A large-scale Israeli operation in northern Gaza has killed and wounded dozens of people and threatens to shut down three hospitals over a year into the war with Hamas, Palestinian officials and residents said Wednesday.

Heavy fighting is underway in Jabaliya, where Israeli forces carried out several major operations over the course of the war and then returned as militants regroup. The entire north, including Gaza City, has suffered heavy destruction and has been largely isolated by Israeli forces since late last year.

The continuing cycle of destruction and death in Gaza, unleashed by Hamas' Oct. 7, 2023, attack on southern Israel, comes as Israel expands a week-old ground offensive against Hezbollah in Lebanon and considers a major retaliatory strike on Iran.

Residents of Jabaliya, a refugee camp dating back to the 1948 war surrounding Israel's creation, say heavy airstrikes and evacuation warnings have driven hundreds of people from their homes. An airstrike early Wednesday killed at least nine people, including two women and two children, according to the Al-Ahly Hospital, which received the bodies.

Strikes in central Gaza killed another nine people, including three children, according to the Al-Aqsa Martyrs Hospital in Deir al-Balah. An Associated Press reporter counted the bodies.

The Gaza Health Ministry said Wednesday that the overall Palestinian death toll in Gaza since the start of the war has surpassed 42,000, with more than 97,000 others wounded.

Palestinians huddle inside as fighting rages

Residents of Jabaliya said thousands of people have been trapped in their homes since the operation began Sunday, as Israeli jets and drones buzz overhead and troops battle militants in the streets.

“It’s like hell. We can’t get out,” said Mohamed Awda, who lives in Jabaliya with his parents and six siblings. He said there were three bodies in the street outside his home that could not be retrieved because of the fighting.

“The quadcopters are everywhere, and they fire at anyone. You can’t even open the window,” he told The Associated Press by phone, speaking over the sound of explosions.

Read: Hezbollah steps up rocket fire as Israel sends more troops into Lebanon

He and other residents fear Israel’s aim is to depopulate the north and turn it into a closed military zone or a Jewish settlement. Israel has blocked all roads except for the main highway leading from Jabaliya to the south, according to residents.

“We are concerned about the displacement to the south,” Ahmed Qamar, who lives in Jabaliya with his wife, children and parents, said in a text message. "People here say clearly that they will die here in northern Gaza and and won’t go to southern Gaza.”

Hospitals are under threat

Fadel Naeem, director of the Al-Ahly Hospital in Gaza City, said it has received dozens of dead and wounded people from across the northern half of the Palestinian enclave since Israel launched its air and ground operation.

Israel's offensive has gutted Gaza's health sector, forcing most of its hospitals to shut down and leaving the rest only partially functioning.

“The situation is tense,” Naeem told The Associated Press in text message. “We declared a state of emergency, suspended scheduled surgeries, and discharged patients whose conditions are stable.”

He said three hospitals further north — Kamal Adwan, Awda and the Indonesian Hospital - have become almost inaccessible because of the fighting. The Gaza Health Ministry says the Israeli army has ordered all three to evacuate staff and patients. Meanwhile, no humanitarian aid has entered the north since Oct. 1, according to U.N. data.

The Israeli military did not immediately respond to requests for comment on the hospitals or the apparent suspension of aid delivery in the north.

Read more: Marcon calls for halt on arms deliveries to Israel for use in Gaza

Rear Adm. Daniel Hagari, the military spokesperson, said late Tuesday that Israeli forces were operating in Jabaliya “to prevent Hamas' regrouping efforts" and had killed around 100 militants, without providing evidence. Israel says it only targets militants and blames civilian deaths on Hamas because it fights in residential areas.

Israel ordered the wholesale evacuation of northern Gaza, including Gaza City, in the opening weeks of the war, but hundreds of thousands of people are believed to have remained there. Israel reiterated those instructions over the weekend, telling people to flee south to an expanded humanitarian zone where hundreds of thousands are already crammed into squalid tent camps.

The war began just over a year ago, when Hamas-led militants stormed into southern Israel, killing some 1,200 people, mostly civilians, and abducting around 250. They are still holding around 100 hostages, a third of whom are believed to be dead.

Israel's offensive has killed 42,010 Palestinians, according to the Gaza Health Ministry, which does not say how many were fighters. It has said women and children make up over half of the dead. The offensive has also caused staggering destruction across the territory and displaced around 90% of the population of 2.3 million people, often multiple times.

Israel warns Lebanon that it could end up like Gaza

Israeli Prime Minister Benjamin Netanyahu has vowed to keep fighting until “total victory” over Hamas and the return of all the captives.

On Tuesday, he warned that Lebanon would meet a similar fate if its people did not rise up against Hezbollah, which began firing rockets into Israel after the initial Hamas attack. That set in motion a cycle of escalation that ignited a full-scale war last month.

“You have an opportunity to save Lebanon before it falls into the abyss of a long war that will lead to destruction and suffering like we see in Gaza,” Netanyahu said, addressing the Lebanese people.

In recent weeks Israel has waged a punishing air campaign across large parts of Lebanon, targeting what it says are Hezbollah rocket launchers and other militant sites. In a matter of days, strikes killed Hezbollah leader Hassan Nasrallah and most of his top commanders.

Read more:Israel intensifies bombardment of Gaza and southern Lebanon ahead of Oct. 7 anniversary

So far, ground operations appear to be focused on a narrow strip along the border, but Israel has warned people to evacuate dozens of cities and towns across southern Lebanon, many of them north of a buffer zone declared by the United Nations after the last war between Israel and Hezbollah in 2006.

Hezbollah's acting leader, Sheikh Naim Kassem, said in a televised statement Tuesday that the group has replaced its slain commanders and was preventing Israeli ground forces from advancing. The militants have extended their rocket fire deeper into Israel, disrupting life but causing few casualties.

Israel is meanwhile considering options for a strike on Iran that could potentially escalate the war on yet another front. Iran, which supports Hezbollah and Hamas, launched a wave of some 180 ballistic missiles at Israel last week in retaliation for the killing of top militants from both groups.