Gaza City residents were trapped in their houses while bodies littered the streets during an intense new Israeli assault Thursday.
The mounting Israeli attack on Gaza's once-largest urban center came as Washington sought a peace deal at talks in Egypt and Qatar.
Palestinian resistance group Hamas said a heavy Israeli assault on Gaza City this week could wreck efforts to finally end the war just as negotiations have entered the home stretch.
Home to more than a quarter of Gaza's residents before the war, Gaza City was destroyed during the first weeks of fighting last year, but hundreds of thousands of Palestinians have returned to homes in the ruins. They have now once again been ordered out by the Israeli military.
The Gaza Health Ministry said it had reports of people trapped and others killed inside their houses in the Tel al Hawa and Sabra districts of Gaza City and rescuers could not reach them.
The Civil Emergency Service said it estimated that at least 30 people had been killed in the Tel al Hawa and Rimal areas and it could not recover bodies from the streets there.
Despite army instructions Wednesday to residents of Gaza City that they can use two "safe routes" to head south, many residents refused to heed the order. Some posted a hashtag on social media: "We are not leaving."
"We will die but not leave to the south. We have tolerated starvation and bombs for nine months and we are ready to die as martyrs here," said Mohammad Ali, 30, reached by text message.
Ali, whose family has relocated several times within the city, said they had been running short of food, water and medicine.
"The occupation bombs Gaza City as if the war was restarting. We hope there will be a ceasefire soon, but if not then its God's will."
Just east of Gaza City in the Shujaiya suburb, residents were returning on foot to a desolate moonscape of destroyed buildings after Israeli forces withdrew following a two-week offensive there.
The territory's main cemetery had been bulldozed by the army. People wheeled supplies on the back of bicycles across rubble-strewn tracks, passing the remains of burnt-out and blasted Israeli armored vehicles.
"We have returned to Shejaia after 15 days. You can see the destruction. They spared nothing, even trees, there was a lot of greenery in this area. What is the guilt of stones and trees? And what is my guilt as a civilian?" resident Hatem Tayeh told Reuters in the ruins.
"There are bodies of civilian people. What is the guilt of the civilian? Who are you fighting?"
The war was triggered by the Oct. 7 Hamas incursion on southern Israel that resulted in the deaths of 1,195 people, according to an AFP tally based on Israeli figures.
The resistance members also seized 251 hostages, 116 of whom remain in Gaza, including 42 the military says are dead.
In response, Israel has carried out a genocidal war that has killed at least 38,295 people in Gaza, mostly women and children, according to the Health Ministry.
At the southern edge of the enclave in Rafah near the border with Egypt, where tanks have been operating in most of the city since May, residents said the army continued to blow up houses in the western and central areas, amid clashes with Hamas, Islamic Jihad and other smaller factions.
Palestinian health officials said four people were killed, including a child, in an Israeli air strike in Tel al-Sultan in western Rafah.
The Israeli military said earlier Thursday around five rockets fired from the Rafah area were successfully intercepted.
The negotiations in Qatar and Egypt follow important concessions last week from Hamas, which agreed that a truce could begin and some hostages released without Israel first agreeing to end the war.
Israeli Prime Minister Benjamin Netanyahu, who faces opposition within his right-wing cabinet to any deal that would halt the war until Hamas is vanquished, says a deal must allow Israel to resume fighting until it meets all its objectives.
Two Hamas officials contacted by Reuters had no immediate comment on the content of the ongoing talks, led by Egypt, Qatar, and the United States.
"There will be a meeting today between Hamas and the mediators to check on what responses they have received from the occupation," said one Palestinian official close to the mediation, without elaboration.
