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Gaza’s largest hospital has “ceased to function” after running out of fuel and being surrounded by Israeli troops, with air strikes and gunfire making it impossible for civilians to escape.

Al-Shifa hospital, in the heart of Gaza City, ran out of fuel over the weekend, local officials and the World Health Organization said, risking the lives of patients as fighting raged just outside its doors.

Efforts by the Israel Defense Forces to take control of the site have become a diplomatic flashpoint between Israel and its allies. The US and EU have asked Israel to show restraint as the scenes at the hospital — including newborn babies being kept warm outside non-functioning incubators — spur support in Arab and some western capitals for a ceasefire to protect Palestinian civilians.

The fighting around al-Shifa came as Israel and Hizbollah, the Iran-backed militia in Lebanon, traded cross-border fire amid fears the conflict could spill over into the region, an outcome the US has sought to avoid with a flurry of Middle East diplomacy.

Anwar Gargash, diplomatic adviser to the president of the United Arab Emirates, warned on Monday that Israel’s “unparalleled” and “disproportionate” attacks on civilians threaten to fuel radicalisation in the Middle East.

Newborns lie on beds after being taken off incubators at al-Shifa hospital on Sunday © Reuters

The campaign to expel Hamas militants from the coastal enclave was triggered by the armed group’s devastating rampage through southern Israel on October 7. Hamas militants killed more than 1,200 people, mostly civilians, and took about 240 hostages, according to Israeli authorities.

More than 11,000 Gaza residents have been killed in Israel’s retaliatory bombardment and ground incursion into the strip, according to Palestinian health officials.

Israeli Prime Minister Benjamin Netanyahu told NBC News on Sunday that the country’s forces “were proceeding as quickly as we can but also as carefully as we can”. He added: “We have no battle with patients or civilians at all.”

Israel claims, without providing evidence, that al-Shifa is a major site for Hamas’s operations as it sits on top of an underground infrastructure the IDF intends to destroy. Doctors at al-Shifa have denied the claim, and said several premature babies and patients had died after the hospital ran out of fuel, and that thousands of patients, medical personnel and civilians were sheltering at the hospital.

“The situation is dire and perilous,” WHO director-general Tedros Adhanom Ghebreyesus said on social platform X after speaking to doctors at the hospital. “The constant gunfire and bombings in the area have exacerbated the already critical circumstances. Regrettably the hospital is not functioning as a hospital anymore.”

A spokesperson for the Hamas-run Gaza health ministry described al-Shifa as under “complete siege”, saying there were more than 100 bodies that were beginning to decompose and “the smell of corpses” everywhere.

He said 8,000 displaced people were sheltering at al-Shifa, and that there was no food or fresh water. He also said Israeli planes were targeting anyone who left the facility.

Thomas White, director of UNRWA Affairs in Gaza, posted on X that “the humanitarian operation in Gaza will grind to a halt in the next 48 hours as no fuel is allowed to enter” the territory. He said two of UNRWA’s main water distribution contractors ceased operations on Monday after they ran out of fuel, “which will deny 200,000 people potable water”.

“A tough decision — fuel for a hospital or fuel to produce drinking water — both save lives. Unfortunately, this is not hypothetical,” he wrote. UNRWA is the UN agency for Palestinian relief.

Israeli soldiers left 300 litres of fuel — enough for less than an hour of the hospital’s needs — at the hospital’s gates on Sunday, an amount that the health ministry in Gaza told Al Jazeera was a “mockery.”

In southern Gaza, a building belonging to the UNRWA sustained significant damage from Israeli strikes. No casualties were reported as staff had left the guesthouse in Rafah 90 minutes before the strike.

“This recent attack is yet another indication that nowhere in Gaza is safe,” said Philippe Lazzarini, UNRWA commissioner-general. At least 100 UN employees, mostly working for UNRWA, have been killed in Gaza since the war began on October 7.

The intensity of the cross-border attacks between Israel and Hizbollah ratcheted up over the weekend following a speech by Hassan Nasrallah, the militant group’s leader, who warned that the Lebanese front would “remain active”.

Hizbollah claimed that anti-tank missile fire wounded Israelis working on repairing electricity infrastructure near the border. It was the most serious incident involving civilians since an Israeli strike killed a Lebanese woman and three children on November 5.

Israel responded with strikes late on Sunday on what it described as Hizbollah military infrastructure. Intense cross-border shelling continued overnight, with several Israeli soldiers injured in the exchanges.

“The IDF has operational plans to change the security status in the north,” Rear Admiral Daniel Hagari, an Israeli military spokesperson, warned on Sunday night, raising fears of a wider escalation on the northern front.

The US carried out air strikes on what defence secretary Lloyd Austin described as “facilities in eastern Syria used by Iran’s Islamic Revolutionary Guard Corps and Iran-affiliated groups”.

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