DEIR AL-BALAH, Gaza Strip. The Israeli military urged all Palestinians to leave Gaza City and head south on Wednesday, continuing a fresh offensive across the embattled territory’s north, south, and center that has killed dozens of people in the past 48 hours.

The increased military activity coincided with U.S., Egyptian, and Qatari mediators meeting with Israeli officials in Doha to push for a cease-fire deal with Gaza’s Hamas militant group.

Israel claims it is targeting Hamas fighters regrouping in various parts of Gaza, nine months into a devastating offensive. However, recent heavy strikes across the territory may also aim to pressure Hamas in the cease-fire talks.

Months ago, Israel ordered residents of northern Gaza, including Gaza City, to flee south as it operated in the area. Hundreds of thousands of Palestinians have remained in the hard-hit north, with many having nowhere to go. Most of Gaza’s 2.3 million people are crowded into squalid tent camps in central and southern Gaza.

Ground troops have recently entered parts of Gaza City, causing thousands of Palestinians to flee from shelling and airstrikes. Last week, the military ordered evacuations from eastern and central parts of the city.

Israel informed Gaza residents of the evacuation order by dropping leaflets urging “all those in Gaza City” to take two “safe routes” south to the area around Deir al-Balah. Gaza City, the leaflets said, will “remain a dangerous combat zone.”

For the second straight night, Israeli strikes in central Gaza early Wednesday hit four houses in Deir al-Balah and the nearby Nuseirat refugee camp, killing 20 Palestinians. Among the dead were six children and three women, according to al-Aqsa Martyrs Hospital, where the casualties were taken. An Associated Press reporter counted the bodies. The house hit in Deir al-Balah was inside the “humanitarian safe zone” where Israel has told Palestinians to seek refuge.

The overnight bombardment occurred hours after Israeli warplanes struck a school entrance sheltering displaced families outside Khan Younis in the south. The toll from that strike rose to 31 people killed, including eight children, and over 50 wounded, officials at the nearby Nasser Hospital said Wednesday.

Footage aired by Al-Jazeera showed children playing soccer in the schoolyard when a sudden explosion shook the area, prompting shouts of “a strike, a strike!”

The Israeli army said the airstrike near the school and reports of civilian casualties were under review, claiming it targeted a Hamas militant involved in the Oct. 7 attack on Israel, though it provided no immediate evidence. The military blames civilian deaths on Hamas for fighting in dense, urban areas, but rarely comments on individual strikes that often kill women and children.

In nine months of bombardment and offensives in Gaza, Israel has killed over 38,200 people and wounded more than 88,000, according to the territory’s Health Ministry, which does not differentiate between combatants and civilians. Nearly the entire population has been driven from their homes, many displaced multiple times, with hundreds of thousands packed into sweltering tent camps.

Israel’s onslaught was triggered by Hamas’ Oct. 7 cross-border raid, where militants killed 1,200 people in southern Israel, mostly civilians, and took roughly 250 hostages. About 120 are still captive, with about a third presumed dead.

Large parts of Gaza City and nearby urban areas in northern Gaza have been flattened or heavily damaged by previous Israeli assaults, with much of the population fleeing earlier in the war. However, several hundred thousand people are believed to remain in the north.

Israel’s new ground assault in Gaza’s largest city has prompted a “dangerously chaotic” exodus, according to the U.N., with people scattering in multiple directions, unsure where to go. Some have fled to other parts of the north. The new Israeli military leaflets encouraged a mass movement south to the purported “humanitarian zone,” promising that people leaving Gaza City on the defined routes would not be stopped at Israeli checkpoints. Many Palestinians fear arrest or humiliation by troops at the checkpoints.

After Israel on Monday called for evacuations from eastern and central parts of Gaza City, staff at two hospitals — Al-Ahli and the Patients Friends Association Hospital — rushed to move patients and shut down, the United Nations said.

The Episcopal Church in the Middle East, which operates Al-Ahli, said the hospital was “compelled to close by the Israeli army.” The Israeli military said Tuesday that it told hospitals and other medical facilities in Gaza City they did not need to evacuate.

Hospitals in Gaza have often evacuated preemptively at any sign of possible Israeli military action, fearing raids. In the past nine months, Israeli troops have attacked at least eight hospitals, causing the deaths of patients and medical workers and massive destruction to facilities and equipment. Israel claims Hamas uses hospitals for military purposes, though it has provided only limited evidence.

Only 13 of Gaza’s 36 hospitals are functioning, and those only partially, according to the United Nations’ humanitarian office.

International mediators are making a concerted effort to push through a proposed deal for a cease-fire and the release of hostages.

Israel and Hamas had appeared to narrow gaps recently, but obstacles remain, even after Hamas agreed to relent on its key demand that Israel commit to ending the war as part of any agreement.

Hamas still wants mediators to guarantee that negotiations conclude with a permanent cease-fire. Israeli Prime Minister Benjamin Netanyahu has insisted he will not sign any deal forcing Israel to stop its Gaza campaign without eliminating Hamas. On Monday, Hamas accused Netanyahu of “putting more obstacles in the way of negotiations,” including operations in Gaza City.

An Egyptian official said Abbas Kamel, head of Egypt’s General Intelligence Service, went to Doha to join discussions over the deal, with U.S. and Israeli officials also attending. The official spoke on condition of anonymity because he was not authorized to brief the press. A day earlier, CIA Director William Burns, who has led American mediation, met with Egyptian President Abdel Fattah el-Sissi in Cairo.

Over 85% of Israelis support a full or temporary cease-fire deal, according to a poll from the Israel Democracy Institute, a Jerusalem-based think tank. The survey of 850 Israelis, both Hebrew and Arabic-speaking, had a margin of error of 3.85%.

Far-right Israeli politicians — on whom Netanyahu relies to keep his governing coalition — remain steadfastly against a deal. Earlier this week, Finance Minister Bezalel Smotrich brandished a photo of Hamas leader Yahya Sinwar making a “V-for-victory” gesture, and wrote on X that a deal will allow “murderous terrorists with blood on their hands to continue to murder Jews.”

National Security Minister Itamar Ben-Gvir, also part of the extreme right, has been pressing for a spot on Netanyahu’s War Cabinet, which could give him greater power to scuttle a deal. For leverage, he has been exploiting political infighting over religious issues with ultra-Orthodox parties, threatening to weaken Netanyahu’s coalition.