U.S. Says Hamas Operates Out of Gaza Hospitals, Endorsing Israel’s Allegations

U.S. intelligence supports the Israeli allegation of Hamas operating within and beneath hospitals, a National Security Council spokesman said on Tuesday.

Israeli troops entered shortly thereafter, and took videos that the military released on Monday and Tuesday as part of a campaign to persuade skeptics that Hamas had turned hospitals into safe houses and command centers and has built tunnels underneath them.

“This is not the last hospital like this in Gaza, and the world should know that,” said Rear Adm. Daniel Hagari, the Israeli military’s chief spokesman. “It’s a crime.”

In the first of the videos, a six-minute presentation released on Monday, Admiral Hagari walks viewers through what he says was found in the basement of the hospital. The Israeli military followed that on Tuesday with a second video, just over two minutes long, posted on X, formerly Twitter. That video purports to show troops rushing into the building and appearing to find explosives, weapons and the room where Admiral Hagari said hostages were kept.

Both videos contained a series of assertions that could not be independently verified. The first includes well-displayed evidence — guns, explosives and other weaponry all arranged as if by police showing the haul from a drug raid — whose provenance similarly could not be confirmed.

The second, though, shows troops in action appearing to find the weaponry that would be showcased in the longer video.

Osama Hamadan, a Hamas spokesman, speaking at a news conference from Beirut on Tuesday called Admiral Hagari’s presentation a “lie and charade.” There was no immediate comment from Gazan officials or Hamas on the second video.

Monday’s video included footage of a piece of paper taped to a wall in the hospital’s basement. Admiral Hagari said the paper — a grid with Arabic words and numbers within each square — could be a schedule for guarding hostages “where every terrorist writes his name.”

The paper included a mark that appeared to be an illegible signature, but did not seem to otherwise include people’s names — the Arabic words were days of the week and numbers underneath dates. The Gazan Health Ministry said in a statement that the paper, including days and dates, was nothing more than “a regular work shift timetable, a standard administrative practice in hospitals.”

The ministry, however, failed to address one key detail: The calendar begins on Oct. 7, the day of the Hamas terrorist attack on Israel, and an Arabic title written at the top uses the militants’ name for the assault: “Al Aqsa Flood Battle, 7/10/2023.”

Dr. Mustafa Al Kahlout, the hospital’s director, said on Tuesday that families fleeing Israeli bombardment have sought shelter at Al-Rantisi and other Gazan hospitals. He called on the Red Cross and other international organizations to “inspect all part of the hospitals.”

The video released on Monday by the Israeli military opens with Admiral Hagari standing a few hundred yards from Al-Rantisi. Speaking in English, he points out what he says is the house of a senior Hamas leader, a school next door and a pile of rubble under which there is the entrance to a tunnel that purportedly runs toward the hospital.

The video then cuts to Admiral Hagari inside what he says is the hospital basement. He enters a room with children’s drawings on blue and pink walls. Neatly laid out on the floor is an array of weapons that he says were found in the hospital.

Admiral Hagari then shows what he says is an area connected to the hospital basement where hostages taken in the Oct. 7 attack were purportedly held.

There is a windowless room with couches and curtains covering bare walls where he says hostage videos could be made. There is a chair with a rope on the floor next to it, an “improvised toilet,” a baby bottle and a package of diapers. There is also a motorcycle that he says was used to carry hostages back to Gaza.

“You don’t build an improvised toilet in the basement, unless you want to build an infrastructure to hold hostages,” Admiral Hagari says.

As for what happened to the hostages and Hamas fighters who were purportedly at the hospital, he says, “They might have left with the patients, they might have run away through tunnels and we have signs that they had hostages with them. It’s still under investigation, but there’s enough signs to indicate that.”

For its part, the Gazan health ministry said the basement rooms shown were used as shelters “for those fleeing airstrikes. The bathroom shown is a necessity.”

The baby bottle and diapers were nothing special in a children’s hospital, it said. As for the weapons, it added: “We don’t know where they got them.”

Mr. Kirby declined to provide details about the U.S. intelligence, but he made clear that it goes beyond the information collected by the Israeli intelligence service. “It comes from a variety of intelligence methods — of our own, of our own,” he said, adding that the classification of the intelligence had been downgraded so that it could be shared publicly.

“I can confirm for you that we have information that Hamas and the Palestinian Islamic Jihad use some hospitals in the Gaza Strip, including Al-Shifa, and tunnels underneath them, to conceal and to support their military operations and to hold hostages,” Mr. Kirby told reporters on Air Force One as President Biden headed to San Francisco for a summit with Asia-Pacific leaders.

“Hamas and the Palestinian Islamic Jihad — J.I.D. — members operate a command and control node from Al-Shifa in Gaza City,” he added. “They have stored weapons there, and they’re prepared to respond to an Israeli military operation against that facility.”

The revelation of the U.S. intelligence comes as Israel is under harsh international criticism for attacks on and around hospitals as it conducts a war against Hamas in the wake of the armed group’s terrorist attacks on Israel on Oct. 7. Israel says more than 1,200 people were killed in the attacks and that 239 others remain hostages.

During Israel’s ensuing military campaign to eradicate Hamas, it has repeatedly said that its military seeks to avoid casualties among civilians, including patients and doctors at hospitals. But they have insisted that Hamas uses such people as human shields.

Mr. Kirby said that the United States does not support attacks from the air on hospitals, despite what he said was the confirmed use of the facilities by Hamas.

“We do not support striking a hospital from the air,” he said. “And we do not want to see a firefight in a hospital where innocent people, helpless people, sick people are simply trying to get the medical care that they deserve, not to be caught in a crossfire. Hospitals and patients must be protected.”

He called that concern an “added burden” for Israel in its military campaign against Hamas.

Palestinian officials and doctors at Al-Shifa have denied that the hospital has been used by Hamas. But Mr. Kirby said that the newly revealed U.S. intelligence supported Israel’s arguments as its military closed in on the hospital.

“We have information that confirms that Hamas is using that particular hospital for a command and control node and probably storage of equipment weapons up underneath,” he said. “That is a war crime.”

Al-Shifa’s director, Dr. Mohammed Abu Salmiya, said on the WhatsApp messaging service that doctors at the hospital had performed surgeries on Monday without anesthesia or oxygen and that multiple people had died at the medical complex. He added that health workers were forced to bury bodies inside the grounds because “there was no consent to take them out” and that the grave being dug would not be sufficient for all of them.

Medical teams at the hospital buried more than 80 people at the hospital complex, according to Gaza’s government press office.

Gaza’s deputy health minister, Dr. Yousef Abu al-Reesh, said on WhatsApp that Israeli forces were preventing the removal of bodies from the complex for burial.

Israeli officials did not immediately respond to a request for comment on the claim. Israel has imposed a siege on Gaza and cut off the electricity it provided to Gaza after Oct. 7, when Hamas launched terrorist attacks from the enclave that, according to Israeli authorities, killed around 1,200 people in Israel.

Israel asserts that Hamas has dug a network of tunnels beneath the hospital, which Hamas denies. The Israeli military has surrounded the facility and is fighting ground battles with the group as part of its broader invasion.

A health ministry spokesman, Dr. Medhat Abbas, said this week that more than 100 bodies were in the hospital’s front yard, another 50 were inside and about 60 others were in a morgue. Overall, more than 11,000 Palestinians have been killed in Gaza in Israel’s military offensive, according to the territory’s health ministry.

The W.H.O. said on Tuesday that a cease-fire was needed to alleviate suffering at the hospital, citing massive overcrowding, insufficient food and clean water for 700 patients and 400 staff members and a lack of fuel needed to run the generators that would enable medical equipment to function.

“We are begging for a cease-fire to happen now,” Margaret Harris, a W.H.O. spokeswoman told reporters in Geneva. The organization has recorded 137 attacks on hospitals and health care facilities in Gaza since the Oct. 7 Hamas attacks and has criticized calls by Israel to evacuate the hospital, arguing that doing so would be in effect a death sentence for the most critically ill.

“You are asking doctors and nurses to move people knowing that that would kill them,” Ms. Harris said. “Why would you need to move them? A hospital should never be under attack.” She said that 20 patients had died at the hospital in the previous 48 hours.

But he made a vital distinction between control above ground and control below, where Hamas militants have built a maze of tactical tunnels, command posts and supply depots. The Israeli military says it has identified hundreds of tunnel shafts in the Gaza Strip since the invasion began.

In a ground invasion that began on Oct. 27, the Israeli military has moved into northern Gaza from multiple directions, trying to trap Hamas fighters in a tightening loop centered on Gaza City, where street battles have raged for days. Israel has told civilians to evacuate northern Gaza and flee southward, which more than a million people have heeded.

When asked whether Israeli troops would operate in southern Gaza as they have in the north, Mr. Gallant said the combat plans he had presented to Israel’s cabinet before the beginning of the ground invasion had required “long months” of fighting and included “both the north and the south.”

In recent days, Israeli forces secured control of various Hamas centers of operations, including government buildings, police headquarters and an engineering faculty “used for weapons production and development,” according to a statement made by the Israeli military.

Some of the outposts, including the Governor’s Residence, were used by Hamas before it led the Oct. 7 terrorist attack on Israel, Rear Adm. Daniel Hagari, the Israeli military’s chief spokesman, said in a post on X, formally known as Twitter.

Once inside the Governor’s Residence, military forces found equipment, including weapons, stolen by Hamas during the Oct. 7 attack, Admiral Hagari said in another post on X. Those weapons will be examined by the Israeli military, he said.

Mr. Biden has said that freeing the hostages is a top priority, and administration officials have said the United States is actively engaged in indirect negotiations involving Israel, Qatar and Hamas to secure their release.

“I’ve been talking to the people involved every single day,” Mr. Biden said during an event in the South Court Auditorium of the White House on Tuesday. “I believe it’s going to happen, but I don’t want to get into any detail.”

Asked if he had a message for the hostages and their families, he said, “Hang in there. We’re coming.”

As he spoke, thousands of people were rallying in a March for Israel on the National Mall in Washington that was organized in support of Israel’s war against Hamas in Gaza, and others gathered near the White House carrying posters of children who were kidnapped in the Oct. 7 attack.

Brett McGurk, Mr. Biden’s senior Middle East adviser, was heading to the Middle East after stopping in Belgium on Tuesday, the White House said, to brief NATO allies and E.U. partners and coordinate efforts to secure the release of the hostages as well as to expand humanitarian aid to Gaza and increase economic pressure on Hamas and other terrorist groups. His next stops will include Israel, the West Bank, the United Arab Emirates, Saudi Arabia, Bahrain, Qatar and Jordan, the White House said.

Jake Sullivan, the president’s national security adviser, said last weekend that the status of the hostages was unclear.

“We know the number of missing and that’s the number the Israelis have given but we don’t know how many of those are still alive,” Mr. Sullivan told ABC’s “This Week” on Sunday.

“As far as the Americans are concerned, there are nine missing American citizens” and one permanent U.S. resident, he said. He added, “That’s the number that we are working with, that’s the number we are trying to ensure the safe return of,” he said.

The Israeli government has said the hostages include 20 children and 10 to 20 people over the age of 60. One of the young hostages, according to the White House, is a 3-year-old American.

The news of the 3-year-old came in a White House readout of a call about the Israel-Hamas war between Mr. Biden and Amir Sheikh Tamim Bin Hamad al-Thani of Qatar on Sunday. In the call, according to the readout, the president “condemned unequivocally the holding of hostages by Hamas, including many young children, one of whom is a 3-year old American citizen toddler, whose parents were killed by Hamas on Oct. 7.”

The event is intended by organizers in part as a response to critics of Israel, where officials estimate that about 1,200 people were killed in Hamas’s Oct. 7 attack. Jewish schools, synagogues and community centers from across the country sent busloads of attendees.

Shortly after the gates opened on Tuesday morning, the Mall was crowded with people waving American and Israeli flags and holding signs declaring support.

Educators, artists, students and relatives of some of the hundreds of hostages seized by Hamas are scheduled to appear, along with the president of Israel, Isaac Herzog, and U.S. lawmakers, including Speaker Mike Johnson, Republican of Louisiana, and the Senate majority leader, Chuck Schumer, Democrat of New York.

Most U.S. lawmakers have rejected calls for a cease-fire in Gaza and maintain that Israel’s military campaign — which the Health Ministry in the Hamas-run Gaza Strip says has killed more than 10,000 people — is justified by the imperative to eradicate Hamas.

But there has been growing pushback in congressional offices and the Biden administration, as well as among Democratic voters generally, over how the war has unfolded and its toll on noncombatants, especially children.

Eric Fingerhut, president of the Jewish Federations of North America, said the march was intended in part to remind the politicians in Washington that “the majority of the American people” support Israel’s actions, even if they disagree on other issues.

It was also meant to show unity in the face of a rising number of antisemitic incidents across the country in recent weeks, he said.

On Saturday, Palestinian health officials announced that one baby who had been born premature had died at the hospital. Unless power was restored to keep the incubators running, the others could face the same fate, Dr. Mai al-Kaila, the health minister for the Ramallah-based Palestinian Authority, said.

The fighting around Al-Shifa has intensified as Israeli troops advance to the hospital’s gates. Israeli and American officials say the hospital hosts an underground Hamas military command center, suggesting the Israeli military intends eventually to storm the site. Hamas and hospital officials have rejected the claims.

As Israel’s aerial bombardments intensified in October, more than 60,000 displaced people were sheltering inside Al-Shifa’s sprawling complex. Israeli authorities have been calling on Palestinian civilians to leave the north, and as the fighting drew nearer last week — including four strikes inside the complex — many holdouts, both patients and staff members, finally fled, according to the Gaza health ministry.

But the babies’ fragile health makes moving them difficult, complicating Israel’s stated goal of emptying Al-Shifa of civilians before its troops attempt to enter the compound.

The Israeli military said late Monday that it was working to deliver mobile incubators and respirators to Al-Shifa hospital in an attempt to help evacuate the babies. In a statement, the Israeli military said it was “willing to work with any reliable mediating party to ensure the transfer of the incubators.”

The New York Times was unable to reach the hospital director or the spokesman for the Gaza health ministry to ask about Israel’s offer, the details of which remained unclear.

In an attempt to show its offer is serious, and as international concern over the threat to Gaza’s hospitals mounts, the Israeli military late Monday released what it said was a recording of a phone call between an Israeli military official and the director-general of Al-Shifa. In the audio clip, the officer asks how many incubators the hospital needs, before agreeing to provide the 37 specified by the director.

According to the recording, the Israeli official asked what else was lacking, and the director requested an additional four respirators for pediatric patients. “They need oxygen,” the hospital official said. The authenticity of the audio recording could not be immediately independently verified.

The World Health Organization said on Sunday that Al-Shifa “is not functioning as a hospital anymore” and warned of a “dire and perilous” situation for patients and the thousands of people sheltering there. The U.N. High Commissioner for Human Rights said on Monday that the lack of electricity had led to at least 12 deaths at the hospital, and the top U.N. aid official for the Palestinian territories said three of Al-Shifa’s nurses were killed on Monday.

Israel’s public pledge to send incubators came after a weekend of conflicting statements by the Israeli military and officials at Al-Shifa.

On Saturday, Rear Adm. Daniel Hagari, the Israeli military’s chief spokesman, said at a televised news conference that the Israeli military would help transfer the babies from Al-Shifa to “a safer hospital.” Soon afterward, Al-Shifa’s director, Muhammad Abu Salmiya, denied the Israeli claim, saying: “These words are completely false.”

On Sunday, the Israeli military said that it had “delivered 300 liters of fuel to the Shifa Hospital’s doorstep, yet the fuel remains untouched after Hamas threatened hospital staff.” But Dr. Nasser Bolbol, the head of Al-Shifa’s neonatal unit, said that the fuel was “half a kilometer” away from the hospital in a combat zone, and the Israeli military had not guaranteed the safety of those who would be sent to retrieve it.

Iyad Abuheweila contributed reporting.

On Sunday night, Air Force F-15E fighter jets struck several buildings in Abu Kamal and one in Mayadin, both towns on the Euphrates River near the border with Iraq. The official said the sites in Abu Kamal were used for training, logistics and storing munitions, and the one in Mayadin was a safe house used as a command headquarters.

American warplanes had previously hit munitions storage sites in eastern Syria on Oct. 27 and again last Thursday. The Pentagon concluded that there were no casualties in those strikes.

U.S. officials blame Iran and the militias aligned with it for what has become a daily barrage of rocket and drone attacks against U.S. forces in Iraq and Syria since the war between Hamas, which is backed by Iran, and Israel began last month. Those attacks have injured dozens of Americans.

On Tuesday, Mr. Alon joined members of the families of about 50 hostages and supporters — a total of about 100 people — who plan to march for five days from Tel Aviv, on the Mediterranean coast, to Prime Minister Benjamin Netanyahu’s office in Jerusalem, setting up camp each night along the way.

Carrying water bottles and sleeping bags, the group marched off from a square across from the military headquarters, chanting “Bring them home now!”

Mr. Alon, like many others at the march, wants Mr. Netanyahu and his cabinet to do everything they can to secure the release of those abducted by Hamas and other armed Palestinian groups in the Oct. 7 attack that the Israeli government says killed 1,200 people.

“We think the Israeli government should pay any price,” Mr. Alon said, whether that entails a prisoner exchange, a cease-fire or fuel delivery. The hostages’ lives are in the government’s hands, he said. Mr. Netanyahu, who has made clear that Israel’s goal is to eradicate Hamas, has maintained that a cease-fire would be contingent on the release of hostages.

In late October, Israeli forces rescued one hostage, and four others were released by Hamas about a week earlier. But, despite negotiation efforts led by the United States and Qatar, there have been no further breakthroughs on a hostage release deal. Families of the hostages have organized rallies over the past two weeks that have drawn thousands to the military headquarters.

Despite the outpouring of public support, those with family members and friends held captive in Gaza are feeling frustrated.

“I’m tired of sitting around,” said Yuval Haran, 36, from Be’eri, a kibbutz near the border with Gaza that was heavily attacked on Oct. 7. He has seven family members being held hostage in Gaza and was an organizer of the march. “I want to start walking to where the decisions are made.”

The marchers, who range in age from their 20s to their 70s, will walk about 10 miles a day along main highways, sleeping each night in campsites on the side of the road. They are filling one lane of the highway, with police escorts, support staff and vans carrying gear taking up another.

Shelly Shem Tov, 51, whose son Omer, 21, was abducted from the Nova festival, joined the march to try to galvanize popular support and pressure Mr. Netanyahu. She also sees leaving her comfort zone, by marching on foot to Jerusalem, as an opportunity to identify on a personal level with her son, who is in “a place I can’t even imagine,” she said.

On Monday, Hamas released a video of a hostage who the group claims was killed by an Israeli airstrike, raising concerns among the families that Israel’s military operations in Gaza are threatening hostages’ lives.

In July, protesters against Mr. Netanyahu’s judicial overhaul organized a similar five-day march from Tel Aviv to Jerusalem. The families of the hostages have described the march as apolitical, but Avi Gur Arye, 73, who joined as a supporter, said that it would be a boon if the movement also contributes to a change in government, which he said is “dividing and unraveling the fabric of this country” after the war.

Mr. Alon said that he wants to be optimistic that the marchers won’t need to walk all the way. He said he hoped that during the march, “Everyone will tell us, ‘Stop walking. They are here.’”

“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.

“This is the most extensive investigation the State of Israel has ever known,” he said. “There was a massacre here — crimes against humanity. We have evidence of acts of murders, rapes, amputations, burning people alive, sexual abuse and confirmation of death and kidnapping.”

The briefing was one of several that Israeli officials have held for journalists in which they have shared graphic photos and videos of the events of Oct. 7, and the images included some they had shown before. A few of the videos shown on Tuesday, including those that show people being killed, were posted on social media by the attackers. Others could not be independently verified.

With international concern growing over the casualties in Gaza as the Israeli military continues its retaliatory operations, which they say are necessary to destroy Hamas, the briefings are an attempt to remind the world of what Israel suffered on Oct. 7. At one point during the event on Tuesday, Mr. Shabtai’s voice cracked, and for several seconds he stopped speaking.

“The world needs to know what we are facing,” he said.

In the witness video, a woman whose face was blurred said she had been hiding during the music festival and saw Hamas terrorists taking turns raping a young woman, mutilating her and then shooting her in the head. Her testimony could not be independently verified but is consistent with other witness accounts.

Mr. Shabtai said that many of the police investigators working on the case had been traumatized, and that he was told this week that 11 survivors of the dance party had been hospitalized for psychiatric treatment.

“I’ve been a cop for 38 years,” he said. “I’ve never seen anything like this.”

Ms. Marciano served in an intelligence unit and was stationed at a lookout post on Kibbutz Nahal Oz when Hamas attacked.

“Our hearts are with the Marciano family,” Israeli military officials said in a statement, noting that a military representative had visited the family and informed them of the video’s release. Military officials pledged to support the Marcianos and other hostages’ families, promising that they are “using all means, both intelligence and operational, to bring the hostages home.”

The video shows Ms. Marciano speaking into a camera and providing identifying information about herself and her family. She says that she is being held in Gaza and has been there for about four days with other hostages, and she pleads with the Israeli military to stop targeting the area, saying the explosions are close by, continual and could harm the hostages. The video ends with still images of Ms. Marciano’s lifeless body splayed on a bloodied white sheet. It was impossible to independently conclude how Ms. Marciano died.

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In the weeks since the war began, a handful of images and videos of hostages have emerged. Last week, Palestinian Islamic Jihad, another extremist group in Gaza, released videos of two hostages — Hanna Katzir, 77, and Yagil Yaakov, 13 — asking Israeli officials to stop bombing Gaza. The Times has not verified the videos.

Hostages often appear in such videos under duress and their statements are likely to have been coerced. Israeli officials have called such videos a form of “psychological warfare” aimed at influencing an Israeli public still reeling from the brutal Hamas-led attacks last month.

On Monday, a video purporting to be of an Israeli-Russian academic, Elizabeth Tsurkov, who was kidnapped in Iraq in March, was published by Iraqi television and on social media. In the video — which The Times has not verified — she speaks in Hebrew, urging the families of the Oct. 7 hostages to do all they can to stop the war in Gaza. It would be, if verified, the first image of Ms. Tsurkov since her capture.

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-staff 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 Israeli government believes that more than 230 hostages taken on Oct. 7 are held in Gaza, including children and older people from several countries.

Ms. Silver’s photo has been featured on posters plastered in cities across the world to draw attention to the Oct. 7 abductions, and her story has been widely shared.

Her family was formally notified of her death by Israeli authorities, her son, Chen Zeigen, said on Tuesday.

Ms. Silver was known for her commitment to peace efforts between Israelis and Palestinians. After the war in Gaza in 2014, she co-founded Women Wage Peace, which lobbies for a diplomatic resolution to the conflict. She also helped found and direct the Arab-Jewish Center for Empowerment, Equality, and Cooperation and served for years on the board of directors of B’Tselem, an Israeli human rights organization.

Ms. Silver regularly drove sick Palestinians from Gaza, near her home, into Israel for medical treatment as part of the Road to Recovery organization.

“We never stopped hoping that she was kidnapped, that she’s alive, that she’s with other people, that she would come back to us,” said Yael Braudo-Bahat, a co-director of Women Wage Peace whom Ms. Silver mentored, in an interview.

Susan Lax, a longtime friend who met Ms. Silver about five decades ago at a kibbutz, said she had been immediately drawn to her.

“She was my role model for women’s rights, for feminism, and for never ever giving up on peace,” Ms. Lax said.

Ms. Silver would have wanted the work of Women Wage Peace to continue, Ms. Braudo-Bahat said.

“Vivian is sitting on my shoulder from now on,” she said. “I’m going to apply all of the things I learned from her so that there will be peace here.”

Roni Rabin contributed reporting.

“Rain will just add further to the suffering,” Margaret Harris, a spokeswoman for the W.H.O., told reporters in Geneva.

The organization, citing one example of health problems, warned last week that since mid-October, more than 33,500 cases of diarrhea have been reported, mostly among children under five. More than half a million people have sought shelter since Oct. 7 at facilities run by the U.N. agency for Palestinians, UNRWA.