Thousands of Palestinians are streaming onto Gaza’s only highway as they try to flee the combat zone in the north, after Israel announced a window for safe passage.
It comes as Israeli forces struck near several hospitals in Gaza City as the military pushes further into dense urban neighbourhoods in its fight against Hamas.
Parents carried children in their arms while others brought what possessions they could in animal-drawn carts in a line stretching as far as the eye could see.
The accelerating exodus to the south came as Israel agreed to start implementing a four-hour humanitarian pause each day and to open a second route for people to flee the north, the White House said.
Those fleeing to the south face the prospect of ongoing airstrikes there, and dire humanitarian conditions.
‘Darkest hour’
More and more people have been living in and around Shifa Hospital – the largest hospital in Gaza – in the hope that it will be safer than their homes or United Nations shelters in the north, several of which have been hit repeatedly.
Early on Friday, Israel struck the hospital’s courtyard and obstetrics department, according to the head of the Hamas-run media office in Gaza, Salama Maarouf.
British-Palestinian surgeon Professor Ghassan Abu-Sittah, who left London for Gaza last month, told Sky News’s Cordelia Lynch that the medical system was destroyed.
“This is by far the darkest hour. It’s gone. There’s no medical system. Shifa is gone,” he said.
“That was one third of the system. All of the children’s hospitals have been attacked and put out of service,” he said, adding that the cancer hospital, the psychiatric hospital and the ophthalmic hospital were out of service.
The health ministry in Gaza later said one person had been killed at Shifa Hospital and several others wounded.
Israel has accused Hamas fighters of hiding in hospitals and using the Shifa Hospital complex as its main command centre, which the militant group and hospital staff deny, saying Israel is creating a pretext to strike it.
Professor Abu-Sittah said: “There’s no one here other than the wounded, their families and some kids trying to get water as we have a water pipe.
“They’re absolutely terrified that they’re targeting the hospital. None of the children, the injured, the displaced has seen anything like this.”
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3:26
Hamas fighter: ‘This is our land’
More than 10,800 Palestinians have been killed since the latest hostilities began on 7 October, according to the Gaza health ministry.
More than 1,400 people have been killed in Israel, mainly in the initial Hamas attack, and more than 30 Israeli soldiers have been killed in Gaza since the ground offensive began.
Israel’s military said it killed 19 Hamas militants overnight – including a company commander and a platoon commander who were involved in the 7 October attack – and also destroyed a shipping container that held some 20 rocket launchers.
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0:23
Biden: ‘No possibility’ of ceasefire in Gaza
Meanwhile, the head of the UN Palestinian refugee agency (UNRWA) said on Friday that more than 100 UN workers had been killed since the start of the Israel-Hamas conflict.
“UNRWA is mourning, Palestinians mourning, Israelis mourning,” Philippe Lazzarini said, reiterating a call for a humanitarian ceasefire.
US Secretary of State Antony Blinken, speaking on a visit to India, said that “far too many” Palestinians have died and suffered as Israel wages war on Hamas.
He urged Israel to minimise harm to civilians and maximise humanitarian assistance that reaches them.
Joe Biden has authorised Ukraine to begin firing US-supplied rockets deep into Russia – as Sir Keir Starmer prepares to push for “further support” for Kyiv at the G20 summit.
Mr Biden’s policy shift means Kyiv will now be able to use Army Tactical Missile Systems (ATACMS)for long-range attacks, two American officials have told Sky News’ US partner network NBC News.
Ukraine plans to conduct its first such attacks in the coming days, the sources said, without revealing details due to operational security concerns.
A Russian politician and the son of president-elect Donald Trumphave both likened the move to risking a third world war.
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Maria Butina told the Reuters news agency: “These guys, Biden’s administration, is trying to escalate the situation to the maximum while they still have power and are still in office.
“I have a great hope that Trump will overcome this decision if this has been made because they are seriously risking the start of World War Three which is not in anybody’s interest.”
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Meanwhile, Donald Trump Jr wrote on X: “The Military Industrial Complex seems to want to make sure they get World War 3 going before my father has a chance to create peace and save lives… Imbeciles!”
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The outgoing Biden administration’s move comes as there are concerns about the level of support the Trump White House may be willing to give Ukraine.
Mr Trump has previously vowed to limit US support for Ukraine and end its war with Russia.
In an evening address after Kyiv was given permission to fire deep into Russia, Ukrainian President Volodymyr Zelenskyy said: “Today, there’s a lot of talk in the media about us receiving permission for respective actions. But strikes are not carried out with words. Such things are not announced. Missiles will speak for themselves. They certainly will.”
Back in September, Russian President Vladimir Putin said if the US were to lift the ban on long-range missile use it would be seen as NATO’s “direct participation” in the war.
He added: “This, of course, will significantly change the very essence, the very nature of the conflict.”
Meanwhile, the UK prime minister has said he has “no plans” to speak with the Russian president as world leaders gather for the G20 summit in Rio de Janeiro.
Mr Putin will not be attending the two-day summit which starts on Monday after saying in October that his presence would “disrupt the normal work of this forum”. Russia’s foreign minister Sergei Lavrov will be attending instead.
It will take place days after German Chancellor Olaf Scholz spoke to Mr Putinon what was the Russian leader’s first publicly announced conversation with the sitting head of a major Western power in nearly two years.
Asked if he had any plans to make a similar call, Sir Keir said: “It’s a matter for Chancellor Scholz who he speaks to. I have no plans to speak to Putin.”
Speaking to reporters while on his way to the summit, he added: “We are coming up to the 1,000th day of this conflict on Tuesday.
“That’s 1,000 days of Russian aggression, 1,000 days of huge impact and sacrifice in relation to the Ukrainian people and recently we’ve seen the addition of North Korean troops working with Russians which does have serious implications.
“I think on one hand it shows the desperation of Russia, but it’s got serious implications for European security […] and for Indo-Pacific security and that’s why I think we need to double down on shoring up our support for Ukraine and that’s top of my agenda for the G20.
“There’s got to be full support as long as it takes and that certainly is top of my agenda, shoring up that further support for Ukraine.”
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2:01
One of Russia’s ‘largest air attacks’
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The latest developments come after Russia launched a large-scale attack on Ukraine on Sunday, with Mr Zelenskyy claiming Moscow had launched a total of 120 missiles and 90 drones.
Two major strikes, which left a total of 18 people dead, hit a residential building in the northeastern city of Sumy as well as energy infrastructure across Ukraine, prompting emergency power cuts.
Hours later, Moscow mayor Sergei Sobyanin said Russia’s air defence units had destroyed a drone heading towards the city.
Joe Biden has authorised Ukraine to begin firing US-supplied rockets deep into Russia – as Sir Keir Starmer prepares to push for “further support” for Kyiv at the G20 summit.
Mr Biden’s policy shift means Kyiv will now be able to use Army Tactical Missile Systems (ATACMS)for long-range attacks, two American officials have told Sky News’ US partner network NBC News.
Ukraine plans to conduct its first such attacks in the coming days, the sources said, without revealing details due to operational security concerns.
The son of president-elect Donald Trumphas criticised the move to allow Ukraine to fire deep into Russia.
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Donald Trump Jr wrote on the X social media platform: “The Military Industrial Complex seems to want to make sure they get World War 3 going before my father has a chance to create peace and save lives… Imbeciles!”
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The outgoing Biden administration’s move comes as there are concerns about the level of support the Trump White House may be willing to give Ukraine.
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Mr Trump has previously vowed to limit US support for Ukraine and end its war with Russia.
In an evening address after Kyiv was given permission to fire deep into Russia, Ukrainian President Volodymyr Zelenskyy said: “Today, there’s a lot of talk in the media about us receiving permission for respective actions. But strikes are not carried out with words. Such things are not announced. Missiles will speak for themselves. They certainly will.”
Back in September, Russian President Vladimir Putin said if the US were to lift the ban on long-range missile use it would be seen as NATO’s “direct participation” in the war.
He added: “This, of course, will significantly change the very essence, the very nature of the conflict.”
Meanwhile, the UK prime minister has said he has “no plans” to speak with the Russian president as world leaders gather for the G20 summit in Rio de Janeiro.
Mr Putin will not be attending the two-day summit which starts on Monday after saying in October that his presence would “disrupt the normal work of this forum”. Russia’s foreign minister Sergei Lavrov will be attending instead.
It will take place days after German Chancellor Olaf Scholz spoke to Mr Putinon what was the Russian leader’s first publicly announced conversation with the sitting head of a major Western power in nearly two years.
Asked if he had any plans to make a similar call, Sir Keir said: “It’s a matter for Chancellor Scholz who he speaks to. I have no plans to speak to Putin.”
Speaking to reporters while on his way to the summit, he added: “We are coming up to the 1,000th day of this conflict on Tuesday.
“That’s 1,000 days of Russian aggression, 1,000 days of huge impact and sacrifice in relation to the Ukrainian people and recently we’ve seen the addition of North Korean troops working with Russians which does have serious implications.
“I think on one hand it shows the desperation of Russia, but it’s got serious implications for European security […] and for Indo-Pacific security and that’s why I think we need to double down on shoring up our support for Ukraine and that’s top of my agenda for the G20.
“There’s got to be full support as long as it takes and that certainly is top of my agenda, shoring up that further support for Ukraine.”
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2:01
One of Russia’s ‘largest air attacks’
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Keep up with all the latest news from the UK and around the world by following Sky News
The latest developments come after Russia launched a large-scale attack on Ukraine on Sunday, with Mr Zelenskyy claiming Moscow had launched a total of 120 missiles and 90 drones.
The sweeping attack, which left at least eight people dead, targeted energy infrastructure across Ukraine overnight and prompted emergency power cuts.
Hours later, Moscow mayor Sergei Sobyanin said Russia’s air defence units had destroyed a drone heading towards the city.
Joe Biden’s belated decision to allow Ukraine to use US-supplied, long-range missiles inside Russia will be cheered by Kyiv and will almost certainly prompt the UK to follow suit.
But the stunning shift in US policy – just weeks before Donald Trump takes over as US president – will also trigger fury and fresh threats from Moscow at a time of increasing uncertainty about the future course of its war.
President Vladimir Putin has warned the West they would be playing with fire if they allowed Ukrainian forces to launch Western-supplied cruise and ballistic missiles at Russia, saying it could even trigger a global conflict.
British and US officials, though, have repeatedly advised their respective capitals not to be intimidated by Moscow’s sabre rattling.
Yet there has been hesitancy, particularly in Washington, over the unleashing of US Army Tactical Missile System (ATACMS) ballistic missiles beyond the borders of Ukraine.
However, it seems that a move by North Korea to send thousands of its troops to fight with Russia has changed US calculations.
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The New York Times, which was among the US media organisations to break news of the Biden administration’s decision on long-range missiles, reported that the first time the American weapons will be used inside Russia will likely be against Russian and North Korean troops battling a Ukrainian incursion in the Russian region of Kursk.
While a significant step up in support for Ukraine, the ability to use American long-range missiles inside Russia is not a war-winning development.
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But it does expand Kyiv’s capacity to hit important military targets deliberately positioned by Russian commanders far back from the frontline. This includes stockpiles of missiles, drones and other ammunition used to strike Ukraine.
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2:59
Biden lifts ban on Russia strikes
Just as important as the military impact, though, is the political signal that the US decision sends to the Kremlin about Washington’s willingness to defy Russian warnings about dire consequences should Mr Biden dare to grant Ukraine the permission it’s so long been seeking.
The dramatic move by the United States comes after months of lobbying by Ukraine’s leader, Volodymyr Zelenskyy.
A key thing to watch now will be how Mr Putin reacts the first time an American missile kills Russian soldiers on Russian soil.
Moscow does not want a direct war with the United States and NATO – nuclear-armed forces with far greater combined firepower – but the Kremlin could well ramp up an already heightened campaign of sabotage and other forms of hybrid warfare across Europe.
Another important reaction to track will be how Mr Trump responds to Mr Biden’s move and whether he continues to allow Ukraine this permission once he takes over as the US commander-in-chief.
The president-elect has vowed to end Russia’s war in Ukraine quickly but he has not said how. Yet he has voiced fierce opposition to the continued gifting of vast quantities of American weapons to the Ukrainian military.