Israel on Monday said soldiers fought near a major hospital in Gaza City and killed 21 Hamas militants in the firefight as clashes around medical facilities intensify.
The Israel Defense Forces (IDF) said Hamas fighters had embedded themselves among civilians in the al-Quds hospital and fired from the entrance of the facility at Israeli soldiers.
The Hamas militants fired rocket-propelled grenade launchers and damaged an Israeli tank, according to the IDF, before soldiers returned deadly fire. No IDF soldiers were injured, the military said.
"This incident is another example of Hamas' continued abuse of civilian structures, including hospitals, to carry out attacks," the IDF wrote in a post on Telegram.
The IDF also shared video footage of the alleged encounter that appeared to show a fighter with a launcher walking near the hospital entrance.
White House national security adviser Jake Sullivan on Sunday said the U.S. has asked Israel bring the battle into Gaza hospitals.
"The United States does not want to see firefights in hospitals, where innocent people, patients receiving medical care, are caught in the crossfire, and we've had active consultations with the Israeli Defense Forces on this," he told CBS's "Face the Nation."
Al-Quds is one of several hospitals across Gaza City where the IDF is fighting Hamas. Israel accuses Hamas of using the hospitals as cover for bases and operations, a claim the Palestinian militant group denies.
Israel has taken the fight to al-Shifa, one of the largest medical facilities in Gaza, which the IDF claims is the main base of operations for Hamas.
Humanitarian group Doctors Without Borders said Sunday al-Shifa is under siege with critically wounded patients and civilians inside.
The fighting around medical facilities raises major concerns around the laws of war. Hospitals are off-limits during war, though that special protection can be lost if the sites are used for harmful acts in a conflict, according to the International Committee of the Red Cross.
World Health Organization Director-General Tedros Adhanom Ghebreyesus said the hospitals in Gaza are struggling to maintain electricity, water and food and reiterated his call for a ceasefire.
"The constant gunfire and bombings in the area have exacerbated the already critical circumstances," he wrote on X, formerly Twitter. "Tragically, the number of patient fatalities has increased significantly."
Israel over the weekend said it provided 300 liters of fuel to support al-Shifa after the hospital ran out of fuel, but it's unclear how long that might last. The IDF has also opened evacuation corridors around the Shifa, Rantisi and Nasser hospitals.
Bob Kitchen, the vice president of emergencies at the humanitarian aid organization International Rescue Committee, said 95 percent of Gaza is without safe water and those crowding together face risk of diseases spreading.
Kitchen said "preserving the protection and functioning of hospitals and safety of civilians with nowhere safe to flee is not just a legal obligation, it’s a moral imperative."
"Our collective humanity demands that we protect all those not participating in war and work to save lives, even in the midst of chaos," he said in a statement.
Israel says it must completely eliminate Hamas in retaliation for a deadly Oct. 7 attack that killed 1,200 Israelis. The IDF says the militant group is hiding in hospitals and accuses Hamas of using civilians as shields.