Thousands of displaced Palestinians looked to Gaza's largest hospital, Al-Shifa, as a safe haven, but with Israeli strikes intensifying and the fighting reaching the gates of the compound, there seems nowhere for them to escape.

Ahmed al-Shawa, who sought refuge in the hospital, said he was afraid he would be "cut down by shrapnel", if he stepped outside.

"The situation is very, very dangerous," the 18-year-old from Gaza City said as the sound of explosions echoed in the background.

Crowds of people have crammed into the corridors of Al-Shifa to escape the fighting in Gaza between Israel and Hamas, adding to the overwhelming number of war casualties at the hospital.

The facility was hit repeatedly overnight in a new round of strikes that knocked out the power for several hours, its director said.

The outage had resulted in the death of two premature babies, the NGO Physicians for Human Rights Israel said, citing doctors inside the hospital.

Many of the displaced were afraid to leave the hospital, with medics including from Doctors Without Borders (MSF) saying they saw people being shot at as they attempted to flee the hospital.

"We are being killed here, please do something," a nurse from MSF pleaded from inside the hospital's basement, where he and his family were sheltering.

"The shelling is so close, my kids are crying and screaming in fear," MSF cited the nurse as saying in a text message.

The Israeli military said "there is no shooting at the hospital" but acknowledged troops were engaged in clashes with Hamas militants around the complex.

- 'Shooting everywhere' -

Israel launched its offensive in Gaza after Hamas fighters poured across the heavily militarised border on October 7, killing about 1,200 people, mostly civilians, and taking around 240 hostages, according to Israeli officials.

Vowing to destroy the militant group, Israel retaliated with relentless bombardments and a ground campaign that the health ministry in the Hamas-run Gaza Strip says has killed more than 11,000 people, mostly civilians and many of them children.

Israel accuses Hamas of operating from tunnels and bunkers located beneath hospitals in Gaza, using civilians as a shield. Hamas denies the charge.

The United Nations humanitarian agency (OCHA) said Israeli bombardments around hospitals in Gaza City and the north of the Palestinian territory intensified on Friday, with "several being directly hit".

Some 20 out of 36 hospitals throughout Gaza are "no longer functioning", according to OCHA.

Outside Al-Shifa, there was "shooting and bombardment everywhere", said the hospital's head of surgery, Marwan Abu Sada. 

"You can hear it at every second," he was quoted as saying by the group Medical Aid For Palestinians.

"No one can get out from the Al-Shifa hospital. No one can come to the Al-Shifa hospital."

- 'Unbearably desperate' -

MSF denounced the intense battles around the facility as the "death warrant of civilians currently trapped in Al-Shifa hospital signed by the Israeli military".

"The unbearably desperate situation for patients (and) staff trapped inside must stop," said Robert Mardini, the head of the International Committee of the Red Cross (ICRC).

"Hospitals, patients, staff (and) health care must be protected."

Despite the intense fighting, doctors inside the complex said they intended to stay put.

"We cannot leave. If I am not here or the other surgeon, who will take care of the patients?" said MSF doctor Mohammed Obeid.

"There are a lot of patients already operated on and they cannot walk. They cannot evacuate," MSF quoted Obeid as saying.

"We need an ambulance to move them, we don't have ambulances to evacuate all of these patients."

Al-Shifa director Mohammad Abu Salmiya, too, expressed his resolve to stay: "We will not leave here, whatever the cost."

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