Gaza hospital encircled by Israeli forces 'must be protected', says Biden

President Joe Biden Monday said that Gaza's largest hospital must be protected, and called for less intrusive action by Israeli forces.

Fighting between Israeli forces and Palestinian militants has encircled the sprawling medical facility, Shifa Hospital, prompting thousands to flee.

Shifa has been without electricity and water for three days, and gunfire and bombings outside the compound have made the situation more difficult.

It is my hope and expectation that there will be less intrusive action, Biden said in the Oval Office.

Battles between Israel and Hamas around hospitals forced thousands of Palestinians to flee from some of the last perceived safe places in northern Gaza, stranding critically wounded patients, including newborns, and their caregivers with dwindling supplies and no electricity, health officials said Monday.

The Israeli military has urged Palestinians to flee south on foot through what it calls safe corridors. But its stated goal of separating civilians from Hamas militants has come at a heavy cost: More than two-thirds of Gaza's 2.3 million people have fled their homes.

Thousands fled Gaza's Shifa Hospital over the weekend as Israeli troops encircled it, but hundreds of patients and displaced people remain, officials say. Shifa is not functioning as a hospital anymore, World Health Organization Director-General Tedros Adhanom Ghebreyesus said.

After power went out for Shifa's incubators, the Health Ministry in Hamas-ruled Gaza released a photo on Monday it says shows about a dozen premature babies wrapped in blankets together on a bed to keep them at a proper temperature. Otherwise, they immediately die, said the health ministry's director general, Medhat Abbas, who added that four of the babies had been delivered by cesarean section after their mothers died.

The Red Cross was attempting Monday to evacuate some 6,000 patients, staff and displaced people from a second hospital, Al-Quds, after it shut down for lack of fuel, but it said its convoy had to turn back because of shelling and fighting.

Both sides have seized on the plight of hospitals, particularly Shifa's, as a symbol of the larger war, now in its sixth week. The fighting was triggered by Hamas' Oct. 7 surprise attack into Israel, whose response has led to thousands of deaths and much destruction across Gaza.

For Palestinians, Shifa evokes the suffering of civilians. For weeks, staff running low on supplies have performed surgery there on war-wounded patients, including children, without anesthesia. Up until days ago, tens of thousands of people driven from their homes by airstrikes lived in and around the complex, hoping it would be safe.

Israel says Hamas shields itself among civilians, and that the hospital, Gaza's largest, is a prime example. It says the militants have a command center in and beneath the medical compound and released maps showing where it says they are located in the complex. But it has not provided any evidence.

Both Hamas and Shifa hospital staff deny the Israeli allegations.

The Palestinians accuse Israel of firing recklessly toward hospitals, while Israel accuses Hamas of using the hospitals for cover. On Monday, Israel released a video showing what it said was a militant with an RPG launcher entering Al-Quds hospital. An Israeli tank was stationed nearby.

Israeli officials recently released photos and footage showing what they described as gunmen firing from inside another hospital and the opening of tunnel next to it, though staff said it was the entrance to the facility's underground fuel tank. They also have shared footage of militants operating in residential neighborhoods and positioning rockets and weapons near schools, hospitals and mosques.

International law gives hospitals special protections during war. But hospitals can lose those protections if combatants use them to hide fighters or store weapons, according to the International Committee of the Red Cross.

Still, there must be plenty of warning to allow evacuation of staff and patients, and if harm to civilians from an attack is disproportionate to the military objective, it is illegal under international law. In an editorial published Friday in Britain's The Guardian newspaper, International Criminal Court prosecutor Karim Khan said the attacker must meet a high burden of proof to show that a hospital has lost its protections.

After the exodus of people from Shifa over the weekend, about 650 patients and 500 staff remain in the hospital, along with around 2,500 displaced Palestinians sheltering inside the complex, said Mohammed Zaqout, the director of hospitals in Gaza.

The Health Ministry said 32 patients, including three babies, have died since Shifa's emergency generator ran out of fuel Saturday. It said 36 babies, as well as other patients, are at risk of dying because life-saving equipment can't function.

Goudat Samy al-Madhoun, a healthcare worker, said he was among around 50 patients, staff and displaced people who made it out of Shifa and to the south Monday, including a woman who had been receiving kidney dialysis. He said those remaining in the hospital were mainly eating dates.

Al-Madhoun said Israeli forces fired on the group several times, wounding one man who had to be left behind. The dialysis pateint's son was detained at an Israeli checkpoint on the road south, he said.

The military said it placed 300 litres of fuel several blocks from Shifa, but Hamas militants prevented staff from reaching it. The Health Ministry disputed that, saying Israel refused its request that the Red Crescent bring them the fuel rather than staff venturing out for it. The fuel would have provided less than an hour of electricity, it said.

The U.S. has pushed for temporary pauses to allow wider distribution of badly needed aid. Israel has agreed only to daily windows during which civilians can flee northern Gaza along two main roads. It continues to strike what it says are militant targets across the territory, often killing women and children.