DEIR AL-BALAH, Gaza Strip (AP) — Israeli troops battled Palestinian militants in an urban refugee camp and outside the gates of a nearby hospital on Tuesday as the army expanded operations across northern Gaza, where residents have been without electricity, water or access to humanitarian aid for weeks.

The front line of the war, now in its seventh week, has shifted to the Jabaliya camp, a dense warren of concrete buildings near Gaza City that houses refugees from the 1948 war surrounding Israel’s creation and their descendants. Israel has been bombarding the area for weeks, and the military said Hamas fighters have regrouped there and in other eastern districts after being pushed out of much of Gaza City.

Fighting has also intensified outside the Indonesian Hospital on the outskirts of Jabaliya, where a strike killed 12 people on Monday. Health officials said Tuesday that hundreds of patients and displaced people are trapped inside with dwindling supplies after some 200 were evacuated the day before.

The war sparked by Hamas’ surprise Oct. 7 attack into Israel has exacted a heavy toll on Palestinian civilians, particularly those who remain in the north after Israel repeatedly called on people to flee south.

It’s unclear how many people remain in the north, but the U.N. agency for Palestinian refugees estimates that some 160,000 people are still in its shelters there, even though it is no longer able to provide services. Some 1.7 million Palestinians, about three fourths of Gaza’s population, have fled their homes.

Hundreds of thousands of displaced people have packed into U.N.-run schools and other facilities across southern Gaza. As the shelters have overflowed, people have been forced to sleep on the streets outside, with little shelter from winter rains that have hit the region in recent days.

Across Gaza, there are shortages of food, water and fuel for generators to power basic infrastructure. There has been a territory-wide blackout since Israel cut off fuel imports at the start of the war.

Israel continues to strike what it says are militant targets across Gaza, including in the southern evacuation zone, often killing women and children, and officials have said it may soon expand its operations in the south.

FIGHTING AROUND HOSPITALS

Tens of thousands of Palestinians in the north had sheltered in hospitals, but those have steadily been emptied out as the fighting has reached their gates, and most are no longer operational.

Marwan Abdallah, a medical worker at the Indonesian Hospital near Jabaliya, said heavy fighting prevented ambulances from bringing wounded people in.

Munir al-Boursh, a senior Health Ministry official who said he was inside the hospital, told Al-Jazeera television by phone that Israeli forces had besieged it, forcing health workers to bury 50 bodies in the courtyard. “The situation is unimaginable,” he said. “We are trapped inside the hospital.”

There was no immediate comment from the military.

Palestinian officials said an Israeli shell struck the hospital on Monday, killing 12 people. Israel denied shelling the hospital, but said its troops returned fire on militants who targeted them from inside.

Some 200 wounded patients and their companions were evacuated from the hospital to southern Gaza on Monday, but up to 600 wounded people and some 2,000 displaced Palestinians remain stranded there, according to Gaza’s Health Ministry.

A similar standoff has played out in recent days at Shifa Hospital, Gaza’s largest, where over 250 patients and medical workers are stranded after the evacuation of 31 premature babies.

Israel has provided some evidence in recent days of a militant presence at Shifa, where its troops have been operating since last week. But it has yet to substantiate its claims that Hamas had a major command center beneath the facility, allegations denied by Hamas and hospital staff.

Michael Ryan, a senior World Health Organization official, said Monday that care for complex medical cases – including most cancer and kidney dialysis patients – is no longer available in Gaza and that remaining hospitals would likely be overwhelmed by some 5,500 births expected in the next month.

“The hospital situation – the primary health care system situation – in Gaza is catastrophic,” he said. In the north, “it is the worst you can imagine.”

RISING TOLL

More than 12,700 Palestinians have been killed in Gaza, according to the Palestinian Health Ministry in the West Bank. Officials there say another 4,000 are missing. Their counts do not differentiate between civilians and combatants. Israel says it has killed thousands of militants.

The Palestinian Health Ministry bases its count on information gathered by its counterpart in Hamas-ruled Gaza, which has been unable to fully update casualty figures for more than 10 days because of the breakdown in services and communications in the north.

About 1,200 people have been killed on the Israeli side, mainly civilians during the Oct. 7 attack, in which Hamas dragged some 240 captives back into Gaza. The military says 68 Israeli soldiers have been killed in Gaza ground operations.

The military said forces are “preparing the battlefield” in the area of Jabaliya. It said they struck three tunnel shafts where fighters were hiding and destroyed rocket launchers. Footage released by the military shows Israeli soldiers patrolling on foot as gunfire echoes around them.

Residents said there had been heavy fighting as Israeli forces tried to advance under the cover of airstrikes. “The (Israeli) occupation is trying to besiege the camp,” said Hamza Abu Mansour, a university student. “They are facing stiff resistance.”

It was not possible to independently confirm details of the fighting.

Military footage from other areas in the north in recent days has shown widespread destruction, with nearly every building appearing to be damaged or destroyed.

TALKS ON HOSTAGES

Israel, the United States and Qatar, which mediates with Hamas, have been negotiating for weeks over a hostage release that would be paired with a temporary cease-fire and the entry of more humanitarian aid.

Izzat Rishq, a senior Hamas official, said Tuesday that an agreement could be reached “in the coming hours,” in which Hamas would release captives and Israel would release Palestinian prisoners. Hamas’ leader in exile Ismail Haniyeh also said they were close to a deal, but similar predictions in recent weeks have proven premature.

Israel’s three-member war Cabinet met with representatives of the hostages’ families Monday evening. Prime Minister Benjamin Netanyahu told families the government considers the release of hostages and the defeat of Hamas to be equally important, according to a family member who attended.

Udi Goren, whose cousin Tal Chaimi is in captivity in Gaza, said that was “incredibly disappointing” for the families, as Israel has said it could take months to dismantle the militant group.

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Magdy reported from Cairo. Associated Press writer Melanie Lidman in Jerusalem contributed.

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Full AP coverage at https://apnews.com/hub/israel-hamas-war.