Hundreds of patients evacuate Al Shifa hospital in Gaza on foot as 450 are left behind - while Israel vows to advance 'wherever Hamas exists'

Hundreds of civilians and health workers fled Gaza's largest hospital on foot today as Israeli troops issued the order to evacuate over loudspeakers on Saturday.

Health officials in Gaza said 450 patients had been left behind at the hospital following repeat warnings the sick and wounded would not be able to escape.

Al-Shifa hospital has become the focus of the Israel-Hamas war, now entering its seventh week, as Israel closes in on what it says is a façade for a Hamas stronghold - claims the hospital and Hamas deny.

The order follows claims by Israel made on Wednesday that troops had found weapons in the hospital - evidence, they say, to support their claims. 

Hospital director Mohammed Abu Salmiya said Israeli troops had told him to ensure the 'evacuation of patients, wounded, the displaced and medical staff' as they swept through the site.

But with the Gaza City devastated by weeks of constant bombardment, the only indication was for civilians to move 'towards the seafront'.

Hundreds of thousands of Palestinians have fled south since Israel's first evacuation order of the north of the Strip on October 13. But unable to pin down Hamas' leaders in Gaza City so far, Israel has now issued the order for residents in the south to flee too, vowing to advance 'wherever Hamas exists'.

The United Nations estimated 2,300 patients, staff and displaced Palestinians were sheltering at al-Shifa before Israeli troops moved in on Wednesday. 

The order to evacuate follows claims made by Israel on Wednesday that troops had found assault rifles and military equipment during raids into the facility.

It was a dramatic revelation after days spent encircling the facility since November 10.

But the Palestinian health ministry in Gaza has announced dozens of deaths as a result of power cuts casued by fuel shortages amid intense combat.

Hamas claimed on November 14 that 650 patients and between 5,000 and 7,000 civilians were trapped inside the hospital's grounds under heavy fire from Israeli snipers and drones.

Ashraf Al-Qidra, Gaza's health ministry spokesman, said: 'The occupation is still besieging the hospital and they are firing into the yards from time to time.'

Qidra said at the time there were about 100 bodies decomposing inside and no way to get them out.

Israel has denied its raids on al-Shifa amount to a siege, though the site has been effectively cut off from Gaza City for more than a week.

Israel has said for years that Hamas has used the hospital as a cover for their operations - claims Hamas and hospital staff have repeatedly denied.

Officials have also suggested that some of the 240 captives seized by Hamas since the October 7 attack might be held under the Gazan hospitals. 

On November 14, the United States said its intelligence also supported claims Hamas used the hospital and tunnels beneath it as a 'command-and-control node'.

Since then, Israel has provided what it says is evidence Hamas has been using the facility for military purposes.

On November 15, the Israel Defense Forces shared images of Kalashnikov-style assault rifles, tactical gear, a handgun, a knife and magazines.

A day later, Israeli troops claimed they had found a tunnel shaft used by Hamas at the hospital - along with the bodies of two hostages held in a building close by.

The IDF released a video it said showed a tunnel entrance in an outdoor area of al-Shifa hospital, two days after Israeli troops entered its grounds.

During the raid, Israel said its troops found the bodies of Yehudit Weiss, 64, and Israeli soldier Noa Marciano, 19 - from a building adjacent to the hospital.

Israeli Prime Minister Benjamin Netanyahu claimed there were 'strong indications' that hostages were held at the hospital but they were no longer there when the facility was raided.

'We had strong indications that they were held in the Shifa Hospital, which is one of the reasons we entered the hospital,' he told CBS Evening News. 'If they were (there), they were taken out.'

The UN has nonetheless maintained its opposition to the raids, stressing that the protection of civilians must outweigh all other concerns.

'I'm appalled by reports of military raids in al-Shifa hospital in Gaza,' UN humanitarian chief Martin Griffiths said on X, formerly Twitter. 

'The protection of newborns, patients, medical staff and all civilians must override all other concerns.'

The International Committee of the Red Cross said it was 'extremely concerned about the impact on sick and wounded people, medical staff and civilians'.

Using a hospital as a military base is a war crime. Once used as a military facility, a hospital may lose its the special protection afforded to it.

The discovery of small arms taken from wounded combatants would not exempt al-Shifa from its protections. 

Israel must also take precautions not to involve civilians in the fighting, for instance by giving adequate notice to evacuate and making sure evacuation is possible.

On October 27, Israel said that the hospital was the 'focus' of Hamas' operations in the Strip.

Israel maintains that the site has 'several underground complexes' with a 'headquarters' from which leaders command forces and store heavy equipment.

According to Israel, the underground hideout has several floors and space for several hundreds people. 

But medical professionals working at the hospital say they have seen no evidence of it so far.

The IDF has notably only scoured a small part of the expansive compound so far, and the evacuation of the site is expected to take several days.

The process will be slowed by fears Hamas might have laid traps for raiding soldiers around the site - Israel sending in robots and dogs instead.

Israel will hope that cutting deeper into the facility will bring them closer to locating the masterminds behind the October 7 attack. But progress is steady as troops battle with the challenges of urban warfare.

In the north, Israel issued the order to evacuate on October 13, amid sustained airstrikes of the Strip designed to make the terrain easier before entering with troops.

Some 1.5mn Gazans, of 2.3mn in the Strip, have been displaced from their homes since the conflict began. The Hamas government says that Israeli strikes have killed some 12,000 people, including thousands of women and children.

But Gazans living in the south have now also been given the order to flee as Israel scours the beleaguered Strip for Hamas' commanders.

Daniel Hagari, spokesperson for the IDF, said in his regular Friday briefing: 'We are determined to advance our operation. It will happen wherever Hamas exists, including in the south of the strip.

'It will happen at the time, place and conditions that are best for the military.'

Civilians in parts of south-east Gaza have been told in leaflets dropped by Israeli aircraft to move into a 'safe zone' in the coastal town of Mawasi, covering just 5.4 sq miles.