Image source, Israel Defense Forces

We've reported a lot of eyewitness accounts of the situation at the Al-Shifa hospital but here's a reminder of what the Israel Defense Forces (IDF) says are the aims of its "precise and targeted" operation at Gaza's largest hospital:

• The IDF says its troops are scanning the complex for Hamas infrastructure, explosive devices and "terrorist means" at the facility
• The forces sent in include translators and medical teams, who it says have undergone "specified training to prepare for this complex and sensitive environment"
• It says they have entered the hospital with "the intent that no harm is caused" to the civilians which it accuses Hamas of using as "human shields"
• The operation was preceded by efforts to evacuate people from Al-Shifa, the IDF says
• It adds it also maintained regular dialogue with hospital authorities - and informed them ahead of time about the entrance of its forces into the compound
• The IDF published a video of its troops delivering medical aid including incubators, baby food and medical supplies to the hospital

Read more: What we know about Israel's raid on Gaza's main hospital

All three sewage pumps and 10 water pumps in the southern Gazan town of Rafah have stopped working because they have ran out of fuel, according to Gaza chief of the UN agency for Palestinian refugees, Thomas White.

Israel has been blocking fuel deliveries to Gaza since the conflict began over a month ago, arguing that they could be used by Hamas for military purposes.

A senior UN official said Gaza had received 23,000 litres (5,060 gallons) of fuel via Egypt's Rafah crossing today - but warned that Israeli authorities had restricted its use to transporting aid into Gaza.

However, Gaza also needs fuel to run sewage pumping stations, hospitals, bakeries, electricity generators and other key facilities.

Thousands of Palestinians have flocked to Rafah, which neighbours Egypt, over the past few weeks, as it is the only point officials have allowed people to leave Gaza and humanitarian aid to enter.

Image source, .

Image source, Reuters

As a reminder, Israel's military has entered Gaza's main hospital in what it describes as a "targeted operation against Hamas" with reports of IDF troops going room to room questioning people.

Natalie Thurtle, deputy medical co-ordinator of charity Doctors Without Borders, says that people attempting to flee Al-Shifa hospital are "at the mercy of gunfire, shelling and fire from drones".

She says her team have only managed to establish brief communication with medical staff inside the hospital following persistent connectivity problems.

At least 300 patients and staff are inside the facility, along with Israeli soldiers, and more than 100 staff members and families are in its vicinity, she tells BBC Radio 4's The World at One programme.

"We've been trying to evacuate them for three days", she says, but the action had been hindered due to "sustained" fighting around the hospital.

"It's very perilous and there is no opportunity for people to leave Shifa at the moment."

The UN has said the rainfall today will make the situation worse for thousands of displaced people living in camps in Gaza, many of whom are sheltering in tents.

Here are some of the pictures coming out of Khan Younis where many Palestinians have moved after fleeing the north of the Strip.

Image source, Reuters

Image source, Getty Images

Image source, Reuters

Image source, Reuters

Multiple clocks ticking on Israeli operationpublished at 14:01 Greenwich Mean Time 15 November 2023

14:01 GMT 15 November 2023

Jeremy Bowen
International Editor

Image source, EPA

We have seen a hardening of the international position around the Israeli offensive in the last few days with the US, the UK and France using language that is shifting the tone - perhaps summed up best by what US Secretary of State Antony Blinken said last weekend: “Far too many” Palestinian civilians have been killed.

The Israelis knew this shift would come because this is a repeat of the pattern we have seen many times before with Israel’s military operations.

They talk about different clocks running during any operation.

One is military: how long do they need before they accomplish their military objectives? The other is diplomatic: how long does Israel hold legitimacy to carry out that operation before its allies say "you’ve killed enough people, civilians, you need to stop now please".

Israel feels that because of the absolute enormity of the numbers of casualties in the Hamas attacks on 7 October, they have more time than usual, and I think they have gone in – as we can see from the levels of casualties in Gaza – using a great deal of force.

I have seen some estimates that suggest the IDF will continue to work in this way for a couple more weeks, but I think the forces are gathering amongst their allies to say you need to change the nature of your military operation.

That doesn’t necessarily translate to a call for this to stop – certainly we haven’t yet heard a call for a ceasefire from the British or the Americans.

Stepping away from Israel's operations in Gaza for a moment, we've heard that Qatari mediators have been trying to negotiate a deal between Hamas and Israel over the release of some hostages taken from Israel by Hamas during the 7 October attack.

The deal, under discussion and coordinated with the US, would involve the release of around 50 civilian hostages from Gaza in exchange for a three-day ceasefire, an official briefed on the negotiations told Reuters news agency.

Some Palestinian women and children would also be released from Israeli jails under the deal and Israel would increase the amount of humanitarian aid allowed into Gaza, the official said.

They added that Hamas has agreed to the general outlines of the agreement, but Israel has not and is still negotiating the details.

Orla Guerin
Reporting from Jerusalem

The doctor in Al-Shifa that the BBC has spoken to has also said the hospital is without power, oxygen and water.

Dr Ahmed Mokhallalati said six premature babies died in recent days and that he’s worried that the others will die “one by one” due to a lack of oxygen and lack of power.

He said essential surgeries were carried out on Tuesday with only light sedation and patients were “screaming in pain”. No surgeries could be carried out on Wednesday.

Dr Mokhallalati said doctors were unable to help one patient with burns yesterday, due to a lack of equipment including ventilators, and had to just “let him die“.

Asked if Israeli troops had brought medical aid to the hospital, he responded: “If it was up to me, I would refuse [any aid]. They are killing us for 40 days and they want to offer me saline drips.”

Orla Guerin
Reporting from Jerusalem

We have managed to reach a doctor trapped inside Al-Shifa Hospital, a site of urgent humanitarian need that was entered by Israeli forces overnight.

Dr Ahmed Mokhallalati's frustration, anger and concern for his patients poured out, down the line.

He asked where the Red Cross and British and American governments were.

"Is everyone just waiting for us all to die here and then say 'we were good people'?"

The plastic surgeon spoke of fear among staff and patients trapped inside Al-Shifa as Israeli soldiers move through the building.

He said people trying to leave the hospital in recent days had been shot at by Israeli forces, with some killed. Israel says it is targeting Hamas and minimises harm to civilians.

It has accused Hamas of running a command centre under the hospital. The doctor told us he has never seen a single gun or any Hamas presence in the hospital, though he said there were tunnels under every building in Gaza, including Al-Shifa.

Dr Mokhallalati insisted there were only civilians in the hospital and challenged the Israeli army to provide proof of Hamas operating there.

Warning of Gaza 'telecom blackout'published at 12:48 Greenwich Mean Time 15 November 2023

12:48 GMT 15 November 2023

BBC Verify is continuing to look for video footage on social media of Israeli forces at Al-Shifa hospital in Gaza City but so far we've seen very little that has been filmed by people at the site.

One reason could be poor connectivity. This morning Paltel, a company based in the West Bank and one of Gaza's main telecommunications providers, announced on its Facebook page that phone and internet communication in the Gaza Strip might be cut soon due to fuel shortages.

“We regret to announce that our main data centres and switches in Gaza Strip are gradually shutting down due to fuel depletion. Currently, main network elements depend solely on batteries.

"This will lead to a complete telecom blackout in the coming hours.”

Image source, Getty Images

It's coming up to 14:30 in Gaza and Israel (12:30 GMT) and if you're just joining us or need a recap, here's where things stand:

• A journalist inside the Al-Shifa hospital in Gaza City says Israeli troops are inside the building, going room to room questioning patients and staff, and assembling men in the courtyard
• The IDF says its mission in Al-Shifa is continuing and its troops are searching for Hamas "terror infrastructure and weapons"
• The IDF said it had delivered medical supplies, including incubators, to the hospital but a medical charity said incubators are not needed - fuel to power them is
• The UN's humanitarian chief and the WHO's director general have expressed concern for the safety of medics and patients, after Israel's mission into the hospital
• Some 25,000 litres of fuel entered southern Gaza through the Rafah crossing - the first such delivery Israel has allowed since the war began
• The delivery means UN trucks can be refuelled, but Israel is still prohibiting any fuel being distributed to hospitals, water pumps or sanitation facilities
• Heavy rain has begun to fall in Gaza, which the UN says will make the "desperate situation" for Gazans forced from their homes "far worse"

Yolande Knell
BBC Middle East correspondent, in Jerusalem

Image source, Getty Images

Since Israel put Gaza under siege after the deadly 7 October attacks by Hamas, no fuel had been allowed to enter, although limited deliveries of humanitarian aid have been crossing in from Egypt.

This week, the UN’s last stocks of fuel in Gaza finally ran out. The UN had warned that for the past day its aid lorries could no longer distribute supplies in Gaza.

The UN says today's delivery of 25,000 litres represents only a fraction of what’s needed for humanitarian operations.

It says the entry of fuel to run generators at hospitals and at water and sanitation facilities remains banned.

Telecommunications firms have said they expect to switch off telephone and internet services in a day’s time due to a lack of fuel.

Image source, Reuters

The Israel Defence Forces (IDF) has issued an update on its movements in Gaza, saying its operation in Al-Shifa Hospital is continuing.

The IDF said its troops are continuing the "precise and targeted operation against Hamas in a specified area in the Shifa Hospital, in which they are conducting searches for Hamas terror infrastructure and weapons".

A journalist inside the hospital told the BBC earlier this morning that the IDF was going room to room questioning staff and patients, accompanied by translators and medics.

The IDF also said it had delivered humanitarian aid to the entrance of the hospital. In an earlier update, the Israeli military said it was trying to bring incubators and baby food to the hospital, where dozens of babies need medical treatment.

Earlier, we heard from a charity which said the hospital already has incubators and what's really needed is the fuel to power medical equipment.

Satellite image shows Israeli armour close to hospitalpublished at 11:25 Greenwich Mean Time 15 November 2023

11:25 GMT 15 November 2023

A satellite image taken yesterday, 14 November at 14:53 local time (12:53 GMT), shows Israeli forces holding positions approximately 300m north and south of Al-Shifa hospital in Gaza City.

BBC Verify has analysed the image from satellite company Planet Labs. We can see what looks like to be about 20 vehicles - including tanks and bulldozers - north of the hospital near the Al-Shate’a primary school.

What appears to be small clusters, numbering about 10 more vehicles, are located in open ground 250m south.

Al-Shifa a symbol of the war itselfpublished at 11:06 Greenwich Mean Time 15 November 2023

11:06 GMT 15 November 2023

Jeremy Bowen
International Editor

Image source, Reuters

This is the main hospital in Gaza city - I’ve been there many times - and it has big grounds, so people went there to seek shelter and camp out, as they saw it as a safe area. It has now become a symbol of the juxtaposition of the war - the Israeli invasion of Gaza inflicting masses of casualties and damage set against the crisis of urgent humanitarian need inside the hospital.

The Israelis have made a very big point about saying that, as well as going after the Hamas military command, they have brought in some fuel and incubators, because there has been a very concerning claim that premature babies in Al-Shifa hospital had to be taken out of their incubators.

However, the issue isn’t lack of incubators, it’s lack of fuel – Israel won’t allow fuel into the Gaza Strip because they argue that Hamas will steal it and use it. Israel says Hamas has stockpiles of its own, and that it should use that fuel for the generators supplying the hospital electrical system.

So there are a lot of strands coming together in what’s unfolding in Al-Shifa hospital this morning, but that’s not the whole war – it will continue once this particular operation is over.

The World Health Organization has said it is "extremely worried" for patients and staff at Gaza's Al-Shifa Hospital, which was raided by Israeli troops overnight.

Tedros Adhanom Ghebreyesus, director general of the WHO, said: "Reports of military incursion into Al-Shifa hospital are deeply concerning.

"We’ve lost touch again with health personnel at the hospital. We’re extremely worried for their and their patients’ safety."

British charity Medical Aid for Palestinians also voiced concern, with its CEO Melanie Ward saying: "Before this operation took place inside the hospital, we were very worried about the lives of the people who were there already because they hadn’t had access to food, to water, to fuel."

Israel's military has said it is carrying out a "targeted operation" at the hospital, which it has said may be the "beating heart" of Hamas - something Hamas denies.

Few pictures and images emerging from Al-Shifapublished at 10:09 Greenwich Mean Time 15 November 2023

10:09 GMT 15 November 2023

The BBC is getting some reports from a journalist from within Gaza's Al-Shifa hospital describing what is going on - but we are also looking for open-source material that will help provide a clearer picture of the scale of this Israeli operation.

BBC Verify is looking at satellite imagery and any videos from within or near the hospital grounds posted on local Telegram channels and other social media accounts.

Currently very little is emerging but we will be providing updates here when we are able to verify more pictures from the scene.

Some 25,000 litres of fuel have entered Gaza this morning from the Rafah crossing in Egypt, a local border official has told the BBC.

The delivery comes after the UN and charity Médecins Sans Frontières warned that fuel stocks would run out in Gaza on Wednesday.

Israel has been blocking fuel deliveries to Gaza for weeks, arguing they could be stolen and exploited by Hamas for military purposes.

Earlier, Israel's military said some UN trucks transporting aid to Gaza would be refuelled on Wednesday.

Image source, Reuters

Martin Griffiths, the UN's chief of humanitarian affairs, has been reacting to the reports of what is happening at the Al-Shifa hospital in Gaza City.

"I'm appalled by reports of military raids in Al-Shifa hospital in Gaza," Griffiths posted to X (formerly Twitter), external.

"The protection of newborns, patients, medical staff and all civilians must override all other concerns. Hospitals are not battlegrounds."

As we've been report, a journalist inside the hospital has told the BBC that the IDF has been questioning people in the facility and is now ordering men to assemble in the hospital courtyard.

Israel's military says it is carrying out a "targeted operation" at the hospital. It accuses Hamas of running a command centre under the hospital, which Hamas denies.

The changing weather is about to make life worse for displaced people in the Gaza Strip, the UN agency for Palestinian refugees, UNRWA, has said.

UNRWA spokesperson Juliette Touma told the BBC on Wednesday that 800,000 displaced Palestinians in the territory were now in overcrowded UN shelters, without heating or clean water.

"The rain is going to make a really desperate situation far worse for the three-quarters of Gaza’s population who have been forced to leave their homes."

"We do not have fuel, so we cannot provide heating or clean water." Touma said.

No fuel has come into the strip since the war began, according to the UN agency.

Rushdi Abualouf
Reporting from Gaza

I've spoken to Khader again, a journalist inside Al-Shifa hospital.

He told me that over loudspeakers, IDF soldiers have asked all men between the ages of 16 and 40 to leave the hospital buildings, except the surgical and emergency departments, and go to the hospital courtyard.

During the past hour, he said soldiers had fired into the air to force those remaining inside to come out.

He also said they have installed a scanning and sensing device and asked the men to pass through it.

The BBC has not been able to independently verify the claims.