Human Rights Watch (HRW) said Thursday it was "gravely concerned" for the thousands of civilians at Gaza's biggest hospital amid the devastating war in the Palestinian enclave.
Al-Shifa Hospital is located in Gaza City and many have sought refuge there from a month-long indiscriminate Israeli military campaign that has killed over 10,800 people, mostly women and children.
"With ongoing strikes and fighting nearby, we are gravely concerned about the well-being of thousands of civilians there, many children among them, seeking medical care and shelter, including people on life support, those who lost limbs in air strikes, and burn victims," HRW said on social media platform X.
Graphic video shared on social media and verified by Reuters on Friday shows a number of dead and wounded people, including children in an area of al-Shifa, which a Gaza health ministry spokesman said had been hit by Israeli airstrikes.
There was no immediate Israeli military comment on the video, which a Reuters correspondent said appeared to have been made in a covered, outdoor area near the hospital's outpatient department, where displaced people had been sleeping.
Israeli forces struck an ambulance outside the hospital last week. HRW said it had verified photos and video showing at least 21 dead or injured – among them five children.
"Israel claimed the ambulance was transporting Palestinian fighters but provided no evidence to support that claim nor justifications for why the attack did not cause disproportionate loss of civilian life," HRW said.
The Israeli army has also claimed Hamas's headquarters are underneath the al-Shifa hospital, but HRW said it could not corroborate the allegation, which the Palestinian armed group denies.
The rights group added that hospitals are afforded special protection under the laws of war and only lose this if they're being used for "acts harmful to the enemy" and following due warning.
Evacuating patients and staff should only be a last resort, HRW said, adding that the Israeli army has ordered al-Shifa to be evacuated.
The Israeli army said Wednesday that "time is running out" for civilians to evacuate northern Gaza using the Salah al-Din Road, which it says it leaves "open" for a few hours at a time.
But HRW said data from US space agency NASA from Monday to Thursday shows several fires on the main route from the hospital to Salah al-Din Road.
Civilians in and around the hospital can't use al-Rashid coastal road to evacuate, the rights group added.
It said satellite imagery from Tuesday shows Israeli armoured vehicles and a roadblock two kilometres southwest of al-Shifa on the road.
There are also armoured vehicles two kilometres northeast of the hospital.
"Israel's evacuation orders raise grave concerns. Warring parties should issue effective warnings when conditions permit. But calls suggesting all civilian structures are targets or alerting civilians to flee without a safe passage or safe place to go does not suffice," HRW said.
"Civilians who remain in place after an evacuation warning – including those who can't leave, fear moving, or don't want to be displaced – don't lose their protections as civilians under the laws of war. No area is a free-fire zone."
Reuters contributed to this report.