DEIR AL-BALAH, Gaza Strip >> Thousands of Palestinians sheltering from the Israel-Hamas war at Gaza City’s main hospital fled south Friday after several reported strikes in and around the compound overnight. They joined a growing exodus of people escaping intense urban fighting in the north — including near other hospitals — as Gaza officials said the territory’s death toll surpassed 11,000.

The search for safety across the besieged Gaza Strip has grown desperate as Israel intensified its assault on the territory’s largest city.

The Israeli army says Hamas’ military infrastructure is based amid Gaza City’s hospitals and neighborhoods, and that it has set up its main command center in and under the largest hospital, Shifa — claims the militant group and Shifa staff deny.

Israel has vowed to destroy Hamas after its deadly Oct. 7 surprise incursion, which killed at least 1,200.

More than 100,000 Palestinians have fled south over the past two days, according to Israel, but they still face bombardment and dire conditions. Reported strikes on or near at least four hospitals in northern Gaza overnight underscored the danger for tens of thousands more who had crowded into the facilities, believing they would be safe.

BATTLES AROUND HOSPITALS

Early Friday, at least three strikes over several hours hit the courtyard and the obstetrics department of Shifa Hospital, according to Ashraf al-Qidra, spokesperson at the Health Ministry in Hamas-run Gaza.

A video of the courtyard recorded the sound of incoming fire waking people in makeshift shelters, followed by shouts for an ambulance. In the blood-spattered courtyard, one man writhed, screaming on the ground, his leg apparently severed.

Al-Qidra blamed the attack on Israel, a claim that could not be independently verified. The Israeli army said one strike at Shifa was the result of a misfire by militants targeting its troops nearby.

For weeks, tens of thousands of displaced Palestinians — reaching as many 60,000 this week, according to the Health Ministry — have been sheltering in the Shifa complex.

The overnight strikes triggered a mass exodus of the displaced. About 10 a.m., large numbers packed up their belongings and began walking toward the south, five people who were among those who left told The Associated Press.

Al-Qidra told the Qatar-based satellite news network Al-Jazeera that more than 30,000 displaced people, medical workers and patients remain in the hospital.

Mainly those who could not walk or did not know where to go remained, said Wafaa abu Hajajj, a journalist who arrived in the south after leaving the hospital Friday.

“The strikes were hoping to scare people and it worked. … It became too much,” said 32-year-old Haneen Abu Awda, who had been at Shifa being treated for wounds from an earlier strike on his house.

At the same time, Shifa has been overwhelmed by thousands of wounded, even as it operates with minimal power and medical supplies.

In video released Friday by the Gaza Health Ministry, bodies of limp children are seen on stretchers across blood-stained floors in the hospital, some dead, some barely breathing. Other patients were strewn around the floor, unable to be treated for lack of supplies. One man is seen gasping for air.

The director of Shifa, Mohammed Abu Selmia, said Israel demanded the facility be evacuated, but he said there was nowhere for such a large number of patients to go.

“Where are we going to evacuate them?” he said, speaking to Al Jazeera television.

The Health Ministry said one person had been killed at Shifa and several were wounded. Another strike near the Nasr Medical Center killed two people, according to the ministry. Abu Selmia said at least 25 people were killed when a strike hit a Gaza City school where people were sheltered inside.

The strike on Nasr forced the shutdown of its children’s hospital, the only remaining specialized pediatric care in north Gaza, said World Health Organization spokesperson Margaret Harris. She said it was not known what happened to patients there, including children receiving dialysis and on life support — “things that you cannot possibly evacuate them safely with.”

Military spokesman Lt. Col. Richard Hecht said Israel is “aware of the sensitivity” of hospitals and that forces were closing in on them slowly. Israel “does not fire on hospitals,” he said, but if militants are seen firing from them “we will do what we need to do” and kill them.

Israel has produced video that it says is evidence that Hamas uses not only hospitals, but schools and mosques as well, as cover for military activities.

U.N. Secretary-General Antonio Guterres has said on multiple occasions that Hamas uses civilians as “human shields,” while stressing that this does not give Israel free rein to target buildings where militants are hiding among civilians. He has pointed to international humanitarian law, which states that protection of civilians and hospitals, schools, and homes is paramount.

CIVILIANS FLEE SOUTH

Tens of thousands of new evacuees from the north, some from Shifa, flowed down Salah al-Din road — the central spine running the length of the Gaza Strip — and reached the central city of Deir al-Balah on Friday. With no fuel for vehicles, the crowds walked for hours as explosions echoed a short distance away. Among them were wounded and older people.

They arrived hungry, exhausted and with a stew of emotions: relief, rage, and despair.

Reem Asant, 50, described seeing bodies on the streets as he and others made their way out of Gaza City, trying to avoid shelling.

“We’re talking about children killed in a hospital,” shouted one man, Abu Yousef. “Hundreds of women killed every day. Houses collapsing on the heads of civilians. … Where are human rights? Where is the United Nations? Where is the United States? Where is the International Criminal Court? Where is the entire world?”

The Israeli military announced an expanded six-hour window Friday for civilians to escape northern Gaza along Salah al-Din, the route used since last weekend. It also announced the opening of a second route, along the coastal road, after an agreement announced by the White House a day earlier.

More than two-thirds of Gaza’s population of 2.3 million have fled their homes since the war began. Israel estimates that more than 850,000 of the 1.1 million people in northern Gaza have left, according to military spokesman Jonathan Conricus.

RISING DEATH TOLLS

More than 11,070 Palestinians, two-thirds of them women and minors, have been killed since the war began, according to the Gaza Health Ministry, which does not differentiate between civilian and militant deaths. Another 2,650 people have been reported missing.

U.S. Secretary of State Antony Blinken said Friday that “far too many” Palestinians have died and suffered. While recent Israeli steps to try to minimize civilian harm are positive, he said, they are not enough.

Assistant Secretary of State Barbara Leaf told U.S. lawmakers this week that it was “very possible” the death toll was even higher than the Gaza Health Ministry’s tally.

At least 1,200 people have been killed in Israel, mainly in the initial Hamas attack, and 41 Israeli soldiers have been killed in Gaza since the ground offensive began, Israeli officials say. The Foreign Ministry had previously estimated the civilian death toll at 1,400, and gave no reason Friday for the revision.

An Israeli official told The Associated Press that the number had been changed after a painstaking weekslong process to identify bodies, many of which were mutilated or burned in the Hamas rampage. The final death toll could still change, according to the official, who spoke on condition of anonymity pending a formal announcement.

Nearly 240 people abducted by Hamas from Israel remain captive.

Palestinian militants have continued to fire rockets into Israel, and an attack on Tel Aviv wounded at least two people Friday, said Yossi Elkabetz, a paramedic with Israel’s rescue services. Hamas claimed credit.

About 250,000 Israelis have been forced to evacuate from communities near Gaza and along the northern border with Lebanon, where Israeli forces and Hezbollah militants have traded fire repeatedly.

Debre reported from Jerusalem, and Jeffery from Cairo. Associated Press writers Bassem Mroue and Sarah El Deeb in Beirut; David Rising in Bangkok, Thailand; Lee Keath in Cairo; and Julia Frankel and Josef Federman in Jerusalem, contributed to this report.