DEIR AL-BALAH, Gaza Strip — The Israeli military urged all Palestinians to leave Gaza City and head south on Wednesday, pressing ahead with a fresh offensive across the north, south and center of the embattled territory that has killed dozens of people over the past 48 hours.

The stepped up military activity came as U.S., Egyptian and Qatari mediators were meeting with Israeli officials in the Qatari capital, Doha, for talks trying to push through a long-elusive cease-fire deal with Gaza’s Hamas militant group.

Israel says it is pursuing Hamas fighters regrouping in various parts of Gaza nine months into the military’s devastating offensive. But heavy strikes in recent days along the length of the territory also could be aimed at hiking up pressure on Hamas in the cease-fire talks.

In a visit to central Gaza on Wednesday, Israel’s military chief Lt. Gen. Herzi Halevi said forces were operating in different ways, in multiple parts of the territory “to carry out a very important mission: pressure. We will continue operating to bring home the hostages.”

Israel informed people in Gaza of the evacuation order by dropping leaflets urging “all those in Gaza City” to take two “safe routes” south to the area around the central town of Deir al-Balah. Gaza City, it said, will “remain a dangerous combat zone.”

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Evacuation Order

Israel ordered residents of northern Gaza, including Gaza City, to flee south months ago as it operated in the area, and much of the population fled earlier in the war. Large parts of Gaza City and urban areas around it have been flattened or left a shattered landscape by previous Israeli assaults.

The United Nations says about 200,000 Palestinians have remained in the hard-hit north, and many say they have nowhere safe to go. Most of Gaza’s 2.3 million people are crammed into squalid tent camps in central and southern Gaza.

Israeli ground troops have pushed into parts of Gaza City in recent days, triggering the flight of thousands of Palestinians trying to escape shelling and airstrikes. The past week, the military ordered Palestinians to evacuate from eastern and central parts of the city. There was no immediate mass exodus out of the city following Wednesday’s order. Many Palestinians have concluded that there is no refuge in war-stricken Gaza.

The evacuation order came after a series of deadly strikes over the past two days in other parts of the territory. Israeli bombardment early Wednesday hit four houses in Deir al-Balah and the nearby Nuseirat refugee camp, killing 20 Palestinians.

Among the dead were six children and three women, said authorities at al-Aqsa Martyrs Hospital, where the casualties were taken. An Associated Press reporter counted the bodies. The house hit in Deir al-Balah was located inside the “humanitarian safe zone” where Israel has told Palestinians to flee for refuge.

The overnight bombardment came hours after Israeli warplanes struck the entrance of a school sheltering displaced families outside the southern city of Khan Younis. The toll from the strike rose to 31 people killed, including eight children, and more than 50 wounded, officials at the nearby Nasser Hospital said Wednesday.

Footage aired by Al Jazeera television showed kids playing soccer in the school’s yard when a sudden boom shook the area, prompting shouts of “a strike, a strike!”

The Israeli army said the airstrike near the school and reports of civilian casualties were under review, and claimed it was targeting a Hamas militant who took part in the Oct. 7 attack on Israel, though it provided no immediate evidence. The military blames civilian deaths on Hamas because the militants fight in dense, urban areas. But the army rarely comments on what it is targeting in individual strikes, which often kill women and children.

In nine months of bombardment and offensives in Gaza, Israel has killed more than 38,200 people and wounded more than 88,000, according to the territory’s Health Ministry, which does not distinguish between combatants and civilians in its count. Nearly the entire population has been driven from their homes. Many have been displaced multiple times.

Israel’s onslaught was triggered by Hamas’ cross-border raid on Oct. 7, during which militants killed 1,200 people in southern Israel, most of them civilians, according to Israeli authorities. The militants took roughly 250 people hostage. About 120 are still in captivity, with about a third said to be dead.

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Efforts for a Cease-Fire

Israel’s new ground assault in Gaza’s largest city has prompted what the U.N called a “dangerously chaotic” exodus of people scattering in multiple directions, unsure where to go. Some have fled to other parts of the north. The new Israeli military leaflets encouraged a mass movement south to the purported “humanitarian zone,” promising that people leaving Gaza City on the defined routes would not be stopped at Israeli checkpoints. Many Palestinians fear arrest or humiliation by troops at the checkpoints.

After Israel on Monday called for an evacuation from eastern and central parts of Gaza City, staff at two hospitals — Al-Ahli and the Patients Friends Association Hospital — rushed to move patients and shut down, the United Nations said.

Hospitals in Gaza have often evacuated pre-emptively at any sign of possible Israeli military action, fearing raids. In the past nine months, Israeli troops have attacked at least eight hospitals, causing the deaths of patients and medical workers along with massive destruction to facilities and equipment. Israel has claimed Hamas uses hospitals for military purposes, though it has provided only limited evidence.

Only 13 of Gaza’s 36 hospitals are functioning, and those only partially, according to the United Nations’ humanitarian office.

Amid the ongoing violence, international mediators were making a new concerted effort to push through a proposed deal for a cease-fire and release of hostages.

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Israel and Hamas had appeared to narrow the gaps in recent days, but obstacles remain, even after Hamas agreed to relent on its key demand that Israel commit to ending the war as part of any agreement.

Hamas still wants mediators to guarantee that negotiations conclude with a permanent cease-fire. Israeli Prime Minister Benjamin Netanyahu has insisted he will not sign any deal forcing Israel to stop its campaign in Gaza without eliminating Hamas. Hamas on Monday accused Netanyahu of “putting more obstacles in the way of negotiations,” including the operations in Gaza City.

An Egyptian official said the head of Egypt’s General Intelligence Service, Abbas Kamel, went to Doha to join discussions over the deal. The official said U.S. and Israeli officials were also attending. The official spoke on condition of anonymity because he was not authorized to brief the press on the meetings. A day earlier, CIA Director William Burns, who has led the American mediation, met with Egyptian President Abdel Fattah el-Sissi in Cairo.