KHAN YOUNIS, Gaza Strip (AP) — Thousands of Palestinians streamed onto Gaza’s only highway Friday, fleeing the combat zone in the north after Israel announced a window for safe passage and following Israeli strikes near hospitals.

Amid an intensifying campaign of airstrikes and ground battles, the search for safety in Gaza has grown increasingly desperate. Tens of thousands have walked south, where they face the prospect of ongoing bombardment and dire conditions. Others have crowded into and around hospitals, sleeping in operating rooms and wards.

Gaza’s largest city the focus of Israel’s campaign to crush Hamas following its deadly October 7 surprise incursion.

BATTLES AROUND HOSPITALS

Early Friday, Israel struck the courtyard and the obstetrics department of Shifa Hospital, where tens of thousands of people are sheltering, according to the head of the Hamas-run media office in Gaza, Salama Maarouf. A video at the scene recorded the sound of incoming fire waking people up in their makeshift shelters in the courtyard, followed by screams for an ambulance.

The Israeli army has alleged that Hamas hides in and under hospitals and that it has set up a command centre under Shifa — claims the militant group and hospital staff deny.

The director of Shifa 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?” Director Mohammed Abu Selmia asked in an interview on the television network Al Jazeera.

The Health Ministry in Hamas-run Gaza later said one person had been killed at Shifa and several were wounded. Another strike near the Al-Nasr Medical Center, which includes two hospitals for children, killed two people, according to the ministry.

Hospital official Bakr Qaoud said the Israeli military has not allowed anyone in or out since Thursday.

“We are on the verge of an environmental and health catastrophe,” he told Al Jazeera television.

In all, Gaza health officials said strikes were carried out near four hospitals overnight and early Friday.

At Shifa, families are sleeping in hospital rooms, emergency rooms, surgical theaters and the maternity ward — or on the streets outside, according to Wafaa Abu Hajjaj, a Palestinian journalist at the hospital, as well as several people who recently left.

Daily food distributions has helped a tiny number for a time, but there has been no bread for the past four days, they said. Water is scarce and usually polluted, and few people can bathe.

CIVILIANS FLEE SOUTH

More than two-thirds of Gaza’s population of 2.3 million have fled their homes since the war began. On Friday, a steady stream of civilians used both sides of Gaza’s main north-south highway.

Parents walked with small children, some evacuees crammed into covered donkey carts with possessions piled on the roof, and others rode on bicycles.

Since last weekend, the Israeli military has set aside several hours a day to enable civilians to escape in northern Gaza, and it announced a six-hour window Friday.

A day earlier, the White House said Israel agreed to implement a brief humanitarian pause each day to allow more Palestinians to flee — an announcement that appeared to be an effort to formalise and expand the process.

Israel has also agreed to open a second route for people to flee the north, the White House said.

More than 120,000 civilians fled between Sunday and Thursday, according to UN monitors.

In all, Israel estimated more than 850,000 of the 1.1 people in northern Gaza have left, according to military spokesman Jonathan Conricus, who called the pauses “quick humanitarian windows” that allow southward movement “while we are fighting.”

On Friday, U.N. expert for the Palestinian territories Francesca Albanese called the four-hour pauses “cynical and cruel,” saying it was just enough “to let people breathe and remember what is the sound of life without bombing, before starting bombing them again.”

More than 10,800 Palestinians have been killed since the hostilities began, according to the Gaza Health Ministry, which does not not differentiate between civilian and militant deaths. Another 2,650 people have been reported missing and may be trapped or dead under the rubble.

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

Though U.S. President Joe Biden and others have challenged the figures from the Gaza Health Ministry as exaggerated, Assistant Secretary of State Barbara Leaf told American lawmakers this week that it was “very possible” the numbers were actually even higher than reported.

More than 1,400 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.

Palestinian militants have continued to fire rockets into Israel, and some 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.