DEIR AL-BALAH, Gaza Strip — Israel launched airstrikes across the Gaza Strip early Tuesday, killing more than 400 Palestinians, local health officials said, and shattering a ceasefire in place since January with its deadliest bombardment in a 17-month war with Hamas.

Prime Minister Benjamin Netanyahu ordered the strikes, which killed mostly women and children, after Hamas refused Israeli demands to change the ceasefire agreement. Officials said the operation was open-ended and expected to expand. The White House said it had been consulted and voiced support for Israel’s actions.

The Israeli military ordered people to evacuate eastern Gaza and head toward the center of the territory, indicating that Israel could soon launch renewed ground operations. The new campaign comes as aid groups warn supplies are running out two weeks after Israel cut off all food, medicine, fuel and other goods to Gaza’s 2 million Palestinians.

“Israel will, from now on, act against Hamas with increasing military strength,” Netanyahu’s office said.

Attack Raises Concerns for Hostages and Regional Stability

The attack during the Muslim holy month of Ramadan could signal the full resumption of a war that has already killed tens of thousands of Palestinians and caused widespread destruction across Gaza. It also raised concerns about the fate of the roughly two dozen Israeli hostages held by Hamas who are believed to still be alive.

The renewal of the campaign against Hamas, which is supported by Iran, came as the U.S. and Israel stepped up attacks this week across the region. The U.S. launched deadly strikes against Iran-allied rebels in Yemen, while Israel has targeted Iran-backed militants in Lebanon and Syria.

A senior Hamas official said Netanyahu’s decision to return to war amounts to a “death sentence” for the remaining hostages. Izzat al-Risheq accused Netanyahu of launching the strikes to save his far-right governing coalition and called on mediators to “reveal facts” on who broke the truce. Hamas said at least six senior officials were killed in Tuesday’s strikes.

There were no reports of any attacks by Hamas several hours after the bombardment.

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Netanyahu Faces Mounting Domestic Pressure

The strikes came as Netanyahu comes under mounting domestic pressure, with mass protests planned over his handling of the hostage crisis and his decision to fire the head of Israel’s internal security agency. His latest testimony in a long-running corruption trial was canceled after the strikes.

The strikes appeared to give Netanyahu a political boost, with a far-right party that had bolted the government over the ceasefire announcing Tuesday that it was rejoining.

The main group representing families of the hostages accused the government of backing out of the ceasefire. “We are shocked, angry and terrified by the deliberate dismantling of the process to return our loved ones from the terrible captivity of Hamas,” the Hostages and Missing Families Forum said.

Wounded Stream Into Gaza Hospitals

Strikes across Gaza pounded homes, sparked fires in a tent camp of displaced people outside the southern city of Khan Younis and hit at least one school-turned shelter.

After two months of relative calm during the ceasefire, stunned Palestinians found themselves once again digging loved ones out of rubble and holding funeral prayers over the dead at hospital morgues.

“Nobody wants to fight,” Palestinian resident Nidal Alzaanin told the AP by phone from Gaza City. “Everyone is still suffering from the previous months.”

A hit on a home in Rafah killed 17 members of one family, according to the European Hospital, which received the bodies. The dead included five children, their parents, and another father and his three children.

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At Khan Younis’s Nasser Hospital, patients lay on the floor, some screaming. A young girl cried as her bloody arm was bandaged. Wounded children overwhelmed the pediatric ward, said Dr Tanya-Haj Hassan, a volunteer with Medical Aid for Palestinians aid group.

“We woke up to an airstrike frenzy. The windows were shaking, the doors flew open,” she said. “The patients have been flowing in ever since.”

Gaza’s Health Ministry said the strikes killed at least 404 people and wounded more than 560. Zaher al-Waheidi, head of the ministry’s records department, said at least 263 of those killed were women or children under 18. He described it as the deadliest day in Gaza since the start of the war.

The war has killed over 48,500 Palestinians, according to local health officials, and displaced an estimated 90% of Gaza’s population. The Health Ministry doesn’t differentiate between civilians and militants but says over half of the dead have been women and children.

The war erupted when Hamas-led militants stormed into southern Israel on Oct 7, 2023, killing some 1,200 people, mostly civilians, and taking 251 hostages. Most have been released in ceasefires or other deals, with Israeli forces rescuing only eight and recovering dozens of bodies.

Follow AP’s war coverage at https://apnews.com/hub/israel-hamas-war