State Dept. Workers Sign Memos Urging Biden to Call for Gaza Cease-Fire

“My hope and expectation is that there will be less intrusive action relative to hospitals,” Mr. Biden told reporters in the Oval Office when asked if he had expressed concerns to Israel.

Mr. Biden said U.S. officials “remain in contact with the Israelis” to secure a pause in the fighting to allow for the release of hostages held by Hamas and other militant groups. “I remain somewhat hopeful, but hospitals must be protected,” Mr. Biden added.

Jake Sullivan, Mr. Biden’s national security adviser, said at a briefing shortly afterward that the United States and Israel “do not want to see firefights in hospitals.”

The Israeli government has told the White House, Mr. Sullivan said, that it is prepared to provide fuel to hospitals to ensure they can continue to operate. In some cases, he said, Israeli officials have told the White House that they have been unable to communicate with hospital administrators.

But Mr. Sullivan underlined the president’s call to ensure hospitals be allowed to operate.

“That’s something we will continue to work on, but the position of the United States on this matter is clear,” Mr. Sullivan said. “Hospitals should be protected, hospitals should be able to run effectively, evacuation routes have to be safe and the Israeli government has told us as recently as today, that there are and will continue to be evacuation routes for people leaving hospital compounds.”

Israeli and American security officials have said a Hamas command base lies beneath the hospital, and have cast it as an example of Hamas’ willingness to use civilians as human shields. Hamas and hospital officials have denied the allegation.

Doctors and Gazan health officials have said for days that patients at Al-Shifa were dying because of power at the hospital, the Gaza Strip’s largest. The U.N. High Commissioner for Human Rights said on Monday that the power cut had led to at least 12 deaths. The top U.N. aid official for the Palestinian territories said three nurses at the hospital were killed on Monday.

Jihan Miqdad, a chief nurse in the emergency room at Al-Shifa, said in a phone interview on Monday that patients who were on life support in the intensive care unit were dying because there was little oxygen.

“The situation here is catastrophic in every sense of the word,” she said.

The Israeli military did not address specific questions about its actions around the hospital. It is “engaged in intense battle against Hamas,” it said in a statement, adding, “This currently includes the area surrounding the Shifa hospital but not the hospital itself.”

The hospital and other medical centers in Gaza City have been struggling for weeks to maintain operations as Israeli forces closed in and as supplies of fuel and medicine dwindled. The head of the World Health Organization warned on Sunday that Al-Shifa was “not functioning as a hospital anymore” and was struggling to provide care after three days “without electricity, without water and with very poor internet.”

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Israeli officials say Hamas uses hospitals in Gaza, including Al-Shifa, as shields for its fighters, including using vast tunnel networks beneath the hospitals. Hamas has denied the allegations.

The Israeli military said in a post on X that on Sunday it “delivered 300 liters of fuel to the Shifa Hospital’s doorstep, yet the fuel remains untouched after Hamas threatened hospital staff.”

Dr. Nasser Bolbol, the head of Al-Shifa’s neonatal unit, said that the Israelis left the fuel “half a kilometer” away from the hospital, in a combat zone, and did not guarantee the safety of those trying to retrieve it. Dr. Medhat Abbas, a spokesman for the Gazan health ministry, said the hospital director had asked the Israeli military to work with the Red Cross in transporting the fuel the remaining distance to the hospital, but was rebuffed.

On Monday, Israeli military vehicles reached a gate on the eastern side of the Al-Shifa complex, where the maternity hospital is, the Gazan health ministry said. Israeli troops have reached at least two other hospitals in northern Gaza, stepping up their push to empty the facilities, according to Israeli military officials, as fighting around them intensifies.

Al-Shifa was “in the circle of death,” said the health ministry, part of the Hamas-run government of the territory.

Ms. Miqdad, the nurse, said that for the staff to remove bodies from the hospital, they need to contact the Red Cross to coordinate with the Israeli military, but the Red Cross has not been responsive.

“No one is asking about us,” she said. “The bodies are decomposing inside the hospital.”

The International Committee of the Red Cross said in a statement that it was “constantly in touch” with the health ministry and other parties, and that “evacuating a hospital amid intense fighting is an extremely complex and risky operation.” It did not respond to a specific question about the bodies.

Dr. Abbas, the health ministry spokesman, said in a phone interview that more than 100 bodies were lying in the hospital’s front yard, another 50 were inside and about 60 others were in the morgue.

Staff members and some 8,000 displaced people sheltering at the hospital are suffering from thirst and hunger, Dr. Abbas said. Medical teams are surviving on biscuits and dates, he added.

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Dr. Bolbol, the neonatal chief, said in a phone interview that three premature babies had died after what he characterized as an Israeli attack disabled the equipment that provides the department with oxygen. His claim that Israel was responsible could not be independently verified.

Hospital staff members moved the 36 remaining premature babies to the only other department that still had oxygen, but that department lacks the incubators the babies need, he said, adding: “Their lives are in danger.”

Dr. Abbas said that medical staff had put sheets of reflective foil and blankets over hospital beds and laid the babies close to one another to simulate as much as possible the warmth of an incubator. He said four of the premature babies at Al-Shifa were born in emergency C-sections after their mothers were killed in strikes.

“Now they have to make it without their mothers and without electricity or special care,” he added.

Dr. Bolbol said the neonatal unit had enough baby formula to last another two or three days. He added that the Red Cross was negotiating with Israeli authorities to evacuate the babies, but that no agreement had been reached so far.

“It’s catastrophic,” Dr. Bolbol said. “I’m watching patients die in front of my eyes and I can’t provide them the slightest bit of help.”

Dr. Bolbol said that there had been continuous shelling and strikes near the hospital, and that the building he works in was constantly shaking. “It feels like we have been living through an earthquake for over 24 hours,” he added.

Medical staff were unable to leave the building to remove corpses, fearing they would be shot at by Israeli forces stationed nearby, Dr. Bolbol said. He added that some displaced people who had tried to leave the hospital to find food and water had come under fire, and that some had been killed. “Their bodies are still lying on the street,” he said.

The Israeli military did not respond to a request for comment about accusations that it was firing on people trying to leave the hospital. It has denied such claims in recent days.

Raja Abdulrahim contributed reporting.

With Gaza under intense Israeli bombardment, tens of thousands of people have sought refuge on the grounds of its hospitals, either because their homes were damaged or because they thought hospitals were less likely to be struck. With Israeli ground forces approaching the hospitals, Israel’s military has repeatedly said that displaced people, patients and hospital staff should evacuate to southern Gaza, a directive that many Palestinians and aid groups have dismissed as infeasible and dangerous.

Many people have left Al-Shifa, but the latest satellite images show that large numbers remain, encamped in courtyards and parking lots between buildings. A spokesman for the Gazan health ministry, Dr. ​​Medhat Abbas, said in a phone interview that about 8,000 displaced people remain.

Israeli officials say that beneath the hospital complex, a roughly 12-acre compound in Gaza City, is a vast, underground Hamas command center, one of their principal targets in the war. Hamas and doctors at the hospital deny the existence of such a command center.

There has been a growing international outcry to spare Al-Shifa and other hospitals, which have been hit repeatedly during the fighting. The Israeli military says it is not striking them intentionally.

Rantisi, Al-Nasr and Al-Quds hospitals in Gaza City have also been surrounded by Israeli forces and have either been evacuated or have gone out of service. The World Health Organization said on Sunday that Al-Shifa is no longer functioning; however, much of the medical staff remains at the complex caring for the hundreds of remaining patients.

In a statement, the Israeli military said that a “terrorist squad” positioned among civilians at the hospital’s entrance had fired rocket-propelled grenades at Israeli soldiers, damaging an Israeli tank. The Israeli forces fired back, it said, killing “approximately 21 terrorists.” The statement did not say whether any civilians had been killed, and its account of the fighting could not be immediately verified.

The statement said that during the exchange of fire, Israeli forces saw civilians leaving the hospital building. “Other terrorists who came out of the adjacent buildings hid among them and joined the attempted attack,” the statement said.

Israel’s claims echoed its longstanding allegations that Hamas, which rules Gaza, and other armed Palestinian groups use civilians as shields. The military published video of what it said was a fighter carrying a grenade launcher who fired on its forces from the hospital grounds. Neither the video nor the Israeli characterization of it could be independently verified.

“This incident is another example of Hamas’ continued abuse of civilian structures, including hospitals, to carry out attacks,” the Israeli military said.

In a statement issued later Monday, the Red Crescent condemned Israel’s claims as “baseless,” and said that there were no armed individuals inside the hospital.

The Red Crescent said on Sunday that Al-Quds, where it said more than 14,000 displaced people had been sheltering, was “out of service and no longer operational,” as power outages and shortages of fuel continued to wreak havoc on Gaza’s health facilities amid raging battles between Israeli troops and Hamas fighters.

“The cessation of services is due to the depletion of available fuel and power outage,” the organization said in a statement Sunday, adding that medical workers were “making every effort to provide care to patients and the wounded.”

Cassandra Vinograd and Vivian Yee contributed reporting.

Two were sent in the first week of the war, and the third was sent more recently, the official said. Another official, also speaking anonymously, confirmed the three cables.

Israel forces have been on the attack in Gaza for more than a month following the Oct. 7 Hamas attacks on Israel. The death toll in Gaza is over 11,000, according to the health ministry there.

The Israeli prime minister, Benjamin Netanyahu, has insisted that there can be no cease-fire, saying that one would only benefit Hamas, and the Biden administration has supported that position. Instead, Mr. Biden has been pressing Israel, with mixed success, to adopt “humanitarian pauses.”

The most recent of the memos, first reported by Axios, proposed that Israel trade Palestinian prisoners it was holding, some of whom have not been charged, for the more than 200 hostages abducted by Hamas from Israel on Oct. 7.

At least one of the memos also asks the administration to offer a serious plan for a long-term peace agreement between Israel and the Palestinians that would create a Palestinian state — and not simply pay lip service to the idea, as critics say Mr. Biden and Mr. Blinken have done.

Mr. Blinken has met in person with signatories to at least one of the cables sent in the first week, one of the officials said. One of Mr. Blinken’s senior aides met with the signers of another cable sent that week, the official said.

Mr. Blinken has conducted at least one other listening session with employees of the Near East Affairs bureau, some of whom believe U.S. policy has been too tolerant of the civilian casualties inflicted by Israel’s military in densely-populated Gaza.

Mr. Blinken responded to the internal dissent in a message emailed to department employees on Monday and obtained by The New York Times. “I know that for many of you, the suffering caused by this crisis is taking a profound personal toll,” he wrote, adding that he was aware that “some people in the department may disagree with approaches we are taking or have views on what we can do better.”

In the message, Mr. Blinken said the State Department had “organized forums in Washington to hear from you, and urged managers and teams to have candid discussions at posts around the world precisely so we can hear your feedback and ideas.”

He added: “We’re listening: What you share is informing our policy and our messages.”

U.S. officials say that while differing opinions and fresh perspectives are welcome, employees at the State Department and elsewhere in the government must accept and implement policy set at senior levels.

The cables come as dissent throughout the Biden administration is increasingly spilling into public view. Earlier this month, more than a thousand employees of the U.S. Agency for International Development signed a letter, first reported by The Washington Post, insisting on a cease-fire.

The State Department’s dissent channel was created in 1971 to allow department officials to express criticisms and disagreements over the Vietnam War. Under State Department rules, dissenters are protected from retaliation.

In recent years, State Department employees have used the channel to warn against President Biden’s withdrawal from Afghanistan, urge the Obama administration to launch airstrikes against Syrian forces and to denounce President Trump’s temporary ban on allowing citizens from seven Muslim-majority countries to enter the United States.

Andrea De Domenico, the head of the U.N. Office for the Coordination of Humanitarian Affairs for Palestinian territories, told reporters on Monday that as of Tuesday the U.N. will no longer have enough fuel to operate either the fork lifts that unload the goods or the trucks that distribute them.

As part of its offensive against Hamas, Israel has cut off electricity to Gaza and blocked the delivery of fuel, saying Hamas uses it for rocket attacks and has stockpiled fuel intended for civilians. More than one million Gazans have been displaced, and civilians are running perilously low on basic human necessities.

“Instead of a much-needed increase of this assistance, we have been informed by colleagues of UNRWA that, due to the lack of fuel, as of tomorrow the operations of receiving trucks will no longer be possible,” Mr. De Domenico said from Jerusalem.

A total of 980 trucks carrying essential aid have crossed into Gaza from Egypt, including 76 trucks on Sunday, Mr. De Domenico said. But the U.N. has said far more is needed. Before Hamas attacked Israel on Oct. 7, about 500 trucks of humanitarian aid crossed into Gaza daily.

The U.N. is worried that the fuel shortage could impede its humanitarian operations and the ability of hospitals, which rely on generators in the absence of power, to treat patients. Gaza’s main hospital, Al-Shifa, has reported that the lack of fuel was putting patients in intensive care at risk of dying and that premature babies were taken out of incubators that were now useless. Three babies and two cardiology patients had died as of Monday, according to Al-Shifa officials.

Al-Shifa’s critical infrastructure — including its water tanks, oxygen stations, maternity ward and cardiovascular facilities — was damaged by the fighting, Mr. De Domenico said. Three nurses were killed, he said.

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Operational conditions for U.N. staff and humanitarian workers in Gaza were deteriorating by the hour, Mr. De Domenico said. Even if fuel were delivered outside, it would be too dangerous for hospital staff members to retrieve it, he said, because of snipers in the area.

“Lives in Gaza are hanging by a thread due to the shortage of fuel and medical supplies,” he said.

The U.N. lowered its flag to half-mast at its headquarters in New York on Monday, observing a minute of silence at its agencies around the world for its 101 staff members killed in Gaza since Oct. 7. The U.N. secretary general, António Guterres, has said it is the most U.N. staff members killed in a conflict since the organization was established in 1945.

Mr. Guterres has been negotiating with officials and colleagues to resolve the fuel situation, which has become a priority for the organization, a U.N. spokesman, Stéphane Dujarric, said.

“We shouldn’t have to negotiate for fuel,” Mr. Dujarric said.

The Pentagon said on Nov. 9 that no U.S. troops had died in the attacks, but it added that about 46 soldiers suffered injuries.

The number of troops — about 2,500 in Iraq and about 900 in Syria — represents a tiny fraction of those who were fighting there during the height of the effort to defeat the Islamic State.

In addition, there are some 6,800 U.S. and third country contractors supporting the military effort, according to the U.S. Central Command, which oversees American forces in the region.

In Iraq, the U.S. military’s mission is to advise and occasionally back up the Iraqi army in its fight against the remnants of ISIS. The U.S. military has a small base, Camp Victory, at the Baghdad airport and a camp in a section of the Al Asad Air Base, in western Iraq. They also have a camp in Kurdistan, north of the main airport in Erbil, the region’s capital.

In Syria, the U.S. has run a discreet counterterrorism mission since 2015 focused on defeating the Islamic State and advising and assisting the Syrian Kurdish Democratic forces, who control the area. The U.S. troops are concentrated close to the Iraqi border in northeastern Syria; at al-Tanf, their outpost on the Baghdad-Damascus highway; and two other smaller locations.

Iranian-linked armed groups made up of Iraqi fighters — primarily, Khataib Hezbollah, a Shiite militia — have camps in eastern Syria and use the area to store weapons and then ferry them to Lebanese Hezbollah, an Iranian ally. The Syrian government, which has a longstanding alliance with Iran, has welcomed the groups.

The war in Gaza and the U.S. support for Israel has given the Iranian-backed groups a new stated reason for attacks on the U.S. military in Iraq and Syria. The Islamic Resistance in Iraq, the newly coined name for several Iran-linked Iraqi armed groups, recently said in a tweet from Sheikh Akraam al Kaabi, a leader of one of the groups, Harakat Hezbullah al Nujaba, that they are telling the world they are ready to defend Palestinians against the “criminal attacks” and “the killing of civilians and children in Gaza.”

“Suddenly, over 200 families have joined the battle, and it’s a surreal spectacle that you were alone, lonely — just you against the world — and suddenly, another 200 families join you,” Mr. Shaul said in a recent phone interview.

The Shaul and Goldin families are actively supporting families whose members were taken on Oct. 7. They described feelings of frustration and abandonment after years of what they saw as failed attempts to pressure the Israeli government into securing the release of Mr. Shaul and Mr. Goldin’s remains. A spokesman with the Israeli prime minister’s office declined to comment.

“Almost 10 years, we’ve been in a never-ending battle to bring him back,” Mr. Shaul said. In a separate interview, Leah Goldin, Mr. Goldin’s mother, said, “We became the face of the failure to bring our hostages home.”

For the family of Mr. Mengistu, the renewed focus on hostages has offered one small glimmer of hope that the long quest for his release might be fulfilled.

Mr. Mengistu walked into Gaza in September 2014, shortly after a cease-fire. Hamas earlier this year released a hostage video appearing to show him calling for his release, the first public evidence that he might still be alive. Hamas released a video last year of the other civilian, Mr. al-Sayed, in a bed and wearing an oxygen mask.

The family of Mr. al-Sayed didn’t respond to requests for an interview.

“The country must take advantage of the current situation — it’s an opportunity that won’t repeat itself — to return Avera and all of the brothers and sisters who are captive in Gaza,” Ilan Mengistu, Mr. Mengistu’s brother, said in an interview last week, adding, “I wish we hadn’t gotten to this situation, but there’s no doubt that it gives hope, a little bit of hope.”

He said he felt the anguish of the newer hostage families.

“As much as we’ve been in pain and suffering for almost nine years, it’s hard,” he said. “I have no words, really, on how to encourage them. It’s really hard, but you can’t lose hope.”

The Goldin and Shaul families said they have held meetings with the families of the new hostages and connected them to various governmental bodies and trauma resources. The newer hostage families have been meeting with officials in Israel and around the world, hanging up posters and putting together public displays in many cities.

Ms. Goldin said she believed that the international community must do more, adding that countries that have pushed Israel for a cease-fire should also push more actively for the release of the hostages and that any aid into Gaza should be limited until the hostages are returned.

The Goldin and Shaul families are also determined to ensure that their relatives are not left behind. Mr. Shaul, in particular, has been concerned that hostage numbers released by the Israeli military since the start of the war have not included his brother.

“It’s impossible to separate between Oron and Hadar and the rest of the civilians and soldiers who were kidnapped,” Mr. Shaul said.

And Israel continued to respond to attacks from Hezbollah, the Iran-backed militia that has been firing missiles and rockets across into Israel from Lebanon. Hassan Nasrallah, the head of Hezbollah, told supporters on Sunday that the group intended to keep up pressure on Israel, targeting sites deeper into Israel.

The latest U.S. and Israeli strikes come as Israel’s military consolidates control of Gaza City, the urban center that it says Hamas uses to store weapons, plan attacks and house fighters. Prime Minister Benjamin Netanyahu has said that the goal is to destroy Hamas, which led a surprise attack on Oct. 7 in southern Israel that killed at least 1,200 people, according to Israeli officials.

As Israel has pushed deeper into Gaza, the United States has been moving military assets, including fighter jets, missile defense systems, and an aircraft carrier, to the Middle East, to prevent a regional war that could drag American forces into conflict with Iranian proxies in Lebanon, Yemen, Iraq and Syria. Secretary of State Antony J. Blinken has said the United States is not seeking a broader conflict with Iran but would not hesitate to respond to attacks on U.S. soldiers.

More than five weeks into the war between Israel and Hamas, nearly 1.5 million Gazans have fled their homes, according to the United Nations. The fighting has led to a humanitarian crisis in Gaza, with hospitals running out of fuel and medical supplies, and food and water becoming scarce.

Conditions at Al Shifa, Gaza’s main hospital, have grown dire in recent days. Hundreds of seriously ill and wounded patients and displaced people have been trapped inside as Israeli tanks and troops close in on the compound, and close-quarters combat is taking place nearby.

The U.N., aid groups and world leaders, including President Emmanuel Macron of France, have asked Israel to agree to a cease-fire to allow more civilians to escape to safety. Israel has rejected calls for a cease-fire and instead agreed to short pauses in fighting on a daily basis.

Last week, Mr. Blinken said that too many innocent Palestinians had died, and asked for a sustained pause in fighting so that more aid could enter Gaza. He stopped short of criticizing the Israeli government, and reiterated that Israel has a right to defend itself, dismissing the idea of a cease-fire. But his comments highlighted the growing frustration among Israel’s allies with the rising death toll in Gaza, which local officials say has surpassed 11,000, according to health authorities in Gaza, which is controlled by Hamas.

Eric Schmitt, Euan Ward and Matthew Rosenberg contributed reporting.

Restarting Tamar likely means that the Israeli government has decided that the fighting with Hamas no longer threatens the facility. The initial anxiety about a wider escalation of the fighting disrupting energy supplies in the region has faded, and prices have recently slumped.

Gas is vital to Israel’s economy, typically accounting for about 70 percent of electric power generation. Israel sells its excess gas to Egypt and Jordan. Bringing Tamar back into operation gives Israel more gas to export to Egypt. Sales of gas are an important component of the ties between the two countries, which together control access to Gaza.

Cairo uses the fuel imported from Israel to generate electric power, run factories and export onward to Europe and other destinations through two liquefied natural gas terminals on the country’s Mediterranean coast.

The closure of Tamar has contributed to a tight gas market in Egypt, crimping domestic consumption and exports.

Chevron is now the key player in Israel’s energy industry, operating not only the Tamar platform but a second large source of gas called the Leviathan field. The production facility for Leviathan is in waters off Haifa in northern Israel and is less vulnerable to rocket fire from Gaza. On the other hand, Leviathan is closer to Lebanon, the base of fighters from Hezbollah, the Iranian-backed militia that has clashed with Israel since the outbreak of fighting in Gaza.

Chevron hopes to use its position in Israel, Egypt and Cyprus as a regional springboard to become a major exporter to Europe. It is not clear what impact the war may have on these ambitions.

A third platform in Israeli waters, run by a company called Energean, also produces gas in the area.

“Regrettably, the hospital is not functioning as a hospital anymore,” the agency’s director general, Tedros Adhanom Ghebreyesus, said in a statement.

The health ministry in Gaza said that at least six wounded patients had died at the hospital, Gaza’s main hospital, on Saturday as a result of a power outage, including two premature babies. Without fuel to run generators, the hospital has been plunged into darkness, the ministry and the hospital’s administrator said.

Israeli security officials say that Hamas has built a vast command complex under the hospital, making it a legitimate military target. Hamas has denied the allegations, as has Al-Shifa’s director, Dr. Mohammed Abu Salmiya, who has called them “untrue.”

In recent days, Israeli soldiers have surrounded at least one other hospital in northern Gaza, stepping up their push to empty the facilities, according to Israeli military officials, as fighting around them intensifies.

At Al-Rantisi Specialized Hospital for Children, the only medical center with a pediatric cancer ward in the strip, Dr. Bakr Gaoud, the head of the hospital, said Israeli forces moved in late last week, damaging the ground floor and destroying several vehicles before providing maps that showed a safe evacuation route, which patients and staff soon used.

A second hospital, Al-Nasr, was similarly emptied out by Israel on Friday, and the health ministry reported strikes against other hospitals over the weekend.

At Al-Quds Hospital, “heavy gunfire” was continuing nearby, the Palestinian Red Crescent Society said on Monday, and that “shelling and violent explosions were heard in the area.” A convoy of vehicles that had been traveling from the south to Al-Quds in an effort to evacuate patients and medical staff could not reach the hospital because of the bombardment, the agency said.

Since the Oct. 7 attack by the Islamist militant group Hamas in southern Israel, Hezbollah and Israel have repeatedly clashed along Israel’s northern border with Lebanon. U.S. officials have been monitoring the situation closely, worried that it could kindle a wider conflict prompting American involvement. They have also tried, with little success so far, to get Prime Minister Benjamin Netanyahu of Israel to pause the fighting in Gaza to allow more humanitarian aid to reach civilians.

Pentagon officials have said that a two-front war for Israel would be the scenario most likely to draw in American military involvement.

But on Monday, Mr. Austin appeared to play down, for the moment, concerns that Israel and Hezbollah had escalated their conflict.

“In terms of the activity we’ve seen up there,” he said, “it’s been tit-for-tat exchanges.”

Hezbollah, which, like Hamas, is backed by Iran, regularly fires missiles and rockets into Israel from Lebanon, and Israel typically responds with airstrikes on weapons depots and other targets. Hassan Nasrallah, the group’s head, said on Sunday that Hezbollah intended to keep up pressure on Israel, targeting sites deeper inside the country with newer and more advanced weapons.