DEIR AL-BALAH, Gaza (AP) — A wave of Israeli strikes across Gaza on Sunday hit a hospital and other sites, killing at least 21 people, including children, as Israel vowed to expand its security presence in the small coastal strip.

The predawn strike on Al-Ahli Hospital in Gaza City was the latest of several attacks on northern Gaza’s last major hospital providing critical health care.

Hospital director Dr. Fadel Naim said the emergency room, pharmacy and surrounding buildings were severely damaged, affecting over 100 patients and dozens of staff.

One patient, a girl, died during the evacuation following an Israeli warning because staff were unable to provide urgent care, Gaza’s Health Ministry said. Israel said it struck a Hamas command and control center at the hospital, without providing evidence. Hamas denied the allegations.

Al-Ahli Hospital is run by the Episcopal Diocese of Jerusalem, which condemned the attack, saying in a statement it happened on “Palm Sunday, the start of the Holy Week, the most sacred week of the Christian year.”

Palm Sunday commemorates Jesus’ entry into Jerusalem, and worshipers in Gaza City marked it in a church whose gilded trim and intact walls were a contrast to the widespread debris elsewhere.

Associated Press video showed the hospital’s caved-in roof surrounded by rubble. The health ministry’s director general, Dr. Munir al-Boursh, said patients had been carried outside in beds and slept in the streets.

“Nothing was left safe inside the hospital, or all over Gaza,” said Mohammad Abu Nasser, an injured man who sat on his bed outdoors and looked at the destruction.

The health ministry said the hospital was temporarily out of service and patients were transferred to other hospitals in Gaza City. The aid group Medical Aid for Palestinians called it the fifth attack on Al-Ahli since the war began.

Hospitals have special protection under international law. Israel has besieged and raided them, some several times, and struck multiple ones while accusing Hamas of using them as cover for its fighters.

Last month Israel struck Nasser Hospital in Khan Younis, the largest in southern Gaza, killing two people and causing a large fire, the health ministry said. The facility had been overwhelmed when Israel ended a two-month ceasefire last month with a surprise wave of airstrikes.

Hours later Sunday, a strike on a car in Deir al-Balah in central Gaza killed at least seven people including six brothers, according to staff at Al-Aqsa Martyrs Hospital, which received the bodies. The youngest brother was 10.

Their father, Ibrahim Abu Mahadi, said his sons worked for a charity that distributes food to Palestinians. “For what sin were they killed?” he said.

AP reporters saw the mangled, bloodied car as relatives wept over the bodies. Israel’s military asserted that it killed the deputy head of a Hamas sniper cell.

An airstrike Sunday afternoon hit a house in the urban Jabaliya refugee camp in northern Gaza, killing at least seven people including two women, according to the Indonesian hospital.

A pregnant woman was rescued from the rubble. Alaa Manoun later wept after learning her youngest daughter had died, along with her husband and her mother. Two other daughters, ages 4 and 7, were injured.

Manoun had a broken ankle but otherwise seemed OK, according to a doctor. No scan was available, since the only machine in northern Gaza was at Al-Ahli Hospital, now damaged.

“We don’t know whose body is this and whose body is that,” said a neighbor, Abdallah Dardouna. “There is no resistance, there is no Qassam, no Hamas, there is no one here. It’s only civilians here.”

Another strike in Deir al-Balah hit a municipal building and killed at least three people, according to Al-Aqsa Martyrs Hospital. In Khan Younis, a strike killed at least three people, according to staff at Nasser Hospital.

Israel’s military said in a statement it had struck over 90 militant targets over the past 48 hours including command and control centers, tunnels and weapons. The military also said it had intercepted a projectile fired from Gaza.

The war started when Hamas-led militants killed 1,200 people, mostly civilians, during an Oct. 7, 2023, attack on southern Israel and took 250 people captive. Many were eventually freed in ceasefire deals.

Israeli authorities have vowed to pressure Hamas to release the remaining 59 hostages, 24 believed to be alive, and accept new ceasefire terms. It cut off all supplies to Gaza over a month ago.

More than 50,000 Palestinians have been killed in Israel’s retaliatory offensive, according to Gaza’s Health Ministry, which does not differentiate between combatants and civilians in its count but says more than half of the dead have been women and children.

Israel’s military said a missile was launched from Yemen on Sunday afternoon and the details were under review. Sirens sounded in several parts of Israel and the occupied West Bank. There were no reports of casualties or damage.

The Iranian-backed Houthi rebels in Yemen continue to target Israel in what they have called solidarity with the Palestinians in Gaza.

Magdy reported from Cairo.

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