An explosion killed hundreds of people on Tuesday at a hospital in Gaza City that was packed with people sheltering there, Gazan officials said, as Palestinians and Israelis blamed each other for a tragedy that inflamed the region just as President Biden was expected to arrive in Israel.

Hamas, the group that controls Gaza, said an Israeli airstrike had caused the blast at the Ahli Arab Hospital. Hours later, Israeli officials said that one of the rockets fired at Israel by Palestinian militants had failed shortly after launch, causing what could be the deadliest single incident of the 10-day-old war.

Photos and videos posted online and verified by The New York Times showed bloodied and battered bodies, flames, grieving witnesses and the blankets, backpacks and mattresses of the dead and wounded littering the area around them. Ali Jadallah, a Palestinian photojournalist in Gaza City, said he watched as victims arrived at another hospital, ferried there in any available vehicle, most of them dead. Many of the bodies were not intact, he said.

A woman shared a video she recorded as she made her way through rubble of the ruined hospital, asking, “Where am I supposed to go?”

The images, as well as Hamas’s immediate statements blaming Israel and the delay in Israeli denials, combined to fuel angry reactions across the Middle East, with large protests in Beirut and a crowd in Amman, Jordan, lighting a fire outside the Israeli embassy there.

Mahmoud Abbas, leader of the Palestinian Authority, which has limited authority over the West Bank, cut short a trip to Jordan, where he was scheduled to meet with Mr. Biden. The foreign ministry of Saudi Arabia, which had been exploring establishing formal relations with Israel, blamed the massacre on “the forces of the Israeli occupation.”

The Israeli military and Prime Minister Benjamin Netanyahu said Tuesday night that the blast at the hospital had resulted from a failed rocket launch by Islamic Jihad, a group allied with Hamas. Islamic Jihad denied the allegation.

In the past, rockets fired by Palestinian armed groups, including Islamic Jihad, have occasionally malfunctioned and hit civilian neighborhoods.

A spokeswoman for the Gazan health ministry put the toll at 500 or more dead, which the ministry later changed to “hundreds.” No figure could be confirmed independently, but images from the hospital, which is run by the Anglican Church, and witness accounts made clear that it was high.

The disaster immediately raised the stakes for Mr. Biden, who is expected to arrive on Wednesday in Israel on a trip to meet with regional leaders in an attempt to de-escalate the crisis. He was scheduled to continue on to Amman to meet with the leaders of Jordan and Egypt, as well as Mr. Abbas, but that meeting was called off late Tuesday.

Shortly before taking off for Israel on Air Force One, Mr. Biden said he was “outraged and deeply saddened by the explosion at the Al Ahli Arab hospital in Gaza, and the terrible loss of life that resulted.” He said he had directed his national security team to look into what had happened.

Israeli planes have been pummeling Gaza in retaliation for Hamas’s Oct. 7 massacre and kidnapping of Israelis. The bombing campaign and Israel’s directive to evacuate northern Gaza, including Gaza City, have displaced hundreds of thousands of people, killed or wounded thousands, and left people throughout the territory perilously low on water, food, fuel and medicine.

People who fled their homes were sleeping in streets, fights were breaking out over food, and hospitals were increasingly unable to care for a flood of wounded patients. More than a week of international talks have yielded no agreement to allow vital supplies into the territory, to let some people exit, or to create safe zones for civilians within Gaza, where more than 2 million people are trapped in worsening conditions.

Aid and human rights groups have stepped up criticism of the Israeli bombing and the instruction to evacuate. Israeli officials do not deny striking residential buildings and mosques, or killing and injuring noncombatants, but they insist that they are targeting Hamas’s officials, weapons caches, tunnels and safe houses, all deeply intertwined with Gazan civilian infrastructure.

Before the hospital explosion in Gaza City, the United Nations High Commissioner for Human Rights’s office in a statement on Tuesday cited “daily indications of violations of the laws of war and international human rights law” in Israel’s campaign in Gaza, and said telling people to evacuate northern Gaza may be considered a forcible transfer of a population, itself a violation of international law.

More than 600,000 people have fled northern Gaza — over half the area’s population — the United Nations said on Tuesday, after Israel told Gazans to go south for their safety as it bombed and prepared for a possible ground invasion. But evacuation has been no guarantee of safety, with airstrikes killing people in the south and on the roads heading to it.

Mohammad Ayoub, 57, and his family fled northern Gaza with only a few personal items, arriving in Rafah, on the border with Egypt, only to find it under attack, too. “There’s constant bombing, even in these areas they say are safe,” Mr. Ayoub said. “But there are no more safe places in Gaza.”

The Israeli military said on Tuesday that it had stepped up bombing in the southern cities of Khan Younis and Rafah, in strikes that Gaza officials said killed 80 people overnight. Maj. Nir Dinar, a spokesman for the military, said Israel sought to avoid civilian casualties but that Hamas fighters were hiding among Palestinian civilians, and that southern Gaza — while not entirely safe — remained safer than the north.

Hamas and Israel have gone to war several times before but never on this scale, and the conflict is a growing focus of international attention. Chancellor Olaf Scholz of Germany went to Israel on Tuesday in a show of support for the country, and António Guterres, the U.N. secretary general, is expected to go to the region on Thursday for meetings on the Israel-Gaza war.

Mr. Biden has called the Hamas attack “pure evil” and said repeatedly that Israel has a right to respond in its defense, while also signaling concern about the human toll.

Hamas’s assault made Oct. 7 the deadliest single day in Israel’s history, and it was the worst breach of the nation’s security since the 1973 Yom Kippur war began with a surprise attack by Egypt, Syria and several other states. In a highly planned assault, thousands of Hamas militants broke through the border fence in multiple locations and poured into Israel, overrunning towns, military bases and a music festival, killing about 1,400 people — mostly civilians, and a number of them visiting foreigners — and taking about 200 hostages back to Gaza.

Israel has retaliated for the attack with the most intense bombing campaign it has ever waged against Hamas, determined to wipe out the fighting ability of an organization dedicated to destroying Israel. Mr. Netanyahu declared last week that “every Hamas member is a dead man.”

The bombing had killed more than 2,800 people in Gaza, officials there said on Monday. The U.N. human rights commissioner’s office said the dead have included at least 14 U.N. workers, 28 medical workers and 11 journalists. Gaza officials said that as many as 1,200 other people may still be under the rubble, as rescue workers struggle to find them.

Late on Monday, Hamas released a video of a 21-year-old Israeli woman it was holding, and the video became a source of hope and anguish for her families and those of other hostages. The group has claimed that the Israeli bombing has killed a number of the hostages, along with the Hamas fighters holding them.

A Hamas official said last week that the group would kill a hostage each time Israel bombed a home in Gaza, but there has been no sign that it has followed through on that threat.

In southern Gaza, people are spending their days scrounging for food and water, and spending nights crammed with other families into small apartments, or sleeping in cars or on the pavement. Some of them say conditions are so dire they are considering returning to their homes in the north, despite the lethal risks. With internet and cellphone service breaking down under the bombing, they are finding it steadily harder to get information about where to go, or how to get there.

“Today is worse than all the previous bad days,” Dr. Mohamed Zaqout, the general manager of Nasser Hospital in Khan Younis, said Tuesday. “With many displaced from the north, more people share the same homes and thus there are more casualties in each strike.”

The bombing has cut off most electricity, and emergency generators have run out of fuel at hospitals, shelters, water pumping stations and desalination plants. Hospitals “have entered the stage of actual collapse due to power outages and fuel scarcity,” the Gazan health ministry said in a statement.

The World Health Organization warned that the water shortage and crowding would lead to unsanitary conditions, inviting outbreaks of disease.

Gaza’s only borders are with Israel and Egypt, which have imposed a partial blockade on the territory since Hamas took power there in 2007. Israel declared a “complete siege” after the Hamas incursion, sealing its border with Gaza and amassing troops and tanks along the boundary.

That leaves the Rafah crossing into Egypt the only potential portal for people to escape — including some 500 to 600 U.S. citizens and permanent residents — and supplies to enter. But reports of imminent deals to open that door and let aid through have all proved unfounded.

Reporting was contributed by Edward Wong, Nicholas Casey, Aric Toler, Riley Mellen, John Ismay, Yousur Al-Hlou, Nadav Gavrielov, Matthew Rosenberg, Monika Pronczuk, Raja Abdulrahim, Farnaz Fassihi, Abu Bakr Bashir, Talya Minsberg, Christopher F. Schuetze, Jeffrey Gettleman, Adam Sella, Peter Baker and Eric Schmitt.





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