Palestinians said a deadly strike on Friday hit Gaza's largest hospital compound as medical facilities sheltering tens of thousands were caught in intense combat between Israel and Hamas.

Gaza's Hamas government, which reported a death toll of 13, and the director of Gaza City's Al-Shifa hospital blamed Israeli forces for the strike. Israel did not immediately comment.

Al-Shifa hospital director Mohammad Abu Salmiya reported two people were killed and 10 wounded in a strike that he said hit the compound's maternity ward.

A Hamas government statement added that dozens were wounded in an Israeli strike on the hospital compound, giving a toll AFP was not immediately able to independently verify.

On Thursday Israel reported heavy fighting near the hospital, saying it had killed dozens of militants and destroyed tunnels that are key to Hamas's capacity to fight.

"There is no safe place left. The army hit Al-Shifa. I don't know what to do," said 32-year-old Abu Mohammad, who was among those seeking refuge at the hospital. "There is shooting… at the hospital. We are afraid to go out."

The Israeli army has repeatedly accused Hamas of using hospitals, particularly Al-Shifa, to coordinate their attacks against the army and also as hideouts for its commanders. Hamas authorities deny the accusations.

Israel launched an offensive in Gaza after Hamas fighters poured across the militarised border on October 7, killing 1,400 people, mostly civilians, and taking around 240 hostages.

Vowing to destroy the militants, Israel retaliated with bombardment and a ground campaign that the health ministry in the Hamas-run Gaza Strip says has killed more than 11,000 people, mostly civilians and many of them children.

Witnesses told AFP that hundreds of people sheltering at Gaza City's Al-Rantisi hospital fled on instruction from the Israeli military, which was surrounding it with armored vehicles.

AFPTV footage showed a fireball and smoke rising over the city at dawn. Early Friday sounds of apparent gunfire and explosions could be heard.

As the fighting raged in Gaza, air raid sirens sounded in Tel Aviv, while Hamas's military wing said it targeted the Israeli commercial hub with rockets. There were no immediate reports of casualties.

'No safe place'

The United Nations called for an end to the "carnage" in Gaza, saying "razing entire neighborhoods to the ground is not an answer for the egregious crimes committed by Hamas".

"To the contrary, it is creating a new generation of aggrieved Palestinians who are likely to continue the cycle of violence. The carnage simply must stop," Philippe Lazzarini, head of the United Nations' agency for Palestinian refugees UNRWA, wrote in an opinion piece.

The war in the densely populated coastal territory, which is effectively sealed off, has prompted repeated calls for a ceasefire to protect civilian lives and allow in more humanitarian aid.

Tens of thousands of people have fled to the south of the territory in recent days, often on foot and with only the things the could carry.

"Enough destruction, there's nothing left. We need a truce to see what will later happen to us, a truce to bring medicine or aid to the hospitals," said Mohammed Khader, who was displaced in Rafah.

"Those hospitals are now full of displaced people and not only injured and martyrs," he added.

Israeli Prime Minister Benjamin Netanyahu has repeatedly rejected halting the fighting, telling Fox News Thursday that a "ceasefire with Hamas means surrender to Hamas, surrender to terror."

He also said Israel does not "seek to govern Gaza" in the long run.

"We don't seek to occupy it, but we seek to give it and us a better future," he told the US broadcaster.

Almost 1.6 million people have been internally displaced since October 7, UNRWA said, more than half Gaza's population.

But the UN estimates hundreds of thousands of civilians remain in the fiercest battle zones in the north.

Hostages

Complicating Israel's military push is the fate of the hostages abducted on October 7.

CIA director Bill Burns and David Barnea, head of Israel's Mossad spy agency, were in Doha for talks on pauses that would include hostage releases and more aid for Gaza, an official told AFP on Thursday.

Four hostages have been freed so far by Hamas and another released in an Israeli operation, and the desperate relatives of those still held in Gaza have piled pressure on Israeli and US authorities to secure the release of their loved ones.

The conflict has also stoked regional tensions, with cross-border exchanges between the Israeli army and Lebanon's Hezbollah, and Yemen's Iran-backed Huthi rebels saying they launched "ballistic missiles" at southern Israel.

Iran's Foreign Minister Hossein Amir-Abdollahian said the expansion of the Israel-Hamas war has become "inevitable".

The Islamic republic, which supports Hamas financially and militarily, has hailed the militant group's attack on Israel as a "success" but denied any involvement. 

Saudi Arabia is hosting Arab leaders and Iran's president for two summits this weekend for emergency meetings of the Arab League and the Organisation of Islamic Cooperation.

The world's biggest oil exporter and its neighbors are "united in fearing one thing in particular, which is a broader escalation", said Elham Fakhro of Chatham House.

US Secretary of State Antony Blinken wrapped up a marathon diplomatic push Friday in India after a whirlwind Middle East trip and G7 talks, saying Israel's pauses in its Gaza offensive would "save lives" but more was needed.

"Far too many Palestinians have been killed," Blinken said in New Delhi, his last stop before heading home, where he repeated US support for ally Israel but was firm that more aid had to reach civilians in Gaza.