A fragile truce between Israel and Hamas held for a fifth day Tuesday, as the militant group released more hostages to delay the expected resumption of the war. Israel came under pressure from the United States to better protect Palestinian civilians in Gaza if its offensive resumes.

The latest swap of hostages for Palestinian prisoners held by Israel happened on Tuesday evening. Israel said 10 of its citizens and two foreigners were freed by Hamas and had entered Israel.

Mediators met in Qatar to try to extend the cease-fire beyond Wednesday. For the first time since it began, Israel and Hamas traded accusations of a serious violation with an exchange of fire between troops and militants in northern Gaza. But there was no indication that it would endanger the truce or the planned exchanges of hostages held in Gaza for Palestinians imprisoned in Israel.

The latest freed hostages – 9 women and a 17-year-old teenager – were being flown to hospitals in Israel, where they will be reunited with their families, the Israeli military said. Around 30 Palestinian prisoners are expected to be released as part of the deal negotiated by Qatar, Egypt, and the United States.

Tuesday's release brought to 60 the number of Israelis freed under the terms of the deal between Israel and Hamas. An additional 21 hostages have been released in separate negotiations. So far, 150 Palestinians have been released from Israeli prisons.

The Palestinian prisoners released so far have been mostly teenagers accused of throwing stones and firebombs during confrontations with Israeli forces. Some were convicted by Israeli courts of attempting to carry out deadly attacks.

Hopes to extend cease-fire

Israel has vowed to resume the war with "full force" to destroy Hamas once it's clear that no more hostages will be freed under the deal.

The Biden administration has told Israel it must avoid "significant further displacement" and mass casualties among Palestinian civilians if it resumes the offensive, and that it must operate with more precision in southern Gaza than it has in the north, according to US officials. The officials spoke on condition of anonymity under ground rules set by the White House.

CIA director William Burns and David Barnea, who heads Israel's Mossad intelligence agency, were in Qatar, a key mediator with Hamas , to discuss extending the cease-fire and releasing more hostages, a diplomat said on condition of anonymity because of the sensitivity of the talks. A US official confirmed Burns was in Qatar, speaking anonymously because the director's travel plans are not publicized for security reasons.

US Secretary of State Antony Blinken is set to visit the region this week , also with an eye to extending the truce.

Hamas and other militants are still holding about 160 hostages out of the 240 seized in their October 7 assault into southern Israel that ignited the war. Israel has said it is willing to extend the cease-fire by one day for every 10 additional hostages that Hamas releases, according to the deal brokered by the Qatar, Egypt and the US. But Hamas is expected to make much higher demands for the release of captive soldiers.

Israel has vowed to end Hamas' 16-year rule in Gaza and crush its military capabilities. That would almost certainly require expanding the ground offensive from northern Gaza to the south, where most of Gaza's population of 2.3 million is now crowded. It's unclear where they would go if Israel expands its ground operation, as Egypt has refused to accept refugees and Israel has sealed its border.

Freed hostages

The freed hostages have mostly stayed out of the public eye, but details of their captivity have started to emerge.

In one of the first interviews with a freed hostage , 78-year-old Ruti Munder told Israel's Channel 13 television that she was initially fed well in captivity but that conditions worsened as shortages took hold. She said she was kept in a "suffocating" room and slept on plastic chairs with a sheet for nearly 50 days.

Israel imposed a siege on Gaza at the start of the war and only allowed a trickle of food, water, medicine and fuel to enter prior to the cease-fire, leading to widespread shortages and a territory-wide power blackout.

Tuesday's exchange of fire between Israeli troops and Hamas fighters in northern Gaza underscored the fragility of the truce, with the warring sides holding their positions in close proximity to each other. Each side accused the other of being the blame for the outbreak, but there was no further report of violence.

Northern Gaza in ruins

The cease-fire has allowed residents who remained in Gaza City and other parts of the north to venture out to survey the destruction and try to locate and bury relatives.

A UN-led aid consortium estimates that, across Gaza, over 234,000 homes have been damaged and 46,000 completely destroyed, amounting to around 60% of the territory's housing stock. In the north, the destruction "severely compromises the ability to meet basic requirements to sustain life," it said.

More than 13,300 Palestinians have been killed since the war began, roughly two-thirds of them women and minors, according to the Health Ministry in Hamas-ruled Gaza , which does not differentiate between civilians and combatants. More than 1,200 people have been killed on the Israeli side, mostly civilians killed in the initial attack.

At least 77 soldiers have been killed in Israel's ground offensive. Israel says it has killed thousands of militants, without providing evidence.

The cease-fire has allowed increased aid of 160 to 200 trucks a day into Gaza , bringing desperately needed food, water and medicine, as well as fuel for homes, hospitals and water treatment plants. Still, it is less than half what Gaza was importing before the fighting, even as humanitarian needs have soared.

Risk of famine

The UN's World Food Program warned that the population at Gaza was at risk of famine. The WFP said it had delivered food to 121,161 people in Gaza since Friday, when a four-day truce between Israel and Hamas began.

"Thanks to the pause, our teams have been in action on the ground, going into areas we haven't reached for a long time. What we see is catastrophic," said WFP's director for the Middle East, Corinne Fleischer.

WFP estimated that it was "highly likely that the population of Gaza, especially women and children, are at high risk of famine if WFP is not able to provide continued access to food".

The agency said that six days was "not enough to make any meaningful impact", calling for "uninterrupted and regular supplies" of food into Gaza.