Israeli forces launched an operation early Monday in and around Gaza's largest hospital, Al-Shifa, with witnesses reporting air strikes and tanks near the complex crowded with patients and displaced people.

The pre-dawn raid came at a time of growing concern over a looming Israeli ground invasion of Gaza's crowded far-southern city of Rafah, and as international mediators and envoys readied to meet in Qatar Monday to revive stalled truce talks.

A meeting between Israel's Mossad chief David Barnea, Qatari Prime Minister Mohammed bin Abdulrahman Al-Thani and Egyptian officials "is expected to take place today", a source said on condition of anonymity given the sensitivity of the talks.

The Israeli military told Gazans to immediately evacuate from Al-Shifa in Gaza City after it launched the raid based on what the army termed intelligence "indicating the use of the hospital by senior Hamas terrorists".

Witnesses told AFP that the Israeli forces had dropped Arabic-language leaflets with the same evacuation instructions and a warning that "You are in a dangerous combat zone!"

The health ministry of the Hamas-run Gaza Strip said residents near the hospital in the largely devastated city had reported dozens of casualties who could not be helped "due to the intensity of gunfire and artillery shelling".

The Hamas government media office condemned as a "war crime" the "storming of the Al-Shifa medical complex with tanks, drones and weapons, and shooting inside", where thousands of displaced Palestinians were sheltering.

The army and the Shin Bet security service said Israeli troops had "identified terrorist fire toward them from a number of hospital buildings. The forces engaged the terrorists and identified several hits."

Israel's military also said troops had been told to "avoid harm to the patients, civilians, medical staff and medical equipment", with Arabic speakers deployed to "facilitate dialogue with the patients remaining in the hospital".

The army had previously raided Al-Shifa in mid-November, sparking an international outcry, in an operation in which it said its troops had found weapons and other military equipment in rooms in and below the hospital.

The bloodiest ever Gaza war broke out after Hamas launched an unprecedented attack on October 7 that resulted in about 1,160 deaths in Israel, mostly civilians, according to an AFP tally based on Israeli official figures.

The Islamist militants also seized about 250 hostages, of whom Israel believes 130 remain in Gaza, including 33 who are presumed dead.

Israel, vowing to destroy Hamas and free the captives, has carried out a relentless bombing campaign and ground offensive that Gaza's health ministry says has killed at least 31,726 people, most of them women and children.

- Fear of Rafah invasion -

An Israeli siege that cut off water, electricity, fuel and basic supplies has brought large-scale shortages in the territory of 2.4 million people that the UN warns is on the brink of famine.

Overland access for aid convoys from Egypt has been limited amid the bombing, ground combat and growing insecurity in Gaza where some vehicles have been looted by desperate crowds.

The United States, Jordan and other western and Arab countries have airdropped food into Gaza, while a first aid vessel sailing from the Mediterranean island-nation of Cyprus has opened a new maritime corridor for humanitarian relief goods.

Halting efforts toward a truce and hostage release deal, which have involved US, Qatari and Egyptian mediators, were expected to resume in Qatar, following a week-long ceasefire in November.

However, Israeli Prime Minister Benjamin Netanyahu has again vowed, in the face of growing global concern, that the army will finish its operation to destroy Hamas, before or after any truce.

Global alarm has focussed on Gaza's far-southern city of Rafah near the Egyptian border, where about 1.5 million Palestinians now live in crowded shelters and tent cities.

Netanyahu's warnings of a looming ground invasion have raised fears the civilians would be in the line of fire, sparking warnings of a potential "slaughter".

Israel's top ally the United States, which has provided it with billions of dollars in military assistance, has stressed it wants to see a "clear and implementable plan" to ensure civilians are "out of harm's way".

- 'Where should they go?' -

The Israeli premier on Sunday reiterated that civilians would be evacuated from Rafah before any ground attack, without detailing where they would go in the largely devastated coastal strip.

"Our goal in eliminating the remaining terrorist battalions in Rafah goes hand-in-hand with enabling the civilian population to leave Rafah," he said during a visit by German Chancellor Olaf Scholz.

"It's not something that we will do while keeping the population locked in place."

Scholz, like others before him, raised the question: "Where should they go?"

Speaking to reporters later, Scholz said that if a Rafah offensive resulted in "a large number of casualties", this "would make any peaceful development in the region very difficult".

In efforts toward a new truce deal, Hamas had so far demanded a complete withdrawal of Israeli forces, which Netanyahu has rejected as "delusional".

A new Hamas proposal calls for an Israeli withdrawal from "all cities and populated areas" in Gaza during a six-week truce and for more aid to come in, according to an official from the group.

Israeli public broadcaster Kan reported Monday that "the cabinet approved the departure of the delegation with a mandate to hold the negotiations. The delegation will leave today."