“The images and video of what appear to be displaced civilians burning alive following an Israeli airstrike are deeply disturbing, and we have made our concerns clear to the Israeli Government,” a US National Security Council spokesperson said, speaking on the condition of anonymity to discuss a sensitive topic. “Israel has a responsibility to do more to avoid civilian casualties – and what happened here is horrifying, even if Hamas was operating near the hospital in an attempt to use civilians as human shields.”

The strike was yet another instance of an Israeli attack on Gaza hospitals, which are supposed to be afforded extra protection under international law. And for the displaced civilians, it showed once again that no place in the Gaza Strip is safe.

A witness told the Washington Post the tents caught fire as several explosions rocked the area. The strike caused gas cylinders to explode, said Ahmed al-Ras, 41, a photojournalist for local network Al-Kofiya TV who was inside the hospital premises at the time.

“The fire was very fast and burned all the tents. I saw three people burning, dozens of injuries and hundreds of families running and screaming and searching for their children,” he said, adding that it took about 40 minutes for the civil defence team to douse the blaze.

Anna Halford, a project coordinator for Doctors Without Borders in Gaza who visited the scene, said the strike appeared to have hit a metal container, next to one of the hospital buildings where some displaced people were staying and that the fire spread from there.

Halford said displaced families typically rely on gas cylinders to cook.

Four munitions experts who reviewed videos of secondary explosions at the scene at the Post’s request, said the explosions were likely caused by a mixture of fuel and relatively small munitions, including small arms ammunition. But they cautioned that the exact balance of these factors would be difficult to determine without access to the site.

The IDF said in its statement, without providing details, that it took steps to mitigate civilian harm ahead of the strike. In response to questions from the Post, the IDF media desk said the air force had “conducted a precise strike” on militants operating in a lot adjacent to the hospital building.

“Shortly after the strike, a fire ignited in the hospital’s parking lot, most likely due to secondary explosions. The incident is under review,” the IDF said.

In a video clip shared with the Post by Louise Wateridge, a spokeswoman for UNRWA, the UN agency for Palestinian refugees, separate from the video that appears to show a person burned alive, rescuers can be seen wrapping a charred body in a blanket. A blackened foot could be seen sticking out of the makeshift shroud. An UNRWA colleague captured the footage, Wateridge said.

“There is a state of fear and panic, and the displaced have no shelter but to sleep in the open,” al-Ras said.

Gaza Civil Defense spokesman Mahmoud Bassal said the hospital compound had been targeted by Israel at least half a dozen times.

The health facility itself was not damaged, according to a medical worker at the hospital, who spoke on the condition of anonymity because of concerns for their safety.

“Most of those who survived have severe burns, but they will die after a while because their burns are massive and deep,” the worker said. “It’s just a matter of time.”

As the blaze swallowed the tents, dozens of injured people streamed into the hospital’s emergency ward. Many of the injured were women and children, said Haddad, the emergency department head.

“We don’t have beds available. We were treating patients on the floor. It was a horrible scene.”

Some of the injured had shrapnel in their body and required critical care, he said, adding that the hospital doesn’t have a burns unit and that at least a dozen patients were transferred to two other hospitals.

As the sun rose, displaced people picked over the charred and mangled remains of tents, sheet-metal structures and vehicles, according to a video published by Reuters.

The fire destroyed structures sheltering 37 families, Halford said. “All of their belongings were burned on the ground.”

The hospital was already overcrowded and overwhelmed; now, Halford said, officials there are trying to encourage the families to find somewhere else to stay. But “there aren’t many places to go,” she added.

Gaza’s health system is under severe strain after repeated Israeli attacks on health facilities and medical personnel, Israeli evacuation orders and shortages of critical supplies.

Israel ordered three hospitals in northern Gaza to evacuate last week, according to Munir al-Bursh, the director general of all hospitals in Gaza, amid an intensifying assault on the enclave’s northernmost governorate. The United Nations estimates that 175,000 people are stuck there.

For the past two weeks, Israel did not allow food aid to enter northern Gaza, where the United Nations says about 400,000 people are trapped. Hospitals were running out of food and water, the Gaza Health Ministry said on Monday, pleading for help to evacuate patients.

Humanitarian and rights groups have accused Israel of violating international law by blocking aid.

“Israel must urgently do more to facilitate the flow of aid to those in need,” Vice-President Kamala Harris said Sunday in a post on X.

On Monday evening, the IDF said 30 trucks carrying flour and food from the World Food Programme had entered the Erez crossing to northern Gaza. Scott Anderson, deputy UN humanitarian coordinator in Gaza, said the United Nations planned to pick up the aid on Tuesday.

More than 42,000 people have been killed and more than 98,000 wounded in Israel’s war in Gaza, according to Gaza’s Health Ministry, which does not distinguish between civilians and combatants but says the majority of the casualties are women and children. Israel launched the military campaign in response to the Hamas-led attack on October 7, 2023, during which militants killed 1200 people in southern Israel and took about 250 hostage.

At least 1.9 million people across the Gaza Strip – 90% of the population – are internally displaced. Israel has repeatedly attacked schools sheltering displaced people as well as hospitals, arguing that Hamas uses the civilian infrastructure for military means.

On Sunday night, Israeli troops fired “a number of tank shells” in the area of the Nuseirat refugee camp in central Gaza – five of which hit an UNRWA school housing displaced people, killing at least 22 people who were sheltering there, the agency said in a statement. The school was supposed to be an immunisation site during the second phase of a UN-led polio vaccination campaign for children, “but because of the damage inflicted it was not able to be used”, UNRWA said. The IDF did not immediately respond to a request for comment on that strike.

“The polio vaccination campaign started as planned this morning at all other facilities in the middle Gaza area,” UNRWA said.

The Israeli military body charged with liaising with humanitarian groups in Gaza said it was facilitating the campaign and would work to ensure civilians could reach vaccination sites.

European Union foreign policy chief Josep Borrell condemned the strikes on the school and hospital in a statement posted to X. A “disregard for civilian casualties will not make Israelis safer”, he said.