s military did not immediately comment on Qidra’s statement, which Reuters could not independently verify.

The month-old Israeli military campaign to wipe out Hamas, following the militants’ October 7 raid on southern Israel, has left Gaza’s hospitals struggling to cope, as medical supplies, clean water and fuel to power generators have been running out.

Gaza’s health ministry has said 18 of Gaza’s 35 hospitals and 40 other health centres were out of service either due to damage from bombardment or lack of fuel.

Palestinian media published video footage on Friday of Al Shifa, which Reuters was unable to authenticate immediately, that it said showed the aftermath of an Israeli attack on a parking lot where displaced Palestinians were sheltered and journalists were observing.

A pool of blood could be seen next to the body of a man being placed on a stretcher.

“With ongoing strikes and fighting nearby (Al Shifa), we are gravely concerned about the well-being of thousands of civilians there, many children among them, seeking medical care and shelter,” Human Rights Watch said on social media site X.

Qidra said Al-Rantisi Pediatric Hospital and Al-Nasr Children’s Hospital “have been witnessing a series of direct attacks and bombardments” on Friday. He said strikes on the hospital grounds at Al-Rantisi set vehicles on fire but they had been partly extinguished.

Indonesia’s foreign ministry said on Friday there were explosions near the Indonesian Hospital overnight, which damaged parts of the hospital, located at the northern end of the narrow coastal enclave. It did not say who was responsible for the explosion and it did not report any deaths or injuries.

“Indonesia once again condemns the savage attacks on civilians and civilian objects, especially humanitarian facilities in Gaza,” the ministry said in a statement.

US SAYS ISRAEL AGREES TO PAUSES

Israel says 1,400 people, mostly civilians, were killed and about 240 taken hostage by Hamas in the Oct.7 raid that triggered the Israeli assault. Israel says it has lost 35 soldiers in Gaza.

Palestinian officials said 10,812 Gaza residents had been killed as of Thursday, about 40% of them children, in air and artillery strikes. A humanitarian catastrophe has unfolded as basic supplies like food and water run out and shelling displaces civilians from their homes.

Israel’s military has said it has evidence that Hamas uses Al Shifa and other hospitals such as the Indonesian Hospital to hide command posts and entry points to an extensive tunnel network under Gaza. It says it does not target civilians, and it has allowed some wounded Palestinian civilians to cross into Egypt for treatment.

But Israel’s military advance on central Gaza City, which brought tanks within about 1.2 kilometre (3/4 mile) of Al Shifa, according to residents, has raised questions about how Israel will interpret international laws on protecting medical centres and displaced people sheltering there.

Deadly air strikes on refugee camps, a medical convoy and near hospitals have already prompted fierce arguments among some of Israel's Western allies over its military’s adherence to international law.

US President Joe Biden said in a post on X on Thursday that Israel has “an obligation to distinguish between terrorists and civilians and fully comply with international law.”

The White House said on Thursday that Israel agreed to pause military operations in parts of north Gaza for four hours a day, but there was no sign of a let-up in the fighting.

The pauses, which would allow people to flee along two humanitarian corridors and could be used for the release of hostages, were significant first steps, White House national security spokesperson John Kirby said.

But Israeli Prime Minister Benjamin Netanyahu suggested any pauses would be scattered, and there was no official confirmation of a plan for recurring breaks.

Asked if there would be a “stoppage” in fighting, Netanyahu said on the Fox News Channel: “No. The fighting continues against the Hamas enemy, the Hamas terrorists, but in specific locations for a given period of a few hours here or a few hours there, we want to facilitate the safe passage of civilians away from the zone of fight and we’re doing that.”

On the ground in northern Gaza, there were no reports of a lull in fighting. Each side reported inflicting heavy casualties on the other in intense street battles.