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.

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DEIR AL-BALAH, Gaza Strip (AP) — Israeli strikes across the Gaza Strip overnight and into Sunday killed at least 22 people, including five children, Palestinian medical officials said, while Gaza’s small Christian community celebrated a pre-Christmas Mass.

Israeli authorities allowed a rare Gaza visit by the leader of the Catholic Church in the Holy Land, Cardinal Pierbattista Pizzaballa, for the Mass while the ever-present buzz of Israeli drones was heard outside.

One of the latest Israeli strikes hit a school housing displaced people in Gaza City and killed at least eight, including three children, according to Gaza’s Health Ministry. Israel’s military said it struck Hamas militants sheltering there.

A strike on a home in the central city of Deir al-Balah late Saturday killed at least eight, including three women and two children, according to Al-Aqsa Martyrs Hospital, which received the bodies. Another six people were killed in separate strikes on Sunday, according to local hospitals.

“The children are still inside the house. We are looking for them. They were sleeping in the living room, five of them together,” said a relative of a victim, Noman Abu Samra, as people searched rubble in Deir al-Balah. A window full of children looked on.

Israel has carried out daily strikes in Gaza more than 14 months into the war with Hamas. It says it only targets militants, accusing them of hiding among civilians, but the bombings frequently kill women and children.

Israel and Hamas recently appeared to draw closer to a ceasefire agreement that would include the release of Israeli hostages and Palestinian prisoners, but several obstacles remain, and the indirect talks have repeatedly stalled.

Dozens of worshipers gathered in the Holy Family Church in Gaza City as Pizzaballa and other clergy celebrated Mass. A twinkling Christmas tree was decorated with golden ornaments.

“I want to say, to tell you, that all the world, not only the Christian world, all the world is with you, So the war will finish and we will rebuild,” the cardinal said, urging Gazans to never be afraid.

His visit came as Pope Francis again criticized Israel’s actions in Gaza. Francis said Saturday that his envoy had been unable to enter the territory because of Israeli bombing.

“Yesterday children have been bombed. This is cruelty, this is not war,” Francis said during his annual Christmas greetings at the Vatican. On Sunday, he called for a ceasefire.

The pope recently called for an investigation to determine if Israel’s actions in Gaza constitute genocide, a conclusion later reached by Amnesty International and Human Rights Watch. The International Court of Justice is investigating genocide allegations brought against Israel by South Africa.

Israel, which was founded as a refuge for Jews after the Nazi Holocaust, rejects such allegations. It says it is only at war with Hamas, which it accuses of genocidal violence in the attack that ignited the war.

In that Oct. 7, 2023, attack, Hamas-led militants stormed into southern Israel and killed some 1,200 people, mostly civilians, and abducted around 250. Around 100 hostages are still in Gaza, at least a third believed to be dead.

Israel’s subsequent bombardment and ground invasion have killed over 45,000 Palestinians in Gaza, more than half of them women and children, according to the Gaza Health Ministry, which does not distinguish between fighters and civilians in its count.

The offensive has caused widespread destruction and displaced some 90% of Gaza’s 2.3 million people, often multiple times. Hundreds of thousands are packed into squalid tent camps along the coast as the cold, wet winter sets in.

Israel has been carrying out a major operation in northern Gaza since early October, battling Hamas in the most isolated and heavily damaged part of the territory. Tens of thousands have fled as the military has ordered a complete evacuation and allowed almost no humanitarian aid to enter.

The Israeli military body overseeing civilian affairs in Gaza, known as COGAT, said on Friday it facilitated the evacuation of over 100 patients, caregivers and others from Kamal Adwan Hospital and Al-Awda Hospital in the north. They have struggled to function. COGAT said it also facilitated the delivery of 5,000 liters of fuel and food packages to the hospitals.

Kamal Adwan’s director on Saturday asserted that Israel’s military had ordered an evacuation and said shelling was occurring. Israel’s military on Sunday said there was no evacuation order and it was unaware of any strikes there.

In the volatile West Bank town of Jenin, militants shot and killed a member of the Palestinian security forces and wounded two others. The Western-backed Palestinian Authority launched a rare crackdown there this month.

A statement from the security forces blamed the shooting on “outlaws,” without elaborating. The PA is internationally recognized but deeply unpopular among Palestinians, in part because it cooperates with Israel on security matters.

The PA exercises limited authority in population centers in the West Bank. Israel captured the territory in the 1967 Mideast War, and the Palestinians want it to form the main part of their future state.

Goldenberg reported from Tel Aviv, Israel.

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