Israel-Hamas war rages as humanitarian crisis spirals in Gaza

The Israeli military reached the heart of Gaza City “much earlier than Hamas had expected” and the forces continue to advance according to the plan, a spokesperson for the Israel Defense Forces (IDF) said Monday. 

“We carried an offensive move that met the heart of Gaza City, through encirclement. It led to us getting to the city’s heart quickly, much earlier than Hamas had expected,” spokesperson Daniel Hagari said in his daily briefing. 

“The troops continue to advance according to the plan, this takes time,” he said, adding that “the war (operates) in stages.” 

The Israeli army is looking for Hamas militants in Zaytun and Jabalya in northern Gaza and is “currently encircling Jabalya and start dismantling the (Hamas) battalion there as well,” Hagari said. 

The spokesperson added that over the past few days, Israeli forces have been conducting face-to-face battles against the Zaytun battalion — one of the central battalions of Hamas operating in Zaytun in the northern Gaza Strip. 

A Doctors Without Borders clinic in Gaza City came under fire on Monday during fierce street fighting, the medical charity said.    

The organization, also known as Médecins Sans Frontières (MSF), wrote on X that “our colleagues saw that a wall was torn down and part of the building was engulfed by fire, as heavy fighting took place all around it.”  

“An Israeli tank was seen in the street," it added.  

CNN is reaching out to the IDF and Hamas for comment.   

One MSF staff member and 20 relatives are currently “in extreme danger” inside the clinic, with their status unknown, the organization said.   

Additionally, five MSF cars that had been used in a failed mission Saturday to evacuate staff and family members were destroyed in Monday’s exchange of fire, the group also said.   

“Four MSF cars burned down. A fifth car, parked across the street, was broken in two pieces as if crushed by a heavy-duty vehicle or a tank. All the cars and the clinic were clearly identified with the MSF logo.”   

On Saturday, a relative of one MSF staff member was killed when the convoy was attacked en route back to Gaza City after a failed attempt to evacuate south, the organization said at the time.     

MSF said on Saturday that both Hamas and the IDF were made aware of the evacuation route. The convoy of 137 people, including 65 children, was forced to turn back at the final Israeli checkpoint near Wadi Gaza when shots were heard nearby.   

 “On their way back, between 3:30 pm and 4:00 pm local time, the convoy was attacked in Al-Wehda street near the junction of Said Al-A’as Street, near the MSF office,” the group reported on Saturday.   

"Two of the MSF cars were deliberately hit, killing a family member of one MSF staff and injuring another."   

On Monday, MSF said the cars, now destroyed, were the only means to evacuate its staff and their families.  

Six American citizens who were serving in the Israeli security forces have died in Israel and Gaza since October 7, State Department spokesperson Matt Miller said Monday.

“There are a total of six American citizens who have died, not from the terrorist attacks on October 7, but in the month-plus since,” said Miller. Five of them were members of the Israel Defense Forces and the sixth was a border officer, he said.

Four of the Americans serving with the IDF died in the Gaza Strip and a fifth was killed in northern Israel, the spokesperson said.

Americans in Gaza: According to Miller, 800 American citizens, legal permanent residents and family members have now departed Gaza through the Rafah crossing with Egypt.

The number of Americans who remain in the enclave — who have registered with the State Department — has increased to 1,200.

On Friday, a State Department official said there were fewer than 900.

“One of the things that happens is we continue to identify either additional American citizens or American citizens or permanent residents who have additional family members that they're reporting to us that we then try to get on the list to get out of Gaza,” Miller said, noting why the 1,200 remaining is a higher number than it had been previously.

Former Prime Minister Ehud Barak said Monday that Israel had built bunkers "decades ago" underneath Al-Shifa Hospital in Gaza City. 

“It's probably not the only kind of command post, several others are under other hospitals or in other sensitive places, but it for sure had been used by Hamas even during this conflict,” he added.  

Israel captured Gaza from Egypt in 1967 and held the territory under full military occupation until 2005 when it withdrew its settlers and soldiers in a move known as the ‘disengagement.’ Hamas assumed full control inside the enclave two years later. 

“It was probably five or four decades ago that we helped (the Palestinians) to build these bunkers in order to enable more space for the operation of the hospital within the very limited size of this compound,” Baruk said. 

Some context: Ahead of raiding the hospital complex last week, Israel claimed that it was being used by Hamas as a command center.

The Israel Defense Forces on Saturday showed CNN what it said was “concrete evidence” that Hamas was using the complex above ground as cover for what it called terror infrastructure underneath, including a command and control hub.

The military showed what a commander described as a big tunnel. “This is a big tunnel,” he said. “I have encountered tunnels — in 2014 in [Operation] Protective Edge, I was a company commander — and this tunnel is an order of magnitude bigger than a standard tunnel.”

Read more about the tunnel shaft

The United States “would welcome China playing a constructive role in the Middle East,” State Department spokesperson Matt Miller said Monday after the Chinese Foreign Minister convened Arab counterparts in Beijing.

Speaking at a briefing, Miller noted that Secretary of State Antony Blinken had “made this clear personally” in conversations with Chinese Foreign Minister Wang Yi. 

Still, Miller stressed that “one of the things that we heard repeatedly from every party with which we engaged on our last trip is the indispensability of the United States in every aspect of this conflict, whether it comes to getting humanitarian assistance and whether it comes to preventing the conflict from widening.”

He noted that it was the US that was able to negotiate an agreement to begin delivering humanitarian assistance to Gaza after October 7, “the United States that was able to push forward and achieve humanitarian pauses” to allow civilians to move about Gaza, and the US that is “the largest humanitarian donor to the Palestinian people.”

On Monday, Wang met counterparts from Saudi Arabia, Jordan, Egypt, the Palestinian National Authority and Indonesia, as well as the head of the Organization of Islamic Cooperation, in Beijing for talks on “de-escalating” the Israel-Hamas conflict.

National Security Council spokesperson John Kirby said Monday that negotiators are “getting close to the end” on the release of hostages held by Hamas – but he declined to elaborate on the details of a potential deal.

He also declined to comment on CCTV footage that Israel said shows two hostages being moved through Al-Shifa Hospital in Gaza on October 7. 

When asked what level of confidence the White House has that the American hostages are alive, Kirby responded, in part, saying in part: “I would say we have no indication otherwise.”

The World Health Organization (WHO) said 28 out of 33 premature babies have been evacuated into Egypt from Gaza.

WHO’s Senior Emergency Officer Rob Holden said two of the 33 neonatal babies died over the weekend, and three other babies were reunited with their families.

The remaining 28 babies were evacuated into Egypt where an “appropriate level of care was initiated,” Holden said during a United Nations briefing on Monday.

Looking ahead, Dr. Michael Ryan, the WHO’s executive director, said that more than 5,000 women will be giving birth in the next month in Gaza. Of those, 15% will need a cesarean section and 25% of their children will be born preterm, he said.

The WHO recommends that skin-to-skin contact, known as kangaroo mother care, be provided to a preterm infant immediately after birth, without any initial time spent in an incubator.

Ryan also said that a combination of large crowds gathered in one place combined with decreasing temperatures in Gaza is “a public health risk,” and could result in an “epidemic.” 

“We're seeing large numbers of people packed into refuges, packed into (United Nations Relief and Works Agency) UNWRA schools, packed into various other kinds of centers. This is creating a concentration of people, which is driving epidemic risks and the rains over the last 24 hours have really added to that,” Ryan said.

He noted that the risks aren't limited to diarrhea or disease. "The sudden drop in temperature is going to create a problem with pneumonia in children…This is an absolute recipe for a large-scale epidemic amongst this population.” 

The “heavy rain” over the past 24 hours has “flooded a lot of makeshift camps,” accelerating those risks, he said.

Ryan added that "nutrition is the baseline for health, nutrition is the baseline for child development, and right now the caloric intake of the quality of that for children particularly has reduced below a critical level.”

Family members of some of the Israeli hostages taken by Hamas say they want answers ahead of their Monday meeting with Israeli Prime Minister Benjamin Netanyahu and his war cabinet. 

The families came to meet the prime minister and the war cabinet to “receive answers,” Meirav Leshem Gonen, whose daughter is held hostage by Hamas, said. 

“We have very concrete questions that we expect them to answer. Every deal or any stage in this path ... doesn’t excuse anyone from their responsibility to return all the hostages home,” she continued. 

Meanwhile, the United States and Qatar have given upbeat assessments on the negotiations surrounding hostages held by Hamas. A deal freeing dozens of civilians could be reached within days, sources told CNN.

German President Frank-Walter Steinmeier will travel to Israel on November 26 and 27 to hold “political talks” with his Israeli counterpart Isaac Herzog, according to a statement from the president’s office.   

During his visit, Steinmeier is also planning to hold meetings in southern Israel and east Jerusalem. 

The president will then travel Oman and Qatar, the statement said.