Warning: This story contains graphic and distressing content throughout.

Doctors and hospitals that were already barely functioning in Gaza have been thrown back into chaos, with Palestinian casualties rapidly climbing as a result of what local health officials say is now the deadliest bombing campaign of Israel’s 17-month offensive.

Israeli Prime Minister Benjamin Netanyahu ordered the slew of airstrikes across Gaza early Tuesday, shattering the fragile ceasefire agreement with Hamas that began two months ago. The strikes killed more than 400 Palestinians overnight, at least 180 of whom were children, according to the Gaza Health Ministry.

“We received many bodies and body parts, most of them children and women,” Dr. Mohammed Qishta, who was at Nasser Hospital in Khan Younis, said in a recording to Doctors Without Borders, or MSF. “The bodies were everywhere in the emergency room, with complete confusion.”

Qishta is among the many doctors — both Gazan and foreign — who recounted to HuffPost, aid groups and on social media the mass-casualty nightmare they faced this week.

Israel and Hamas agreed to a ceasefire deal in January that included exchanging hostages from both sides over three phases, as well as the withdrawal of Israeli soldiers from Gaza. Despite sporadic attacks that mostly consisted of Israeli gunfire, displaced Palestinians had a chance to return to what little was left of home — retrieving loved ones’ bodies for burial and even beginning to rebuild.

But amid the truce, Dr. Feroze Sidhwa told HuffPost he had still been treating injuries that ultimately stemmed from the initial shootings and explosions, including buildings that collapsed after Israeli strikes rendered them structurally unsound.

“The first trauma operation I did here was for a 24-year-old guy who was trying to retrieve his dad’s dead body from inside their apartment,” said the surgeon, who entered Gaza with a MedGlobal team on March 6. “It had been bombed months before, and while he was doing that the apartment collapsed on him and tore his left kidney off of his aorta. He almost bled to death from this.”

The Israeli military killed at least 150 people during the ceasefire in Gaza, according to Euro-Med Monitor. The human rights group’s field team said Palestinians were usually targeted when they tried to return to their homes near the border.

Dr. Sabrina Das arrived in Gaza for the first time last week as part of a training mission to help doctors in the territory learn specific obstetrics tools. Before Tuesday’s bombardment, Das was at a United Nations clinic teaching doctors how to use handheld ultrasound devices on pregnant women — 50,000 of whom are currently trapped in Gaza, according to UNFPA, the U.N. agency focused on global reproductive health.

On March 2, Israel cut off all aid from entering Gaza, leaving Palestinians without access to food, water, fuel, shelter, medicine and other basic supplies. Dozens of ultrasound devices, some of which could save the lives of these women and their unborn children, have been stalled at the border for weeks now, says UNFPA, and Das said the blockade means pregnant women have no reliable access to pain relief.

“We have a lot of NGOs that are carrying basic infant nutrition, basic medicines,” the OB-GYN said. “And when you don’t allow them to come in, then you have bare shelves in the pharmacy, and you have bare shelves in the hospital.”

In the middle of the night, Israel began raining bombs across the entire Palestinian territory, killing hundreds of people in a matter of hours. Netanyahu said the attack was “only the beginning,” blaming Hamas for refusing to free half the remaining hostages as a precondition of extending the ceasefire, despite it not being what either party had initially agreed to.

Das was asleep in southern Gaza’s Al-Mawasi area when the strikes began. She recalled the bombs hitting so close to her that the doors shook with every explosion, describing her reaction as “an out-of-body experience” where “your brain knows what’s happening but you don’t want to believe it.”

Before Tuesday, Sidhwa had not heard a single bomb since his arrival — so when the door to the medical team’s living quarters at Nasser Hospital smashed open, the surgeon leaped out of bed.

“I jumped up and all of a sudden it was, I couldn’t tell you how many, but it was a lot of explosions in very rapid succession, and it continued all night long,” he said. “I kind of expected this to happen while I was here, but at the same time I don’t wanna pretend it’s not frightening to be in a place that’s being bombed to smithereens.”

Sidhwa and his colleagues ran downstairs to Nasser’s emergency room, an area he described as initially well-prepared ahead of the incoming flood of mass casualty patients.

Normally the first wave of people coming into the hospital for care aren’t in the most desperate need, he explained, since they were likely able to transport themselves. It’s the patients who are brought in by emergency personnel who usually need hospital resources the most.

But as the sheer number of casualties climbed, hospitals began struggling to keep up.

“The situation was very tense, and the doctors in the emergency room fell down and collapsed,” Qishta said. “They were crying due to the intensity and the difficulty of the situation.”

Hospitals across Gaza — most of which are only partially functioning, at most — became quickly overwhelmed. The situation is even worse due to the continued aid blockade and the Israeli military’s latest ground invasion, which has resulted in Gaza’s north and south again being cut off from each other.

Below are graphic details of some of the cases these doctors encountered.

“We’ve run out of ketamine, we’ve run out of propofol, we’ve run out of all painkillers,” Dr. Mohammed Mustafa said in a video he recorded from a hospital in the north and shared on Instagram. “We can’t sedate anyone, we can’t give them any analgesia. When we intubate people, they wake up and they’re choking because we have no sedation.”

The Gaza Health Ministry says most of the casualties from this week’s bombardment have been children and women, including the pregnant people Das and other OB-GYNs were hoping they could help.

An OB-GYN who has chosen to be publicly identified only as “Dr. Yacoub” for their security recalled a 30-year-old woman who was 22 weeks pregnant when she came to Kuwaiti Hospital with a head injury, only to be pronounced dead. Upon examination, Yacoub found that the baby was also dead.

At Nasser, Sidhwa and fellow trauma surgeon Dr. Morgan McMonagle went to what they called the “red area,” where patients are at the most immediate risk of death. Sidhwa himself worked on at least seven cases within seven hours, including a 29-year-old woman who had a hole in her sacrum, a rectum torn in half, and a wounded vagina, bladder and colon.

At the time he spoke to HuffPost, the surgeon said that the woman had died about a half hour earlier — and that she was the sister of another physician there.

“Almost every health care worker in Gaza has had somebody from their own family, either immediate or extended, come into the hospital while they were working in the ER, dead,” he said.

McMonagle also operated on startling cases, including a 6-year-old child with shrapnel wounds all over his chest and abdomen. The boy had two holes in his heart; a laceration in his left lung; his liver’s right side split in half; two holes in his colon; three holes in his stomach; and five holes in his small bowel. He did not survive.

Mustafa said that many of the people his hospital received were women and children “burned head to toe,” with limbs and sometimes heads missing from their bodies. Seven girls were getting their legs amputated without anesthesia, he added.

“I don’t know what to tell you. I was here in June – nothing to this intensity. This is unbelievable, and the bombing is still going on. The rooms are still shaking. The screams are everywhere. It’s insane,” he said.

“I need to just take 15 minutes or even an hour, just to rest to go back in there and go back down again,” he continued. “I feel awful to leave but I’ve been there all night and I haven’t stopped, and my legs are shaking. And I feel dizzy and lightheaded. The smell of burnt flesh is still in my nose.”

The carnage from Tuesday’s barrage of Israeli airstrikes is hardly over, with local health officials saying the military killed at least 85 more Palestinians over Wednesday night into Thursday. The victims were targeted in southern Gaza’s Khan Younis and Rafah, as well as northern Gaza’s Beit Lahiya.

Nasser Hospital received the bodies of several people killed in the new attack. Sidhwa said he operated on a young patient who needed a splenectomy, a left kidney repair, and a repair of holes in his transverse colon — all from shrapnel. He also had to break up a fight between a doctor and a patient’s husband, and “everybody said before the war that kind of thing would never have happened.”

Das is now helping at Nasser’s maternity ward, along with extra residents from the now-destroyed Al-Shifa Hospital. On Wednesday, she saw 110 people in the outpatient department, where droves of pregnant women are coming for scans due to their anxiety and the illusion that it’s safer to walk in the daytime. Cleanliness also remains an issue, she added.

“The stories are heartbreaking — like I said, the long-term impact of war on women — the nurse I was working with has 4 children and has to leave them alone to come to work,” Das updated HuffPost in a Thursday message. “Her husband was a teacher and was captured by the Israelis. Her 16 year old daughter is the same age as my daughter. Has to look after her siblings.”

Meanwhile, Israel’s aid blockade on Gaza has entered its 18th day and led to the closure of community kitchens and water desalination plants in the territory. Hospitals have either run out of supplies or are dangerously close to doing so.

“If this continues, we will absolutely be out of supplies, and quickly. I couldn’t tell you the number of hours or days, but it would not be very many,” Sidhwa said. “I cannot imagine we would have enough supplies that I would be able to operate competently to any kind of standard … for even another week.”

Humanitarians have accused Israel this week of violating international law, including in the killing of a U.N. staffer the agency called “no accident.” A slew of countries, human rights organizations, the U.N. and others in the international community have already accused Israel of committing genocide against the Palestinian people.

The U.S. has so far continued to support Israel, with President Donald Trump openly pushing to “take over” the territory and forcibly resettle residents. The White House admitted to signing off on Tuesday’s attack.

Israel has come under particular scrutiny for its targeting of Gaza’s health care system, laying siege to multiple hospitals and either killing doctors or taking them captive. On Thursday, Human Rights Watch released a report that claimed Israel had committed war crimes by causing deaths and unnecessary suffering while occupying Gaza’s hospitals.

Sidhwa recalled speaking with several doctors who were interested in helping Palestinians in Gaza, stressing to potential volunteers what they must consider before doing so.

“Look, if you want to, that’s good and you should. I wish more people did,” the surgeon said. “But you have to accept if you come here, that if the Israelis want to kill you they will, and nothing will happen to them for doing it. The U.S. won’t care, your own congressman won’t care, your president won’t care – whether it’s Biden or Trump, doesn’t matter.”

“And that’s just what it is,” he continued. “Don’t have any illusions about you being safe when you’re here.”

CAIRO (AP) — Hamas said Saturday it will only release an American-Israeli and the bodies of four other hostages if Israel implements their ceasefire agreement, calling it an “exceptional deal” aimed at getting the truce back on track. Meanwhile, Israeli airstrikes killed nine people in Gaza including local journalists, medics and a watchdog said.

A senior Hamas official said long-delayed talks over the ceasefire’s second phase would need to begin the day of the release and last no longer than 50 days. Israel also would need to stop barring the entry of humanitarian aid and withdraw from a strategic corridor along Gaza’s border with Egypt. Israel has said it won’t withdraw there, citing the need to combat weapons smuggling.

Hamas would also demand the release of more Palestinian prisoners in exchange for hostages, said the official, who spoke on condition of anonymity to discuss the closed-door talks.

Edan Alexander, 21, who grew up in New Jersey, was abducted from his military base during Hamas’ Oct. 7, 2023, attack that ignited the war. He is the last living U.S. citizen held in Gaza. Hamas still has 59 hostages, 35 believed to be dead.

Speaking at a protest camp set up last week outside Israeli military headquarters in Tel Aviv, relatives of hostages said Netanyahu was “violating the agreement he signed and abandoning the hostages in Gaza.”

“You want to sacrifice our children for the pleasures of power,” said Itzik Horn, father of hostage Eitan and freed hostage Iair.

Prime Minister Benjamin Netanyahu late Saturday told negotiators to prepare for the continuation of talks regarding the release of hostages, his office said.

Two Israeli airstrikes in the northern town of Beit Lahiya near the border killed at least nine people, according to Gaza’s Health Ministry.

The Palestinian Journalists’ Protection Center, a local watchdog, said the dead included three Palestinian journalists who were documenting aid distribution. Local health official Fares Awad identified one as Mahmoud Islim, who was operating a drone.

The Israeli military said it struck two people operating a drone that it said posed a threat to soldiers in the area. It said it launched another strike at a group of people who came to collect the drone equipment. The army identified all of those targeted as suspected militants, without providing evidence.

Hamas in a statement called the attack a “serious escalation” showing Israel’s attempts to “sabotage any opportunity” to implement the ceasefire agreement.

Also Saturday, Israel’s military said it removed a platoon of soldiers from Gaza who were seen in a video on social media opening fire during a celebration of the Jewish holiday of Purim. The video shows soldiers shooting, apparently randomly, while another performs the customary reading of the Book of Esther. The military said the soldiers “will face disciplinary measures.”

No major fighting has occurred in Gaza since the ceasefire took hold on Jan. 19, but Israeli strikes have killed dozens of Palestinians who the military said had entered unauthorized areas, engaged in militant activities or otherwise violated the truce.

The United States said it presented on Wednesday a proposal to extend the ceasefire a few weeks as the sides negotiate a permanent truce. It said Hamas was claiming flexibility in public while privately making “entirely impractical” demands.

Talks continued in Egypt, which along with Qatar has served as mediators with Hamas in the indirect talks with Israel.

Israel and Hamas were to begin negotiations on the ceasefire’s second phase in early February, but only preparatory talks have been held. In Phase Two, Hamas would release all remaining hostages in exchange for a lasting truce.

The first phase saw the release of 25 Israeli hostages and the bodies of eight others in exchange for nearly 2,000 Palestinian prisoners. Israeli forces pulled back to a buffer zone along Gaza’s border and allowed a surge of humanitarian aid.

After the first phase ended early this month, Israel said it had agreed to a new U.S. proposal in which Hamas would release half the remaining hostages in return for a vague commitment to negotiate a lasting ceasefire. Hamas rejected that offer.

Netanyahu’s office said in a statement that he held in-depth discussions with the negotiating team and security officials on Saturday evening. Afterward, he told the negotiating team to prepare for continued talks as per the mediator’s response to U.S. envoy Steve Witkoff’s proposal, the statement said.

For two weeks, Israel has barred the delivery of food, fuel and other supplies to Gaza’s roughly 2 million Palestinians, and cut electricity to the territory a week ago, to pressure Hamas to accept the new proposal.

The southern city of Rafah, on the Gaza-Egypt border, said it could no longer provide fuel needed to pump water from dozens of wells.

Ahmed al-Sufi, head of the municipality, said fuel shortages caused by the Israeli siege have forced it to “suspend essential services, threatening the lives of thousands.”

The war has destroyed vast areas of Gaza, displaced most of the population and left nearly everyone dependent on international aid.

The war began when Hamas-led militants stormed into southern Israel, killing some 1,200 people, mostly civilians, and taking 251 hostage. Most have been released in deals, while Israel rescued eight living hostages and recovered the bodies of dozens more.

Israel’s military offensive has killed over 48,000 Palestinians, mostly women and children, according to Gaza’s Health Ministry, which does not say how many were combatants. Israel says it has killed around 20,000 militants, without providing evidence.

Associated Press writer Natalie Melzer in Nahariya, Israel contributed to this report.

CAIRO (AP) — Hamas said Thursday it would release three more Israeli hostages as planned, paving the way toward resolving a major dispute over the ceasefire in the Gaza Strip.

Hamas had threatened to delay the next release of captives, accusing Israel of failing to meet its obligations to allow in tents and shelters, among other alleged violations of the truce. Israel, with the support of U.S. President Donald Trump, had threatened to renew its offensive if hostages were not freed.

There was no immediate comment from Israel on Hamas’ announcement, but it should allow the ceasefire to continue for now, though the future of the truce remains in doubt.

Hamas said its delegation held talks in Cairo with Egyptian officials and was in contact with Qatar’s prime minister about bringing into Gaza more shelters, medical supplies, fuel and heavy equipment for clearing rubble — its key demand in recent days. It said in a statement that the mediators had pledged to “remove all hurdles.”

Shortly after the announcement, Hamas spokesman Abdul Latif al-Qanou confirmed to The Associated Press by phone that three hostages will be released on Saturday.

Egypt’s state-run Qahera TV, which is close to the country’s security services, reported that Egypt and Qatar had succeeded in resolving the dispute. The two Arab countries have served as key mediators with Hamas and helped broker the ceasefire, which took effect in January, more than 15 months into the war.

Egyptian media also aired footage showing trucks carrying temporary housing and bulldozers on the Egyptian side of the Rafah crossing with Gaza. They reported that the trucks were heading to an Israeli inspection area before crossing into Gaza.

The truce faces a much bigger challenge in the coming weeks. The first phase is set to conclude at the beginning of March, and there have not yet been substantive negotiations over the second phase, in which Hamas would release dozens of remaining hostages in return for an end to the war.

Trump’s proposal to remove some 2 million Palestinians from Gaza and settle them in other countries has thrown the truce’s future into further doubt. The plan has been welcomed by Israel but vehemently rejected by Palestinians and Arab countries, which have refused to accept any influx of refugees. Human rights groups say it could amount to a war crime under international law.

Israeli Prime Minister Benjamin Netanyahu’s far-right allies are already calling for a resumption of the war after the first phase with the goal of implementing Trump’s plan and annihilating Hamas, which remains in control of the territory after surviving one of the deadliest and most destructive military campaigns in recent history.

The war began on Oct. 7, 2023, when Hamas-led militants stormed into Israel, killing some 1,200 people, mainly civilians, and abducting around 250 people. More than half have been released in deals with Hamas or other agreements, eight have been rescued and dozens of bodies have been recovered.

The captives are among the only bargaining chips Hamas has left, and it may be difficult to get the group to commit to further releases if it believes the war will resume.

Trump has given mixed signals about what he wants to see in Gaza.

He took credit for brokering the ceasefire, which was reached days before he took office after more than a year of negotiations under the Biden administration. But he has also expressed misgivings about how the agreement is unfolding and says it’s up to Israel whether to resume the war or not, while pledging continued U.S. military support.

Seventy-three hostages have not yet been released, around half of whom are believed to be dead. Nearly all the remaining hostages are men, including Israeli soldiers.

The war has killed over 48,000 Palestinians, mostly women and children, according to Gaza’s Health Ministry, which does not say how many were fighters. Israel says it has killed over 17,000 militants, without providing evidence.

Israel’s offensive has obliterated large parts of Gaza. At its height, the fighting had displaced 90% of the territory’s population of 2.3 million. Hundreds of thousands have returned to their homes since the ceasefire took hold, though many have found only mounds of rubble and buried human remains and unexploded ordnance.

Israeli Defense Minister Israel Katz, echoing Trump, said Wednesday that “all hell will break loose” if Hamas stops releasing hostages. He said a “new Gaza war” wouldn’t end until Hamas was defeated, which would allow for Trump’s vision of mass displacement to be carried out.

With far fewer hostages remaining in Gaza, Israel’s military would have more freedom to act.

It would also face far fewer constraints from the United States, its main military patron. The Biden administration, while providing crucial military and diplomatic support, had occasionally pressed Israel to allow in more aid and at one point suspended some weapons shipments. It had also said there should be no permanent displacement of Gaza’s Palestinian population.

Trump has lifted restrictions on arms transfers, and his administration is pressing ahead with the sale of $7 billion worth of weapons approved under President Joe Biden.

Trump has said Gaza’s population should be resettled elsewhere in the region, with wealthy Arab countries paying for it. He has suggested that once the fighting ends, Israel would transfer control of Gaza to the United States, which would then redevelop it as the “Riviera of the Middle East.”

Israeli Finance Minister Bezalel Smotrich, a key partner in Netanyahu’s fragile governing coalition, has called for a resumption of the war, the “voluntary migration” of large numbers of Palestinians from Gaza and the reestablishment of Jewish settlements there.

Lidman reported from Jerusalem.

Follow AP’s war coverage at https://apnews.com/hub/israel-hamas-war

TEL AVIV, Israel (AP) — Four female Israeli soldiers who had been held hostage by Hamas returned safely to Israel Saturday after the militants paraded them in front of a crowd of thousands in Gaza City and then handed them over to the Red Cross. In exchange, Israel released 200 Palestinian prisoners as part of the fragile ceasefire in the Gaza Strip.

The four Israelis smiled broadly as they waved and gave the thumbs-up from a stage in Gaza City’s Palestine Square, militants on either side of them and a crowd of thousands watching before they were led off to waiting Red Cross vehicles. They were likely acting under duress, with previously released hostages saying they were held in brutal conditions and forced to record propaganda videos.

Israel’s Prison Service later said it had completed the release of 200 Palestinians. They included 121 who had been serving life sentences after being convicted of deadly attacks against Israelis. Around 70 were released into Egypt, according to Egypt’s state-run Qahera TV. Egypt had served as a key mediator in the talks that led to the truce.

Thousands of Palestinians gathered in the occupied West Bank city of Ramallah to celebrate the arrival of buses carrying the prisoners. Many waved Palestinian flags or the flags of different political factions.

As the four Israelis were released, hundreds of people cheered in Tel Aviv’s Hostages Square where they were watching the drama unfold on a big screen television.

“I had goosebumps watching them,” said Aviv Bercovich, one of the onlookers. “I just want the war to end.”

The freed hostages were taken to an Israeli army base, where they were reunited with their parents, and could be seen in pictures hugging them emotionally.

As they arrived by helicopter to a Tel Aviv hospital, thousands of people dancing and celebrating outside outside looked up to see them land.

Prime Minister Benjamin Netanyahu’s office later said Israel would not allow displaced Palestinians to begin returning to northern Gaza, which had been expected to begin by Sunday, because a civilian hostage who was supposed to be released by Hamas had not been freed.

It said Israel would not allow Palestinians to begin returning to northern Gaza, which had been expected to begin by Sunday, until Arbel Yehoud was freed.

A senior Hamas official said the group has informed mediators that Yehoud will be released next week.

Meantime, an Egyptian official involved in the negotiations called the matter a “minor issue” that mediators are working to resolve. Both officials spoke on condition of anonymity because they were not authorized to discuss the matter publicly.

It was the second such exchange between Israel and Hamas since a ceasefire began in the Gaza Strip last weekend. The excitement in Israel was palpable, with TV stations filled with live reports from smiling news anchors and reporters interviewing ecstatic friends and relatives of the hostages.

The truce is aimed at winding down the deadliest and most destructive war ever fought between Israel and the militant group. The fragile deal has so far held, quieting airstrikes and rockets and allowing for increased aid to flow into the tiny coastal territory.

When the ceasefire started Sunday, three hostages held by the militants were released in exchange for 90 Palestinian prisoners, all women and children.

The four Israeli soldiers, Karina Ariev, 20, Daniella Gilboa, 20, Naama Levy, 20, and Albag, 19, were captured in Hamas’ Oct. 7, 2023, attack that ignited the war.

In exchange, Israel agreed to release 200 prisoners, including 121 who were serving life sentences, according to a list released by Hamas.

The more notorious militants being released include Mohammad Odeh, 52, and Wael Qassim, 54, both from east Jerusalem. They were accused of carrying out a series of deadly Hamas attacks against Israelis, including a bombing at a cafeteria at the Hebrew University of Jerusalem in 2002 that killed nine people, including five U.S. citizens.

Of the 70 who were expelled to Egypt, some may eventually go to other countries, with Algeria, Tunisia and Turkey all expressing a willingness to take them in, according to Abdullah al-Zaghari, the head of a Palestinian prisoner advocacy group.

The four Israeli soldiers released were taken from Nahal Oz base near the border with Gaza when Palestinian militants overran it, killing more than 60 soldiers there. A fifth female soldier in their unit, Agam Berger, 20, was abducted with them but not included in the list.

“This is huge,” said Gaza City resident Radwan Abu Rawiya, one of thousands who watched the hostages turned over in Palestine Square.

“People forgot about the war, destruction and are celebrating,” he said.

In a televised statement, Israel’s army spokesman Rear Adm. Daniel Hagari criticized what he called the “cynical” public display of the young women by Hamas before their release.

He also said that Israel is concerned about the fate of the two youngest hostages — Kfir and Ariel Bibas — and their mother Shiri. Kfir Bibas marked his second birthday in captivity earlier this month.

Hagari said the army is committed to bringing all hostages home.

Israel had been expected to begin pulling back from the Netzarim corridor — an east-west road dividing Gaza in two — and allowing displaced Palestinians in the south to return to their former homes in the north for the first time since the beginning of the war.

But that appears to be on hold pending the release of Yehoud.

The Hamas-run interior ministry said earlier said that displaced Palestinians will be allowed to return to northern Gaza starting Sunday.

What happens after the deal’s initial six-week phase is uncertain, but many hope it will lead to the end of a war that has leveled wide swaths of Gaza, displaced the vast majority of its population and left hundreds of thousands of people at risk of famine.

The conflict began with a cross-border attack led by Hamas on Oct. 7, 2023, when Palestinian militants killed some 1,200 people, mostly civilians, and took around 250 others hostage.

More than 100 hostages were freed in a weeklong truce the following month. But dozens have remained in captivity for over a year with no contact with the outside world. Israel believes at least a third of the more than 90 captives still inside Gaza were killed in the initial attack or died in captivity.

While many rejoiced in Tel Aviv’s Hostage Square after the four soldiers were released Saturday, some worried about the fate of those still in captivity.

“It’s hard that she’s still there,” said Yoni Collins, a family friend of Berger, the fifth female soldier taken from Nahal Oz base.

“There were five girls, four are out and now she’s there alone,” he said. “We’re just waiting for her to come home.”

Israel’s air and ground war, one of the deadliest and most destructive in decades, has killed over 47,000 Palestinians, according to local health officials, who do not say how many were militants. They say women and children make up more than half the fatalities.

Magdy reported from Cairo, Shurafa reported from Deir Al-Balah, Gaza Strip. Joseph Federman in Jerusalem, Sam McNeil at Reim Military Base, Israel, Isabel DeBre from Ramallah, West Bank, and David Rising in Bangkok contributed to this report.

After more than a year of relentless attacks and tens of thousands of deaths, Israel and Hamas have finally agreed to a deal that includes a ceasefire in Gaza and the release of dozens of hostages.

But until now, Israel had ignored the international community in its decimation of the territory, so Palestinians and humanitarians are expressing cautious optimism that the military will keep its promises in the agreement.

There is deep skepticism and caution as a humanitarian, “but if the bombing stops even for a bit I’m elated,” Dr. John Kahler, MedGlobal’s co-founder who has provided medical aid in Gaza, told HuffPost.

The agreement came 15 months after Hamas militants launched an attack in Israel in which about 1,200 people were killed and more than 200 were taken hostage, roughly half of whom are estimated to still be in captivity. Since that attack on Oct. 7, 2023, Israeli forces, largely armed by the U.S., have killed more than 46,000 Palestinians and reduced most of the Gaza Strip to rubble ― a military campaign that leading human rights groups and United Nations experts have labeled a genocide.

The deal is “a crucial step toward reducing the killing of Palestinians through deadly force,” the Palestinian Al-Mezan Center said. “However, the ceasefire alone will not the ongoing genocide that Israel is perpetrating against the Palestinian people in Gaza.”

“What is required is for Israel to end all ongoing genocidal acts, open Gaza, and for the international community to ensure accountability for those responsible.”

The Gaza Media Office warned residents on Telegram to show “complete vigilance and the utmost caution” when it comes to the Israeli military, which has escalated attacks before when a ceasefire and hostage deal appeared close. Since early Tuesday, during negotiations, the Gaza Health Ministry reported at least 57 Palestinians have been killed in Israeli attacks, all while the region’s rainy winter continues to affect 1.9 million displaced Palestinians.

“There’s no confined rooms where patients can be treated,” Dr. Sayed Sayeed, who recently returned to the U.S. from providing medical aid in Gaza, said earlier this month. “The anti-sepsis measures that we can take are extremely limited. Antibiotics are limited, dressings are limited, to the point where sometimes I would examine patients with one glove because there is a limitation on gloves.”

The skepticism from Gaza also comes from seeing how November’s ceasefire agreement between Israel and Hezbollah has played out in Lebanon. Both the Lebanese government and the U.N. peacekeeping forces in the country’s southern region have accused Israel of repeatedly violating the terms of the agreement and listed to the U.N. Security Council more than 800 incidents of Israeli forces attacking the country since the deal was reached.

“A ceasefire between Israel and Hamas is a vital first step towards alleviating the current humanitarian catastrophe afflicting civilians in Gaza, but it must be followed by immediate access by the civilian population to objects indispensable to its survival and the facilitation of full, rapid, safe and unhindered entry of humanitarian assistance,” said Anna Gallina, Gaza project lead for the Global Rights Compliance’s starvation and humanitarian crisis division.

“A hallmark of the tactics used by the Israeli Defense Forces in this war has been the deliberate obstruction and restriction of humanitarian aid, coupled with attacks on aid workers and a neglect of the basic tenets of international humanitarian law,” she continued. “As a result, the population of Gaza has experienced an unprecedented scale of civilian casualties, repeated displacement and widespread famine ― it is now vital that all actors persevere with demands to restore basic standards of living in Gaza and lasting peace.”

The Israeli military had blocked most aid routes into Gaza, greatly limiting the humanitarian assistance that could enter the territory and creating uninhabitable conditions that led to the breakdown of social order when trucks did arrive. The military also made it nearly impossible for UNRWA, the U.N. agency responsible for assisting Palestinian refugees, to enter Gaza and distribute necessary aid.

For over a year, humanitarians and experts have warned that rebuilding Gaza will be a long-term project that requires a massive increase in aid and the withdrawal of the occupation. In addition to rebuilding homes that have turned to ash, Palestinians will also need to re-create all the life-sustaining infrastructure Israel destroyed.

“Conditions must be created right now to allow humanitarian organizations to safely carry out their work, quickly reach people wherever they are in Gaza, and massively scale up their operations so we can stem the overwhelming tide of suffering,” CARE global humanitarian director Deepmala Mahla said.

“Today, we honor the memory of the hundreds of humanitarian workers who were killed doing their duty of trying to help those in need and hope that this ceasefire will allow us to adequately address the immense and catastrophic needs.”

Satellite imagery shows that Israel has destroyed 69% of buildings in Gaza, and the U.N. estimates it would take up to 15 years to clear 40 million tons of rubble, as well as unexploded bombs. Since October 2023, Israeli forces have destroyed every single university, as well as 90% of school buildings, according to Doctors Without Borders. Palestinians experiencing malnutrition, especially children, will have to recover over a long-term period due to the health risks that come with quickening the refeeding process.

“This ceasefire will save lives ― but it won’t end the devastation Israel has wrought on the people of Gaza,” the Institute for Middle East Understanding posted on Tuesday.

“Israel has invaded Gaza’s hospitals and destroyed critical infrastructure like sewage facilities, water treatment plants, agricultural land, and more,” the group continued. “Even if the rebuilding of Gaza begins today, Palestinians will suffer from the impact of Israel’s genocide for years to come.”

Outgoing Secretary of State Antony Blinken laid out the U.S.’s proposed “day after” plan for Gaza on Tuesday at the Atlantic Council. The plan includes the international community helping the West-backed Palestinian Authority oversee Gaza’s civil affairs, such as access to water, energy and health care. It also includes an interim security force made of “partner nations” to help ensure “a secure environment for humanitarian and reconstruction efforts.”

Blinken did not mention that he and the Biden administration repeatedly crossed their own red lines to send billions of dollars worth of military aid to Israel, which used it to destroy Gaza’s water, energy and health care infrastructure in the first place. The administration also disputed human rights groups’ claims that Israel was blocking humanitarian aid to Gaza, despite overwhelming evidence and testimony from aid workers themselves.

“Let’s be clear. President Biden and his failed foreign policy team deserve zero credit for this belated deal,” Nihad Awad, executive director for the Council on American Islamic Relations, said in a statement. “Instead of using U.S. leverage to secure this deal long ago, they spent over a year violating U.S. law and making a mockery of international law by using billions of American taxpayer dollars to fund the Israeli government’s war crimes and depriving the American people of critical services.”