By Nidal al-Mughrabi and Humeyra Pamuk
GAZA (Reuters) - The United States on Friday expressed growing concern about the rising Palestinian death toll in the Gaza Strip where health officials said the number killed in a five-week-old Israeli bombardment had topped 11,000.
Fighting between Israeli forces and Hamas militants escalated near and around Gaza City's besieged and overcrowded hospitals, which Palestinian officials said were hit by explosions and gunfire.
In his strongest comments to date on the plight of civilians caught in the Gaza cross-fire, U.S. Secretary of State Antony Blinken told reporters on a visit to India: "Far too many Palestinians have been killed; far too many have suffered these past weeks."
Blinken welcomed daily four-hour humanitarian Israeli pauses that the White House announced on Thursday but said more action was needed to protect Gaza's civilians.
Israel has faced growing calls for restraint in its month-long war with Hamas but says the Islamist militants, who attacked Israel on Oct. 7 and took hostages, would exploit a truce to regroup.
"Israel is now launching a war on Gaza City hospitals," said Mohammad Abu Selmeyah, director of Al Shifa hospital.
He said later that at least 25 people were killed in Israeli strikes on Al-Buraq school in Gaza City, where people whose homes had been destroyed were sheltering.
Gaza officials said missiles landed in the courtyard of Al Shifa, the enclave's biggest hospital, in the early hours, damaged the Indonesian Hospital and reportedly set fire to the Nasser Rantissi paediatric cancer hospital.
Israel's military said later that a misfired projectile launched by Palestinian militants in Gaza had hit Shifa.
The hospitals are in northern Gaza, where Israel says the Hamas militants who attacked it last month are concentrated, and are full of displaced people as well as patients and doctors.
Israeli government spokesperson Eylon Levy said the Hamas headquarters was in Shifa hospital's basement, which meant the hospital could lose its protected status and become a legitimate target.
Israel says Hamas hides weapons in tunnels under hospitals, charges Hamas denies.
Israeli tanks, which have been advancing through northern Gaza for almost two weeks, have taken up positions around the Nasser Rantissi hospital as well as the Al-Quds hospital, medical staff said earlier, raising the alarm.
Gaza health ministry spokesman Ashraf Al-Qidra said Israel had bombed Shifa hospital buildings five times.
"One Palestinian was killed and several were wounded in the early morning attack," he said by phone. Videos verified by Reuters showed scenes of panic and people covered in blood.
GAZA DEATH TOLL TOPS 11,000
Palestinian officials said on Friday 11,078 Gaza residents had been killed in air and artillery strikes since Oct. 7.
On Friday Israel's Foreign Ministry said around 1,200 people had been killed, mostly civilians, in the Hamas attack on Oct. 7, a revision of the earlier death toll, although it added that might change again once all the bodies are identified.
Israel has also said about 240 were taken hostage by Hamas on Oct. 7, while 39 soldiers have been killed in combat since.
The Palestinian Red Cross said Israeli forces were shooting at Al-Quds hospital, and there were violent clashes, with one person killed and 28 wounded, most of them children.
Israeli army spokesperson Lieutenant Colonel Richard Hecht told an evening briefing the army "does not fire on hospitals. If we see Hamas terrorists firing from hospitals we'll do what we need to do. We're aware of the sensitivity (of hospitals), but again, if we see Hamas terrorists, we'll kill them."
The White House said on Thursday that Israel agreed to pause military operations in parts of north Gaza for four hours a day, and the army said Palestinians on Friday were allowed to leave over seven hours along a road south, but there was no sign of a let-up in the fighting.
Palestinians said an Israeli missile struck the road used by people to flee south and Hamas-run media said three people were killed.
More than 100,000 residents had fled south over the last two days as Israeli forces operate "deep in Gaza City", chief military spokesperson Daniel Hagari said.
But evacuations from Gaza into Egypt for foreign passport holders and for Palestinians needing urgent treatment were suspended on Friday, sources said. A Palestinian official and an Egyptian medical source blamed problems bringing medical evacuees to the Rafah border crossing from inside Gaza.
The armed wing of Hamas said on Friday it was still firing rockets and shells into Israel and fighting off troops in Gaza.
Sirens sounded in Tel Aviv and surrounding areas to alert people to Hamas rocket fire. Medics reported two women in Tel Aviv suffered shrapnel wounds from a salvo.
Tensions also flared again on Israel's northern border. The Israeli military said it struck targets belonging to the Lebanese Islamist group Hezbollah in response to aerial attacks over the past day that wounded five soldiers.
MANY FLEE
Gaza's hospitals were struggling to cope, even before the conflict closed in on them, with medical supplies, clean water and fuel to power generators running out.
In the wake of the blast at Shifa hospital, many people fled. Ayman Al-Masri, wounded early in the war, told Reuters he had taken shelter there with his mother and sister 10 days ago.
"We want a truce, we want a solution, a political solution. Tens of our children are killed every day," he said.
The International Committee of the Red Cross said the healthcare system in Gaza had reached a "point of no return."
More than 100 United Nations employees have been killed since the Israel-Hamas war began in Gaza, the U.N. Palestinian refugee agency said, making it the deadliest conflict ever for the U.N. in such a short period of time.