DEIR AL-BALAH, Gaza Strip (AP) — Israeli troops and Hamas gunmen battled Saturday outside Gaza ‘s largest hospital where frantic doctors said the last generator had run out of fuel, causing the death of a premature baby and four other patients. Thousands of war-wounded, medical staff and displaced civilians were caught in the fighting.

In recent days, fighting near Shifa and other hospitals in northern Gaza has intensified and supplies have run out. The Israeli military has alleged, without providing evidence, that the militant group Hamas has established command posts in and underneath hospitals, using civilians as human shields. Medical staff at Shifa have denied such claims and accused Israel of harming civilians with indiscriminate attacks.

Shifa hospital director Mohammed Abu Selmia said the facility lost power Saturday.

“Medical devices stopped. Patients, especially those in intensive care, started to die,” he said by phone, with gunfire and explosions in the background. He said Israeli troops were “shooting at anyone outside or inside the hospital” and prevented movement between buildings.

Israel’s military confirmed clashes outside the hospital, but Rear Admiral Daniel Hagari denied Shifa was under siege. He said troops will provide assistance Sunday in moving babies treated there and said “we are speaking directly and regularly” with hospital staff.

Amos Yadlin, a former head of Israeli military intelligence, told broadcaster Channel 12 that as Israel aims to crush Hamas, taking control of the hospitals would be key but require “a lot of tactical creativity,” without hurting patients, other civilians and Israeli hostages.

Five patients died at Shifa after the generator shut down, including a premature baby, said Medhat Abbas, a Health Ministry spokesman.

The “unbearably desperate situation” at Shifa must stop now, the director general of the International Committee of the Red Cross, Robert Mardini, said on social media. UN humanitarian chief Martin Griffiths posted that “there can be no justification for acts of war in health care facilities, leaving them with no power, food or water.”

Elsewhere, the Palestinian Red Crescent said Israeli tanks were 20 metres (65 feet) from al-Quds hospital in Gaza City’s Tal al-Hawa neighbourhood, causing “a state of extreme panic and fear” among the 14,000 displaced people sheltering there.

A 57-nation gathering of Muslim and Arab leaders in Saudi Arabia called in their communique for an end to the war in Gaza and the immediate delivery of humanitarian aid. The statement also called on the International Court of Justice, a UN organ, to open an investigation into Israel’s attacks, saying the war “cannot be called self-defense and cannot be justified under any means.”

Prime Minister Benjamin Netanyahu has said the responsibility for any harm to civilians lies with Hamas, and that while Israel has urged civilians to leave combat zones, “Hamas is doing everything it can to prevent them from leaving.”

A Hamas official denied that their fighters opened fire at residents trying to leave Gaza City or its hospitals. Speaking by phone, Ghazi Hamad called such assertions by Israel lies and said Hamas doesn’t have guards at hospital gates to prevent people from entering or leaving.

The spokesman of the Hamas military wing said militants were ambushing Israeli troops and vowed that Israel will face a long battle. The Qassam Brigades spokesman, who goes by Abu Obaida, acknowledged in audio aired on Al-Jazeera that the battle is disproportionate “but it is terrifying the strongest force in the region.”

Israel’s military has said soldiers have encountered hundreds of Hamas fighters in underground facilities, schools, mosques and clinics during fighting in Gaza. Israel has said a key goal of the war is to crush Hamas, a militant group that has ruled Gaza for 16 years.

Following Hamas’ deadly October 7 attack on Israel, in which at least 1,200 people were killed, Israel’s allies have defended the country’s right to protect itself. But now into the second month of war, there are growing differences in how many feel Israel should conduct its fight.

The US has been pushing for temporary pauses that would allow for wider distribution of badly needed aid to civilians in the besieged territory where conditions are increasingly dire. However, Israel has only agreed to brief daily periods during which civilians can flee the area of ground combat in northern Gaza and head south on foot along the territory’s main north-south artery.

Since these evacuation windows were first announced a week ago, more than 150,000 civilians have fled the north, according to UN monitors. On Saturday, the military announced a new evacuation window, saying civilians could use the central road and a coastal road.