KHAN YOUNIS, Gaza Strip — Thousands of Palestinians on Friday fled from around Gaza City’s main hospital after a series of strikes that staff blamed on Israel hit in and around several hospitals overnight. They joined a growing exodus of people toward the south amid intensified fighting as Gaza officials said the Palestinian death toll from the war surpassed 11,000 people.

Thousands of Palestinians streamed onto Gaza’s only highway Friday, fleeing the combat zone in the north after Israel announced a window for safe passage.

But the search for safety in the besieged enclave has grown increasingly desperate. The tens of thousands who fled south in the past few days face the prospect of ongoing bombardment and dire conditions. The overnight strikes in northern Gaza underscored the danger for tens of thousands more who have crowded in and around hospitals, believing they will be safe.

Gaza medical officials accused Israel of striking near four hospitals Friday, though Israel said at least one was the result of a misfired Palestinian rocket.

Gaza’s largest city is the focus of Israel’s campaign to crush Hamas following its deadly Oct. 7 surprise incursion.

BATTLES AROUND HOSPITALS

Early Friday, Israel struck the courtyard and the obstetrics department of Shifa Hospital, Gaza’s largest, where tens of thousands of people are sheltering, according to Ashraf al-Qidra, spokesperson at the Health Ministry in Hamas-run Gaza.

A video at the scene recorded the sound of incoming fire waking people in makeshift shelters in the courtyard, followed by shouts for an ambulance. Blood was seen splattered across a yard of the facility while one man writhed on the ground, his leg apparently severed.

The Israeli army alleges that Hamas hides in and under hospitals and that it has set up a command center under Shifa — claims the militant group and hospital staff deny.

After the explosions, thousands at the hospital fled, a number of evacuees said. Tens of thousands of displaced people — as many as 60,000, according to the Health Ministry — have been living at the Shifa complex. The scale of the flight was not immediately clear. Doctors at Shifa Hospital could not immediately be reached for comment because of phone and internet connectivity disruptions.

The director of Shifa said Israel demanded the facility be evacuated, but he said there was nowhere for such a large number of patients to go.

“Where are we going to evacuate them?” Director Mohammed Abu Selmia asked in an interview on the television network Al Jazeera.

The Health Ministry later said one person had been killed at Shifa and several were wounded. Another strike near the Al-Nasr Medical Center, which includes two hospitals for children, killed two people, according to the ministry.

In all, Gaza health officials said strikes were carried out near four hospitals overnight and early Friday.

A senior Israeli security official said initial findings indicated that one strike at Shifa was the result of a misfire by militants. The military is conducting a review. The official spoke on condition of anonymity because the investigation is ongoing.

At Shifa, families are sleeping in hospital rooms, emergency rooms, surgical theaters and the maternity ward — or on the streets outside, according to Wafaa Abu Hajjaj, a Palestinian journalist at the hospital, as well as several people who recently left. Morgues have overflowed, with bodies now piled up outside under tents,

Daily food distributions has helped a tiny number for a time, but there has been no bread in recent days, they said. Water is scarce and usually polluted, and few people can bathe.

World Health Organization spokesperson Margaret Harris said 20 of Gaza’s 36 hospitals are no longer functioning, including a pediatric hospital where children had been receiving care such as dialysis and life support — “things that you cannot possibly evacuate them safely with.”

CIVILIANS FLEE SOUTH

More than two-thirds of Gaza’s population of 2.3 million have fled their homes since the war began. On Friday, a steady stream of civilians used both sides of Gaza’s main north-south highway.

Parents walked with small children, some evacuees crammed into covered donkey carts with possessions piled on the roof, and others rode on bicycles.

Since last weekend, the Israeli military has set aside several hours a day to enable civilians to escape northern Gaza, and it announced a six-hour window Friday.

A day earlier, the White House said Israel agreed to implement a brief humanitarian pause each day — in what appeared to be an effort to formalize and expand the process. Israel has also agreed to open a second route for people fleeing, the White House said.

In all, Israel estimated more than 850,000 of the 1.1 people in northern Gaza have left, according to military spokesman Jonathan Conricus, who called the pauses “quick humanitarian windows” that allow southward movement “while we are fighting.”

U.N. expert for the Palestinian territories Francesca Albanese called the pauses “cynical and cruel,” saying it was just enough “to let people breathe and remember what is the sound of life without bombing, before starting bombing them again.”

RISING DEATH TOLLS

More than 11,070 Palestinians, two-thirds of them women and minors, have been killed since the war began, according to the Gaza Health Ministry, which does not not differentiate between civilian and militant deaths. Another 2,650 people have been reported missing.

U.S. Secretary of State Antony Blinken said Friday that “far too many” Palestinians have died and suffered and that while recent Israeli steps to try to minimize civilian harm are positive, they are not enough.

Though U.S. President Joe Biden and others have challenged the figures from the Gaza Health Ministry as exaggerated, Assistant Secretary of State Barbara Leaf told American lawmakers this week that it was “very possible” the numbers were even higher than reported.

More than 1,400 people have been killed in Israel, mainly in the initial Hamas attack, and 41 Israeli soldiers have been killed in Gaza since the ground offensive began.

Palestinian militants have continued to fire rockets into Israel, and an attack on Tel Aviv wounded at least two people Friday, said Yossi Elkabetz, a paramedic with Israel’s rescue services. Hamas claimed credit.

Some 250,000 Israelis have been forced to evacuate from communities near Gaza and along the northern border with Lebanon, where Israeli forces and Hezbollah militants have traded fire repeatedly.