Israel has ordered civilians to leave four towns in the southern part of the Gaza Strip, raising fears its war against Hamas could spread to areas it had told people were safe.

In the north of the Hamas-ruled Palestinian enclave, Israel said its forces were still present at Gaza’s biggest hospital, Al Shifa, but gave no further details of their operations since the previous day when they entered the facility culminating a days-long siege.

Reuters was unable to verify the situation at Shifa on Thursday morning, having lost contact with doctors inside it since Wednesday.

Leaflets dropped overnight from aircraft told civilians to leave the towns of Bani Shuhaila, Khuzaa, Abassan and Qarara, on the eastern edge of Khan Younis, the main southern city.

The towns, collectively home to more than 100,000 people in peacetime, are now sheltering tens of thousands more who fled other areas.

“The acts of Hamas terrorist group require the defence forces to act against them in the areas of your residence,” the leaflets said.

“For your safety, you need to evacuate your places of residence immediately and head to known shelters.”

Residents said the area came under heavy bombardment overnight.

Israel has already ordered the evacuation of the entire northern half of Gaza before sending in its ground forces at the end of October.

Tactical pauses

Long processions of people clutching just a few possessions have made their way south each day under the eyes of Israeli soldiers during six-hour “tactical pauses” to allow residents to leave.

The United Nations says about two-thirds of Gaza’s 2.3 million people have been made homeless, most of them sheltering in towns in the south, since Israel began retaliation against Hamas for a deadly rampage in southern Israeli towns.

Hamas militants burst through the fence around Gaza on October 7 in an assault that Israel says killed 1200 people in the deadliest day in its history. Around 240 hostages were dragged back to Gaza.

Since then, Israel has pounded Gaza with air strikes and cut off food and fuel. Gaza health authorities deemed reliable by the United Nations say more than 11,000 people have been confirmed killed, more than 40 per cent of them children, with many more feared trapped under rubble of bombed out homes.

The situation on the second day of Israel’s operation in Al Shifa hospital was impossible to confirm, with communications cut off since Wednesday afternoon.

The plight of the hospital had drawn international alarm, with hundreds of patients and thousands of other displaced civilians trapped inside without fuel, oxygen or basic supplies.

Patients become casualties

Medics said dozens of patients had died in recent says as a result of Israel’s siege, including three newborn babies in incubators that lost power.

A day after entering Shifa, Israel had yet to produce evidence showing what it had claimed was a vast Hamas headquarters in tunnels beneath the facility, which it had said justified treating it as a military target.

Israel released a video in which a soldier toured a hospital building, showing three bags with guns and flak jackets he said had been found stashed there, as well as several other rifles in a closet, and a laptop computer.

Hamas said the video was staged. Other Palestinians said that even on its face it depicted nothing like the vast underground militant headquarters complex that Israel had claimed was inside the compound.

Attention was focused anew on Thursday on Israel’s future plans for Gaza after its president, Isaac Herzog told Britain’s Financial Times a “very strong force” may need to remain there for the near future to prevent the Hamas militant group re-emerging after the war.

US President Joe Biden warned on Wednesday that occupying Gaza would be “a big mistake” for Israel.

-AAP