DEIR AL-BALAH, Gaza Strip — One of Gaza’s last functioning hospitals has been emptying out in recent days as Israel has ordered the evacuation of nearby areas and signaled a possible ground operation in a town that has been largely spared throughout the war, officials said Monday.

The Al-Aqsa Martyrs Hospital in Deir al-Balah is the main hospital serving central Gaza. The Israeli military has not ordered its evacuation, but patients and people sheltering there fear that it may be engulfed in fighting or become the target of a raid.

Also Monday, Israeli strikes in Gaza City and Khan Younis killed at least 19 people, according to local officials, and fighting between Israel and Hezbollah resumed across the Lebanon border.

Israeli forces have invaded several hospitals in Gaza over the course of the 10-month-old war, accusing Hamas of using them for military purposes, allegations denied by Palestinian health officials.

Israeli evacuation orders now cover around 84% of Gaza’s territory, according to the United Nations, which estimates that 90% of Gaza’s population of 2.3 million have been forced from their homes. Many have been displaced multiple times. Hundreds of thousands of people have packed into swollen tent camps along the coast where there are few if any public services.

Associated Press reporters saw people fleeing the hospital and surrounding areas Monday, many on foot. Some could be seen pushing patients on stretchers or carrying sick children, while others held bags of clothes, mattresses and blankets. Four schools in the area also are being evacuated.

“Where will we get medicine?” Adliyeh al-Najjar said as she rested outside the hospital gate. “Where will patients like me go?”

Fatimah al-Attar fought back tears as she left the hospital compound heading in the direction of the tent camps.

“Our fate is to die,” she said. “There is no place for us to go. There is no safe place.”

The Israeli military has issued three evacuation orders since Friday for over 19 neighborhoods in northern Gaza and in Deir al-Balah, the U.N. Office for Humanitarian Affairs known as OCHA said, affecting more than 8,000 people staying in these areas.

The order affects an area where UN and other humanitarian centers are located, the Al-Aqsa hospital, two clinics, three wells, one water reservoir and one desalination plant. “This effectively upends a whole lifesaving humanitarian hub,” said Jens Laerke, a spokesman for OCHA.

Doctors Without Borders, an international charity known by its French acronym MSF, said an explosion around 250 yards from the hospital Sunday caused panic, accelerating the exodus.

“As a result, MSF is considering whether to suspend wound care for the time being, while trying to maintain life-saving treatment,” it said on X.

The hospital says it was treating over 600 patients before the evacuation orders, which apply to residential areas about half a mile away. Around 100 patients remain, including seven in intensive care and eight in the children’s ward.

The Israeli military said it was operating against Hamas in Deir al-Balah and working to dismantle its remaining infrastructure there. It said the evacuation orders were issued to protect civilians and did not include nearby hospitals or medical facilities. It said it had also informed Palestinian health officials that the facilities did not need to be evacuated.

The army has excluded hospitals from past evacuation orders, but patients and others have still fled.

Israel’s military said Monday that its forces were expanding operations on the outskirts of Deir al-Balah and had discovered weapons in a residential apartment and dismantled an underground Hamas tunnel 765 yards long.

Local health officials said an Israeli airstrike hit a group of people on the seashore in Gaza City, killing at least seven men while they were fishing.

Another strike hit a vehicle inside the Israeli- declared humanitarian zone near Khan Younis in the south, killing at least five people, according to a Kuwaiti field hospital, where the bodies were taken.

The Israeli military did not immediately respond to a request for comment on those attacks.

The war began Oct. 7 when Hamas-led militants attacked Israeli army bases and farming communities. The militants killed 1,200 people, mostly civilians, and dragged around 250 hostages back to Gaza.

Israel’s retaliatory offensive has killed over 40,000 Palestinians, according to Gaza’s Health Ministry, and caused heavy destruction across much of the territory. Hamas is still holding around 110 hostages, about a third of whom are believed to be dead. Most of the rest were freed in a cease-fire last year.

Israel has continued strikes across Gaza as the United States, Egypt and Qatar have tried to broker a lasting cease-fire and the release of the remaining hostages. Major gaps remain despite several months of high-level negotiations.

Israel says Hamas and other militants hide inside hospitals, which have served as shelters for thousands of displaced people, and use them for military purposes. Medical staff deny the allegations.

Hospitals can lose their protected status under international law if they are used for military purposes.

Only 16 of Gaza’s 36 hospitals are even partially functioning, the World Health Organization has said.