“They call me many times to evacuate this hospital,” a Palestinian doctor who works at Al-Awda facility in the north of Gaza City told The Telegraph by voice note on Thursday evening. “[But] I refuse completely to leave … I’m here with my staff to provide health services and health care for injured people and pregnant women.”

Only hours later, as night fell, huge explosions were recorded pummelling the vicinity of Al-Awda, the main maternity provider in northern Gaza. It was one of four hospitals to experience direct, or extremely close, overnight bombardment as the Israel Defense Forces (IDF) pushed into Gaza City. 

By the morning, harrowing footage was circulating online showing men, women and children screaming and covered in blood in a courtyard of Al-Shifa hospital, the largest in Gaza. Reuters news agency said it had verified the footage and that one person had died.

“Allah, Allah,” victims cry, as the camera scans the aftermath of the shelling. One boy lies face-up, a pool of blood under his head, his arm draped across the curb. A young girl, no more than 12, cries into the camera, her face and hands covered in blood.

Israel has been urging hospitals in Gaza City to evacuate for weeks but to little avail. While the great bulk of the population has moved south, hospitals have remained open, with the UN and World Health Organisation unable or unwilling to evacuate them.

Some have emptied as fuel has run low and the fighting has got closer. But in others – notably the Al-Shifa, whose grounds the IDF says conceal Hamas command bunkers – civilians have flooded in, seeking shelter.

Between 50,000 and 60,000 people were sheltering inside and around the grounds of Al-Shifa as of Thursday, according to the Hamas-controlled health ministry in Gaza.

That may now finally be starting to change, as the IDF pushes ever deeper into the city and Hamas loses control over the local population. On Friday, there were reports and dramatic pictures of tens of thousands of people moving south, including hospital patients.

On Thursday evening, Dr Ghassan Abu Sitta, a British surgeon based at Al-Shifa, told the Telegraph that numbers in the hospital grounds were increasing but by Friday evening the tide appeared to have turned.

“Shifa hospital has collapsed. Wounded and staff leaving in droves,” he said on Twitter on Friday afternoon. 

Photographs released by the Associated Press appeared to confirm the exodus, showing thousands of people walking south, some carrying white flags and others being pushed in hospital wheelchairs. 

“People are forced to walk and being forced to raise white flags and hold their IDs and hands in the air,” said Tarneem Hammad, an advocacy and communications officer at Medical Aid Palestinian. 

“Many report their relatives being arrested [by soldiers], they don’t know what happens to them … People report seeing dead bodies on the road, with birds, crows and dogs eating the bodies.” 

Israeli troops now control what they describe as Hamas’s “military quarter”, a significant area of military and administrative facilities adjacent to Al-Shifa hospital in Gaza City. 

Israeli tanks have also taken up positions around the Rantisi, Al-Quds and Nasser Children’s hospitals, which were also starting to evacuate.

Mustafa al-Kahlout, the head of Al-Nasr Hospital for Children and Al-Rantisi Pediatric hospital, just north of Al-Shifa, told CNN that they were surrounded and asked for the Red Cross to assist with an evacuation.

“We are completely surrounded, there are tanks outside the hospital, and we cannot leave,” Mr Kahlout told the broadcaster. “We do not have electricity, no oxygen for the patients, we do not have medicine and water. We do not know our fate.”

Ever-encroaching Israeli troops, armour and air strikes were believed to be forcing similar panicked evacuations from hospitals across the area. The IDF has promised to push on in its fight to purge Gaza of Hamas terrorists.

“We won’t stop fighting for the people of Israel. That’s what we’re here for, and we’ll do everything so the communities surrounding Gaza can prosper again,” the IDF tweeted on Friday afternoon.

The IDF did not comment directly on Gaza’s hospitals on Friday, but confirmed fierce fighting in the surrounding areas, with some 150 Hamas operatives being killed.

Hospital evacuations of civilians and the walking wounded to the south will save many thousands of civilian lives, but they come far too late for serious patients who could only be moved with a negotiated temporary truce and intensive medical support.

Last month, the WHO said attempts to relocate the sick and injured from Gaza’s hospitals “could be tantamount to a death sentence”, despite mass evacuations of this kind being successfully executed in previous conflicts.
“There is no way that we can evacuate, there is no practical way of doing it,” the Gazan health ministry spokesman continued to insist on Friday.

“We are talking about 45 babies in incubators, 52 children in intensive care units, hundreds of wounded and patients, and tens of thousands of displaced people.”

There is no doubt that conditions in hospital wards are appalling and that help is desperately needed.

Fuel, medicines, blood supplies and other essentials have fallen to critically low levels, officials say, power cuts and a lack of clean water is making infection control nearly impossible.

The Telegraph reported last month that C-sections and other major surgeries were being performed by torchlight and without anaesthetic in some cases, while poor hygiene is causing terrible infections as patients’ wounds become full of worms and flies.

Footage and photos shared with The Telegraph on Wednesday by Palestinian medics showed terrible conditions inside Al-Shifa.

In one video clip, Dr Marwan Abusada, head of surgery at the hospital, describes how its cardiac surgery unit has been turned into a recovery area. The room is overflowing with cots, hospital beds, and injured patients.

“We are overwhelmed by a huge number of patients here”, he says. “There is no place to accommodate them.” 

A young boy can be seen in one of the beds with both legs in plaster and a medical screw in his left foot. The doctor explains that he was struck by an explosion while standing in front of the gates of the hospital.

In another video filmed at Al-Shifa, Dr Abusada shows a corridor overflowing with patients, many with terrible injuries.

“This is the corridor of our operating theatre. Many cases in the corridor, there is no place to accommodate more people here in Gaza,” he explains.

Doctors in scrubs weave between beds, stepping over unconscious bodies as they go.

On the floor, a grown man sits cross-legged, wiping the tears from his eyes as he looks down at a boy, a bandage wrapped around his bloodied head, wired up to an oxygen tank.

Dr Abu Sitta also shared with the Telegraph pictures of refrigerated food trucks that he says have been brought to Al-Shifa as an additional morgue for dead bodies.

Humanitarian groups have warned that thousands of mothers and newborn babies are now at risk owing to a lack of functioning maternity services in Gaza.

An estimated 50,000 pregnant women are living in Gaza, with an average 160 births expected to occur every day over the next month, according to the United Nations Population Fund (UNFPA).

In an audio recording shared by UNFPA with The Telegraph, one pregnant teenager who had entered labour described how she was turned away from Al-Shifa because of a lack of space.

“My contractions started at 4 o’clock in the morning,” said 17-year-old Samaa. “I went to Al-Shifa Hospital. They told us there was no maternity care. We kept walking in the street until we found a car.

“I was in a bad condition. I had a caesarean section. I didn’t wish to give birth in such a situation, during a war and in dire circumstances.”

Another pregnant woman described being “buried in rubble” following an airstrike.

“My face was all covered in blood, my hands, and my legs. Honestly, I couldn’t feel them,” said 26-year-old Sondos.

“I was transferred to the operating room for my legs because bones were shattered. After that, thank God, I gave birth to a girl. I will name her Habiba al-Rahman, after her sister who was martyred on the same day.”

The outbreak of secondary infections continues without clean water and antimicrobial drugs.

“We have a health disaster. We have a type of worm, called white flies, covering the wounds after the surgery. They appear after one day,” said Dr Abusada.

“Most injuries and surgeries have no follow-ups as the medical teams cannot cope with the influx of injuries every hour.”

Calling the situation “disastrous”, he said that the wards have “zero” space left for patients.

“On a normal day, we have a capacity of 210 beds, and now we have more than 800 patients that need to be admitted.”

As night settled over Gaza on Friday, there was no sign of a let up in the fighting around the hospitals.

Palestinian sources report that there is a heavy exchange of fire in Al-Quds Hospital area in Gaza City. The Red Crescent reported one dead and 20 wounded, including two seriously, from IDF fire.

There were also calls for the IDF to make greater efforts to reduce civilian deaths.

Speaking in New Delhi at the end of an intense nine-day diplomatic tour of the Middle East and Asia, Antony Blinken, the US secretary of state, said on Friday that the US “appreciates” Israel’s formalisation of pauses in their military operations to allow Palestinians to move south and its creation of a second safe corridor for them to use to escape harm but that more needed to be done.

Mr Blinken added that Israel’s steps “will save lives and will enable more assistance to get to Palestinians in need”, but at the same time ”much more needs to be done to protect civilians and to make sure that humanitarian assistance reaches them”.

He said “far too many Palestinians have been killed, far too many have suffered these past weeks” and that everything possible should be done to prevent harm and maximise the assistance they need.

Margaret Harris, a World Health Organisation spokesman, said on Friday that Al-Shifa hospital had been “coming under bombardment”, adding that 20 hospitals in Gaza were now out of action entirely.

Asked about the Gaza health ministry’s allegation of an Israeli strike on the hospital courtyard, Ms Harris said: “I haven’t got the details on Al-Shifa, but we do know they are coming under bombardment.” Asked to elaborate, she said there was “intense violence” at the site, quoting colleagues on the ground.

At the same briefing, Jens Laerke, a UN humanitarian office spokesman, said: “If there is hell on earth today, it’s name is northern Gaza. It is a life of fear by day and darkness at night and what do you tell your children in such a situation, it’s almost unimaginable – that the fire they see in the sky is out to kill them?”

Although the current focus is on the hospital in the north of Gaza, there are fears also for the south.

The flow of aid into the strip remains a fraction of what is usually delivered, as the Israeli government continues to limit the provision of supplies amid concerns it could be diverted to Hamas terrorists.

The US government said it “saw 106 trucks of humanitarian aid flow into Gaza through the Rafah crossing” on Wednesday. Prior to the war, more than 500 trucks were granted daily access to distribute food, water, medicine and other resources among the territory’s 2.3 million civilians.

With Gaza’s healthcare system on its knees, Turkey said on Friday it had sent a ship loaded with field hospital equipment, ambulances and generators to Egypt to treat war casualties. Other governments, including the UK, have sent officials to the border to support the flow of aid.

Despite the increasing international pressure, Israel has reiterated its intention to push ahead with its military operations until Hamas is destroyed in Gaza.

“It’s a process that will end in the defeat of Hamas as a governing authority,” said Lt Col Peter Lerner, the spokesman of the IDF, on Tuesday.

“We’re determined to do it. And, as I said, we really don’t have any other choice. There is no way that Israel can go back to the situation of October 6, the day before.”