An Israeli air strike on Tuesday killed at least 500 Palestinians at the al-Ahli Arab Hospital in Gaza City crammed with patients and displaced people, health ministry in the besieged enclave said.

The strike was the bloodiest single incident in Gaza since Israel launched an unrelenting bombing campaign against the densely populated territory in retaliation for the Oct 7 Hamas attack.

It took place on the eve of a visit by US President Joe Biden to Israel to show support for Israel.

Key developments

• Gaza health ministry says ‘hundreds of victims’ under hospital rubble
• Israeli military denies responsibility for attack, says facility hit by ‘failed rocket’
• Palestinian President Mahmoud Abbas cancels meeting with Biden
• Protesters and Palestinian forces clash in occupied West Bank

In a statement, the health ministry in the Gaza Strip said there are “hundreds of victims” under the rubble of a Gaza hospital compound that was hit by Israeli bombing, Al Jazeera reported.

Gaza’s Hamas government described the attack as a “war crime”. It said the bombing mostly killed people left homeless by Israel bombardments, and that the dead included patients, women and children.

“There are scores of dismembered and crushed bodies, baths of blood,” said Izzat El-Reshiq, a senior Hamas member.

Video on social media showed several full ambulances arriving at another Gaza hospital carrying people injured at hospital. One man was staggering, bleeding heavily from the head. A boy was being carried on a stretcher.

Soon after the deadly strikes, Palestinian President Mahmoud Abbas canceled his scheduled meeting with the US president, Reuters reported quoting a Palestinian official.

Abbas also declared three days of mourning following the Israeli bombing, the official Palestinian news agency WAFA reported.

United Nations Relief and Works Agency for Palestine Refugees commissioner-general Philippe Lazzarini called the bombing at Al-Maghazi refugee camp, also in central Gaza, “outrageous” and warned the death toll would likely rise.

“It again shows a flagrant disregard for the lives of civilians. No place is safe in Gaza anymore, not even UNRWA facilities,” he added.

The Israeli military denied responsibility for the blast at the Al-Ahli al-Arabi hospital, suggesting the hospital was hit by a failed rocket inside Gaza.

“An analysis of IDF operational systems indicates that a barrage of rockets was fired by terrorists in Gaza, passing in close proximity to the Al Ahli hospital in Gaza at the time it was hit,” a spokesperson for the Israel Defense Forces said.

Protesters and Palestinian forces clash in West Bank

After the hospital bombing, scores of people took to the streets in occupied West Bank, calling for President Abbas to step down.

The demonstration later turned in a clash after Palestinian forces fired tear gas at the protesters.

“The people want the fall of the president,” demonstrators chanted in Ramallah.

An Al Jazeera correspondent reporting from the site said: “This is by far the biggest protest in Ramallah since the Israel-Hamas war started. There are groups of men running and throwing rocks. Police are firing tear gas.”

Hussein al-Sheikh, a senior Palestinian official, said Abbas was returning immediately “to the homeland”.

Abbas “calls for an emergency meeting of the leadership tonight,” Sheikh wrote on X, formerly Twitter.

‘Violation of international laws’

Taking to social media platform X, World Health Organisation Director General Tedros Adhanom Ghebreyesus condemned today’s deadly hospital bombing in Gaza. He called for the “immediate protection of civilians” and for Israel’s “evacuation orders to be reversed”.

UN High Commissioner for Human Rights Volker Turk termed today’s incident “totally unacceptable”.

“Hospitals are sacrosanct & must be protected at all cost,” he said and called on all the states with influence to do everything in their power to end the violence and killings.

“This attack is unprecedented in scale,” said Richard Peeperkorn, WHO Representative for the West Bank and Gaza. “We have seen consistent attacks on healthcare in the occupied Palestinian territory.”

Peeperkorn said there so far have been 51 attacks against healthcare facilities in Gaza, with 15 health workers killed and 27 injured.

Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean, said there were patients, healthcare workers and internally displaced people in the hospital when it was struck.

“The hospital was one of 20 in the north of the Gaza Strip facing evacuation orders from the Israeli military,” he said.

“The order for evacuation has been impossible to carry out given the current insecurity, critical condition of many patients, and lack of ambulances, staff, health system bed capacity, and alternative shelter for those displaced,” he added.

Tamara al-Rifai, from the UN Relief and Works Agency, told Al Jazeera that was there was “direct Israeli fire” on the al-Ahli Arab Hospital and another refugee centre in the area.

“An attack on densely populated refugee camps where people are sheltering in UN schools and premises is something that is utterly shocking. It is a very sad violation of international humanitarian law. I am lost for words right now,” al-Rifai told Al Jazeera.

Arab countries, Iran and Turkey swiftly condemned the attack.

Lebanon’s Iran-backed Hezbollah movement on Tuesday called for a “day of rage” to condemn a strike on a Gaza Strip hospital, blaming Israel for what it called a “massacre”.

“Let tomorrow, Wednesday, be a day of rage against the enemy,” Hezbollah, an ally of Hamas militants who are at war with Israel, said in a statement, calling the strike a “massacre” and “brutal crime”.

In a statement issued after the attack, the Foreign Office said Pakistan strongly condemned the Israeli bombing on a hospital.

“Attacking a hospital where civilians are seeking shelter and emergency treatment is inhumane and indefensible,” it stated, adding that targeting the civilian population and facilities was a grave violation of international law.

Humanitarian crisis

Prior to Tuesday’s bombing, the Palestinian health ministry said 3,000 people, mostly children, have been killed in Israeli strikes on the Gaza Strip since Oct 7.

More than 12,500 others have been wounded since Israel started bombarding Gaza in retaliation for Hamas attacks in Israel which killed more than 1,400 people. The ministry added that 61 Palestinians were also killed while 1,250 were wounded in the occupied West Bank during the same period.

Israel has vowed to annihilate the Hamas group after its fighters killed 1,300 people — the deadliest single day in Israel’s 75-year history. It now prepares to escalate a ground offensive in response to the Hamas blitz.

On Tuesday, Prime Minister Benjamin Netanyahu called for broad international support in the country’s war against Hamas.

“The savagery that we witnessed perpetrated by the Hamas murderers coming out of Gaza were the worst crimes committed against Jews since the Holocaust,” Netanyahu said, referring to the extermination of more than six million Jews by the Nazis.

Israel has tightened its blockade on Gaza, including by restricting the entry of food, water and fuel and bombarding the area with air strikes that have killed thousands of Palestinians, displaced hundreds of thousands more and resulted in severe shortages of food, water and medical supplies.

According to the United Nations’ World Food Programme, the food situation in the besieged Gaza Strip is running “really short”.

“Inside the shops, the stocks are getting close to less than a few days, maybe four or five days of food stocks left,” WFP’s Middle East spokeswoman Abeer Etefa, told reporters in Geneva via video link from Cairo.

She said that out of five flour mills in the Gaza Strip, only one was operating due to security concerns and the unavailability of fuel.

“So the bread supply is running low and people are lining up for hours to get bread,” she said.

Only five bakeries out of 23 in Gaza contracted by WFP were still in operation, she added. “Our food supplies within Gaza are running really short,” said Etefa.

The spokeswoman said there has been no looting of WFP warehouses, and “anyway, whatever we have left in the warehouses is so little”.

Gaza hospitals at ‘breaking point’

“Hospitals are at a breaking point and are overflowing and with people desperately seeking a safe shelter,” the WHO has said.

“Crowding is getting worse. Over 30,000 people are sheltering at Shifa Hospital alone,” the UN agency told AFP, quoting Hamas health ministry figures.

“We are extremely concerned about disease outbreaks due to mass displacement and poor water and sanitation among people who are already in a dire situation.”

The hospitals are attractive because they have been relatively spared from the Israeli bombing raids that have hit Gaza every day since the October 7 attacks.

But the WHO says that 111 medical buildings have been hit, 12 medical workers have been killed and 60 ambulances targeted.

About one million people from northern Gaza have moved to Khan Yunis and other southern districts to avoid the looming Israeli ground offensive.

About 100,000 people are left in the northern district around Gaza City that Israel says is a Hamas stronghold and has warned will be the target of its assault.

Conditions across the tiny territory are worsening every day for the 2.4 million population, according to aid agencies.

Unicef, the UN children’s agency, has said that unless water and fuel are sent “immediately”, Gaza inhabitants are in “imminent danger” of epidemics and death.

Aid at Rafah

Aid agencies have been flying supplies into El Arish airport in Egypt — around 20 kilometres away from the Rafah border crossing and the only one into the Gaza Strip not controlled by Israel.

So far Egypt has kept the crossing closed to aid going in or foreign nationals trying to flee, as Israel has repeatedly struck the Palestinian side of the crossing.

Ahmed Salem of the Sinai Foundation said that the trucks heading for the border contained Egyptian aid and that the international aid remained in warehouses.

Salem and another security source said Egypt had repaired the roads within the crossing that had been damaged by Israeli strikes.

Etefa said the WFP had mobilised over 300 metric tonnes of food that was either at or on its way to the Rafah border crossing from Egypt into the Gaza Strip — enough food to feed around 250,000 people for one week.

“Everyone is still very hopeful that we will be able to get inside and this is why more supplies are on the way,” she said.

“We call for unimpeded access, safe passage for desperately-needed humanitarian supplies into Gaza.”

The UN’s humanitarian chief Martin Griffiths is due to arrive in Cairo on Tuesday on a visit to the region, expected to last several days, to negotiate aid access to the Gaza Strip.

He is set to go to Israel, and, if conditions permit, to the Palestinian territories, a spokesman said.

Separately, Dr Richard Brennan, regional emergency director of the World Health Organisation Eastern Mediterranean regional office, said the agency was meeting with “decision-makers” today to open access to Gaza as soon as possible.

“We have aid south of Rafa and waiting for the go ahead to get entry to Gaza,” he said, referring to the Rafa crossing, which was a vital artery before the fighting and is now a key route for desperately needed supplies into Gaza.

Biden to visit Israel

US President Joe Biden will make a high-stakes visit to Israel in a significant show of US support for its top Middle East ally.

US Secretary of State Antony Blinken concluded hours of talks with Israeli Prime Minister Benjamin Netanyahu in Tel Aviv early on Tuesday by saying that Biden would visit Israel.

“The president will hear from Israel what it needs to defend its people as we continue to work with Congress to meet those needs,” Blinken told reporters.

Biden would meet with Netanyahu, reaffirm Washington’s commitment to Israel’s security, and receive a comprehensive brief on its war aims and strategy, Blinken said.

“(The) president will hear from Israel how it will conduct its operations in a way that minimises civilian casualties and enables humanitarian assistance to flow to civilians in Gaza in a way that does not benefit Hamas,” Blinken added.

Blinken also said he and Netanyahu had agreed to develop a plan to get humanitarian aid to Gaza civilians. He did not provide details.

After visiting Israel, Biden would travel to Jordan to meet King Abdullah, Egyptian President Abdel Fattah al-Sisi and Palestinian Authority President Mahmoud Abbas, US national security spokesperson John Kirby said.

Israeli officials say that in addition to the casualties Hamas inflicted, the group took some 199 hostages into Gaza.

Khaled Meshaal, a top Hamas leader, said on Monday the group “has what it needs” to free all Palestinians in Israel’s jails, indicating it may try to use the kidnapped Israelis as bargaining chips.

Soon after Meshaal’s remarks, the group’s armed wing separately said the non-Israelis it had taken captive were “guests” who would be released “when circumstances allow”.

Hamas released a video on Monday in which a French-Israeli woman captive was shown having her injured arm treated by an unidentified medical worker. She identified herself as 21-year-old Mia Schem and asked to be returned to her family as quickly as possible.

The Israeli military claimed it had struck Hamas targets overnight, including Hamas’ headquarters and a bank used by the group. It also claimed that a Hamas operative was killed in the strikes.

FM Jilani in Jeddah for OIC meeting

Meanwhile, the Foreign Office (FO) said that caretaker Foreign Minister Jalil Abbas Jilani has reached Jeddah to attend the urgent open-ended ministerial meeting of the Organisation of Islamic Cooperation (OIC) in Saudi Arabia tomorrow (October 18).

In a statement today, the FO said the meeting was co-convened by Pakistan and Saudi Arabia to discuss the Gaza crisis and the humanitarian situation of the besieged civilians.

It stated that the foreign minister has been engaged in consultations with his counterparts in OIC countries.

“In the leadup to this Extraordinary Session, he has held telephone conversations with the Foreign Ministers of Egypt, Iran, Türkiye and the UAE.

“During these consultations, the Foreign Minister expressed Pakistan’s deep concerns on the current situation in Gaza resulting from Israeli bombardment and siege of the enclave. He will continue these consultations with in-person meetings in Jeddah,” the FO said.

Regarding tomorrow’s session, the statement highlighted that FM Jilani has underlined Pakistan’s priority for a collective demand by OIC for a ceasefire and provision of humanitarian assistance through corridors so that food, medicine, water and other necessary supplies could reach the people of Gaza without further delay.

“Subsequent efforts should be directed towards a just, comprehensive and lasting solution to the Palestinian question anchored in international law and in line with relevant United Nations and OIC resolutions.

“A viable, sovereign and contiguous State of Palestine should be established on the basis of pre-1967 borders, with Al Quds Al-Sharif as its capital,” the FO added.

Chinese envoy heads to Middle East in bid to contain war

China will this week weigh into the Israel-Hamas war by sending its special envoy to the Middle East, after the United States asked it to use its influence to stop the conflict from spreading.

Washington says it hopes China’s friendship with Hamas backer Iran could help calm the conflict, particularly after Beijing brokered a detente between long-time foes Tehran and Riyadh earlier this year.

Iran has warned of a possible “pre-emptive action” against Israel as it prepares a ground offensive on the Gaza Strip. There are also fears that Lebanon-based Hezbollah, which is also backed by Iran, could open up a second front with Israel.

“Our message was that he thinks it’s in our shared interest to stop the conflict from spreading,” US State Department spokesman Matthew Miller told reporters on Saturday, after Antony Blinken spoke with Chinese Foreign Minister Wang Yi by phone.

“He thought it could be useful if China could use its influence.”

China then announced envoy Zhai Jun will visit the Middle East this week, with foreign ministry spokeswoman Mao Ning saying his objective was “to pool international consensus, urge relevant parties to stop hostilities, cool down the situation and create necessary conditions for political settlement”.

No details have yet been announced on Zhai’s itinerary or the exact timing of his trip.

Iran warns of ‘long-term war’

Iranian Foreign Minister Hossein Amirabdollahian told state TV that Israel would not be allowed to act in Gaza without consequences, warning of “preemptive action” by the “resistance front” in the coming hours.

Iran refers to regional countries and forces opposed to Israel and the United States as a resistance front.

“All options are open and we cannot be indifferent to the war crimes committed against the people of Gaza,” Amirabdollahian said. “The resistance front is capable of waging a long-term war with the enemy.”

Japan, the current president of the Group of 7 developed nations, said it was in the final stages of arranging a call with Iran, Foreign Minister Yoko Kamikawa said, as she announced $10 million in humanitarian aid for Gaza.

Last week, Iran’s Supreme Leader Ayatollah Ali Khamenei said Tehran was not involved in the Hamas attack on Israel, but hailed what he called Israel’s “irreparable” military and intelligence defeat.

In the biggest sign yet that the war could spread to a new front, Israel ordered the evacuation on Monday of 28 villages in a 2-km-deep (1.2-mile) zone near the Lebanese border.

Netanyahu said Israelis should prepare for a long battle.

“And I have a message for Iran and Hezbollah, don’t test us in the north. Don’t make the same mistake you once made. Because today the price you will pay will be much heavier,” he told the Israeli parliament on Monday.

Russia push for UN Security Council action on Israel, Gaza fails

A Russian-drafted UN Security Council resolution that would have called for a humanitarian ceasefire in the war between Israel and Hamas in Gaza failed to get the minimum nine votes needed in the 15-member body on Monday.

The draft resolution received five votes in favour, four votes against and there were six abstentions.

Russia proposed the one-page draft text on Friday, which also called for the release of hostages, humanitarian aid access and the safe evacuation of civilians in need.

The text condemned violence against civilians and all acts of terrorism, but did not name Hamas.

Former prime minister Shehbaz Sharif said the failure to adopt the resolution was “not just disappointing but deeply troubling”.

US general visits Israel

Diplomatic efforts have concentrated on getting aid into Gaza through the Rafah crossing with Egypt, the sole route that is not controlled by Israel. Cairo said the Rafah crossing was not officially closed but was inoperable due to Israeli strikes on the Gaza side.

On the military front, the US has deployed two aircraft carriers and their supporting ships to the eastern Mediterranean since the attacks on Israel. The ships were meant as a deterrent to ensure the conflict did not spread, US officials said.

The top US general overseeing American forces in the Middle East, Central Command chief Army General Michael “Erik” Kurilla, made an unannounced trip to Israel on Tuesday, saying he hoped to ensure its military has what it needs.

As Israel masses troops on Gaza’s border, it has told more than a million people in the northern half of the enclave to flee to the southern half for their safety, even though Hamas has told them to stay put.

While tens of thousands have fled south, the United Nations says there is no way to move so many people without causing a humanitarian catastrophe.

The United Nations says a million Gazans have already been driven from their homes. Power is out, sanitary water is scarce and fuel for hospital emergency generators is running low.

Russian President Vladimir Putin told Netanyahu on Monday that Moscow wanted to help prevent a humanitarian disaster. A Russian-drafted UN Security Council resolution that would have called for a humanitarian ceasefire failed to get the minimum nine votes needed in the 15-member body on Monday.