Israel pounded Gaza early Tuesday while people were asleep or preparing the suhour meal that is eaten before dawn ahead a day of Ramadan fasting.

“It felt like Armageddon,” according to Tanya Haj-Hassan, an American doctor currently working at Nasser Medical Complex in Khan Younis.

People reported that the attacks were similar in intensity to those of the first days of the offensive that followed the Hamas attack on Israeli military bases and colonies near Gaza’s periphery on 7 October 2023.

Most of the estimated 250 people captured in the Hamas attack have been released during prisoner exchanges that commenced during a week-long truce in November 2023 and following the declaration of a ceasefire in January this year.

Many Palestinians who were displaced during the 15 months of attacks that preceded the ceasefire have streamed back to their largely destroyed neighborhoods in Rafah, Gaza’s southernmost city, and the north. With the absence of alternative shelter, many people were living in damaged and structurally unsound buildings.

Much of Gaza’s infrastructure was destroyed during the Israeli offensive, during which the military targeted and badly damaged or destroyed many of Gaza’s hospitals, which struggled to cope with the casualties from the new attacks on Tuesday.

The government media office in Gaza said that the lack of fuel prevented the transfer of victims to hospital. The office said the Israeli escalation “comes amid the collapse of the health system” in the territory due to the Israeli siege, which has prevented the entry of medical supplies and humanitarian aid.

Benjamin Netanyahu, Israel’s prime minister, said that he ordered the attacks on Tuesday and claimed that Hamas had repeatedly refused to release the remaining captives in Gaza.

“From now on, Israel will act against Hamas with increasing military strength,” Netanyahu added.

But an advocacy group representing family members of the captives stated that by attacking Gaza, “the Israeli government has chosen to abandon the hostages.”

“We are shocked, angry and terrified by the deliberate dismantling of the process to return our loved ones,” the group added.

Hamas in turn accused Israel of attempting to overturn the ceasefire agreement, exposing the remaining captives in Gaza “to an unknown fate.”