By Nidal al-Mughrabi and Dan Williams
GAZA/JERUSALEM (Reuters) -Israeli tanks advanced on Monday to the gates of Gaza City's main hospital, a chief target in Israel's battle against Hamas, as U.S. President Joe Biden said hospitals must be protected and he hoped for less intrusive Israeli action.
Separately, the armed wing of the Palestinian militant group said it was ready to release up to 70 women and children held in Gaza in exchange for a five-day truce in the war triggered by Hamas' Oct. 7 rampage into southern Israel.
Gaza health ministry spokesperson Ashraf Al-Qidra, who was inside Al Shifa hospital, said 32 patients had died in the last three days, including three newborn babies, as a result of the siege of the hospital in northern Gaza and a lack of power.
At least 650 patients were still inside, desperate to be evacuated to another medical facility. Israel says the hospital sits atop tunnels housing a headquarters for Hamas fighters using patients as shields, which Hamas denies.
"The tanks are in front of the hospital. We are under full blockade. It's a totally civilian area. Only ... hospital patients, doctors and other civilians staying in the hospital. Someone should stop this," a surgeon at the hospital, Dr Ahmed El Mokhallalati, said by telephone. "We are hardly surviving."
In his first comments since the weekend's events, including patient deaths reported at the Shifa hospital, Biden said that hospitals must be protected.
"My hope and expectation is that there will be less intrusive action relative to hospitals and we remain in contact with the Israelis," Biden told reporters at the White House.
"Also there is an effort to get this pause to deal with the release of prisoners and that's being negotiated, as well, with the Qataris ... being engaged," he added. "So I remain somewhat hopeful but hospitals must be protected."
Israel launched its campaign last month to annihilate Hamas, the Islamist group that runs the Gaza Strip and that is officially dedicated to the destruction of Israel, after Hamas gunmen rampaged through southern Israel killing civilians.
Around 1,200 people died in that attack and 240 were dragged to Gaza as hostages according to Israel's tally.
Since then thousands of Gazans have been killed and two-thirds of the population have been made homeless by an Israeli military campaign. Israel has ordered the evacuation of the northern half of Gaza.
Gaza medical authorities say more than 11,000 people have been confirmed killed, around 40% of them children.
Israel says Hamas hospitals serve as military facilities and Israel's military on Monday released video and photos of what it said were weapons the group stored in the basement of Rantissi hospital, a pediatric hospital specializing in cancer treatment.
HOSTAGES FOR CEASEFIRE?
Al-Qassam Brigades, the armed wing of Hamas, posted an audio recording on its Telegram channel saying the group was ready to release some of the hostages it took in exchange for a five-day ceasefire, an offer Israel is unlikely to embrace.
"The enemy has asked for the release of 100 women and children from his captives in Gaza but we told the mediators that in a five-day truce, we can release 50 of them and the number could reach 70 due to the difficulty that the captives are held by different factions," al-Qassam Brigades spokesman Abu Ubaida said, referring to a request by Israel.
The spokesman said the Qatari mediators last week sought the release of some of the women and children hostages in return for Israel freeing 200 Palestinian children and 75 women it detains.
"The truce should include a complete ceasefire and allow aid and humanitarian relief everywhere in the Gaza Strip," he said.
White House national security adviser Jake Sullivan told reporters that Washington would "like to see considerably longer pauses - days, not hours - in the context of a hostage release."
Speaking on condition of anonymity, another U.S. official said the release of dozens of hostages, could lead to a several-day pause, saying negotiations were extremely delicate.
Israel, which effectively blockades Gaza, has rejected a ceasefire, arguing that Hamas would simply use it to regroup, but has permitted brief humanitarian "pauses" that have allowed food and other supplies to flow in and foreigners to flee.
Fighting also took place on Monday at a second major hospital in northern Gaza, al-Quds, which has stopped functioning. The Palestinian Red Crescent said the hospital was surrounded by heavy gunfire, and a convoy sent to evacuate patients and staff had been unable to reach it.
Israel said it had killed "approximately 21 terrorists" at al-Quds in return fire after fighters shot from the hospital entrance. It released footage it said showed a group of men at the hospital gate, one of whom appeared to be carrying a rocket-propelled grenade launcher.
In a sign of Israel's advance in Gaza, the country's Channel 12 TV broadcast a photo of soldiers carrying Israeli flags in the Gaza parliament chamber. Israeli security cabinet minister Israel Katz said on X social media that the picture showed "the symbol of Hamas rule in Gaza" was in the hands of Israeli soldiers.
Israel's military and security services said they had killed a number of Hamas commanders and officials in the last day, including Mohammed Khamis Dababash, who they described as the group's former head of military intelligence.
Hamas media said more than 30 people were killed and scores injured in an Israeli airstrike on the Jabalia refugee camp in northern Gaza. An Israeli military spokesperson said the army was checking the report on Jabalia.
In Israel, sirens sounded across the centre of the country and in the city of Tel Aviv on Monday night, with Hamas' armed wing saying on its Telegram account that it had fired a batch of missiles at Tel Aviv.
There was also fresh concern that the war could spread beyond Gaza, with an upsurge of clashes on Israel's northern border with Lebanon, and the United States launching airstrikes on Iran-linked militia targets in neighbouring Syria.
HOSPITAL AT HEART OF BATTLES
At Al Shifa, Gaza health ministry spokesperson Qidra said Israeli snipers and drones were firing into the hospital, making it impossible for medics and patients to move around.
Israel has told civilians to leave and medics to send patients elsewhere. It says it has attempted to evacuate babies from the neo-natal ward and left 300 litres of fuel to power emergency generators at the hospital entrance, but the offers were blocked by Hamas.
Qidra said Shifa needed 8,000-10,000 litres (2,100-2,600 gallons) of fuel per day delivered by the Red Cross or an international agency.