The Israeli army is advancing through the south and east of Gaza City after taking full control of the enclave’s largest hospital as Prime Minister Benjamin Netanyahu vowed to resist international pressure for a ceasefire.

The fighting in the Zeitoun and Jabalia neighbourhoods, east of al-Shifa hospital, picked up overnight even as an early winter storm set in. Nine Israeli soldiers were killed over the weekend, the army said.

Hundreds of people on Saturday left the hospital — a focus of Israel’s three-week long ground offensive — joining more than a million displaced people living either outdoors or in crowded UN shelters.

Speaking on Saturday night, Netanyahu said that a limited amount of fuel — no more than two trucks a day — would now be allowed into Gaza to stave off a feared outbreak of disease, a concession he said he made after US pressure.

“This is not a change of policy but a limited, localised response in order to prevent the outbreak of epidemics,” Netanyahu said, adding that the spread of disease would affect Israeli soldiers as well as Gazans.

But he also appeared to reject a call from US President Joe Biden, made in an opinion column in the Washington Post, that the Palestinian Authority, a West Bank-based political rival of Hamas, would play a greater role in Gaza after the war. Without naming the PA, he said he would not back the presence of any element that “supports terrorism, pays terrorists and their families”.

Netanyahu vowed a “diplomatic Iron Dome” — a reference to Israel’s air defence system — to resist mounting international pressure for a ceasefire, unless it accompanied a release of hostages held by Hamas. “I reject these pressures and say to the world: We will continue to fight until victory,” he said.

Israel launched its air and land offensive on the strip after Hamas’s devastating October 7 attack killed about 1,200 people, according to Israeli officials. The Palestinian Islamist group, which has controlled Gaza since 2007, also seized about 240 hostages.

More than 11,500 Palestinians have been killed, many of them women and children, the health ministry said, but cautioned that it has not been able to update that toll since early last week because of a communications blackout. More than 3,000 people are buried in the rubble, the ministry estimated.

Qatar’s Prime Minister, Sheikh Mohammed Bin Abdulrahman Al Thani, who has been leading negotiations with Hamas over the release of hostages, said at a press conference in Doha that “there has been good progress in the past few days,” and minor obstacles remain between Israel and Hamas agreeing a deal.

The expanded military operations come as Israeli forces scoured al-Shifa hospital for evidence to support its claims that Hamas had built a vast underground command and control centre underneath it.

The limited findings of any large scale Hamas infrastructure, both at al-Shifa and at the al-Rantisihospital, which Israel took control of earlier this week, have prompted widespread criticism of the IDF’s decision to attack the overcrowded facilities.

At al-Shifa, the army has so far found the entrance to a tunnel, a small cache of weapons, some radios and a laptop, according to videos released by the IDF. The military has yet to fully investigate the tunnel.

At al-Rantisi, Rear Admiral Daniel Hagari, showed TV crews a cache of weapons he said was discovered there and then pointed to a calendar that began on October 7, the day of the Hamas attack, a piece of rope on the floor and a curtain over a windowless wall as evidence that a hostage may have been held there.

IDF officials said on Friday that they were frustrated by the pressure to produce more evidence. On Saturday, doctors and patients who fled the al-Shifa hospital were forced to leave behind at least 32 sick babies and about 300 patients who were too ill or wounded to move, the UN said.

The IDF now has full control of the facility and is expected to continue searching for evidence to support its assertion that Hamas had built a large command and control centre underneath it.

Fewer than two dozen staff remained at the hospital, once the best equipped in Gaza, and the remaining patients were at risk of infection from medical and solid waste and lack of medication, the UN added.

The WHO said the hospital was a “death zone”, adding that its team had found a mass grave containing 80 bodies. In recent days the hospital provided shelter to 2,500 people as well as doctors, nurses and at least 600 patients.

Israel’s western allies have advised caution as the army expands operations to the south of Gaza, where the Israel Defense Forces had initially told civilians to flee to as it invaded from the north. The US has asked Israel to keep operations in the south “targeted and precise” to avoid civilian casualties and allow people to move to safe areas, a person familiar with the discussions said on Saturday.

But defence minister Yoav Gallant said on Saturday that all of Gaza would soon feel the “IDF’s lethal force”, according to a recording of his comments broadcast on Israel’s Kan Radio. The army has declined to comment on leaflets found in Khan Younis, southern Gaza, demanding Palestinians leave their homes immediately.

The UN also reported explosions at two schools where civilians had taken shelter. The head of UNRWA, the UN agency for Palestinian refugees, said that it had received “horrifying images and footage of scores of people killed and injured” after the UN school in al-Fakhoora was struck.

A second school in Zeitoun, where the Israeli army has been expanding operations, was hit twice, with “dozens reported killed including children”, Philippe Lazzarini, UN commissioner-general for UNRWA, wrote on social media site X. Israel’s military said it was looking into the incident.