Prime Minister Benjamin Netanyahu has ordered the Israeli military to draw up plans to evacuate Rafah, a city in the southern Gaza Strip packed with more than 1 million people, in advance of an expected ground offensive that has set off international alarm.

In a statement announcing the orders Friday, Netanyahu’s office did not give any details of when the evacuations might be carried out, when the Israeli military might enter the city or where people might go. Many civilians in Rafah are sheltering in rickety tents made of plastic and wood and say there is nowhere left in Gaza to avoid Israeli shelling.Netanyahu’s office said it would be impossible to realize Israel’s goal of smashing Hamas’ rule in Gaza without destroying what it said were the group’s four battalions in Rafah, on Egypt’s border. The military’s “combined plan” would have to both “evacuate the civilian population and topple the battalions,” the statement said.

“Any forceful action in Rafah would require the evacuation of the civilian population from combat zones,” it said.

Netanyahu’s office announced the orders less than a day after President Joe Biden issued some of his sharpest criticism of Israel’s conduct in the war, calling it “over the top” and saying the starvation, suffering and killing of civilians has “got to stop.” His criticism, which dominated Israeli news headlines, revealed growing frustration with Netanyahu as the death toll in Gaza has risen above 27,000, according to the territory’s health officials.

After Netanyahu said this week that he had ordered troops to prepare to enter Rafah, aid agencies, the United Nations and U.S. officials said the prospect of an incursion there was particularly alarming.

About 1.4 million Palestinians are sheltering in Rafah after the Israeli military invaded Gaza and ordered people to evacuate northern and central sections of the strip. Many people have moved multiple times over the past four months and say that finding enough food, water and medicine has become a daily struggle.

“What would happen to us if there were tanks, clashes, an invasion and an army?” said Ahlam Shmali, 31, who has been living in Rafah with her husband and 14-year-old son. She said they managed to eat only one meal a day and to burn paper and old clothes for cooking fuel.

On Friday, UNICEF warned against any escalation in Rafah, where, it said, more than 600,000 children and their families had been displaced.

“Thousands more could die in the violence or by lack of essential services, and further disruption of humanitarian assistance,” the agency’s executive director, Catherine Russell, said in a statement. “We need Gaza’s last remaining hospitals, shelters, markets and water systems to stay functional. Without them, hunger and disease will skyrocket, taking more child lives.”

The Palestinian Authority, which partly governs the Israeli-occupied West Bank, said the expected Israeli advance was “a dangerous prelude to implementing Israel’s unacceptable policy that aims to expel the Palestinian people from their land.” It appealed to Israel’s allies to stop the military from moving into Rafah.

Giora Eiland, a former Israeli national security adviser, said that unless civilians were properly evacuated, a ground operation in Rafah could lead to high casualty counts and “enormous pressure on the border with Egypt” by Palestinians in Gaza fleeing the incursion. The international community could significantly raise pressure for a cease-fire.

“We might reach the opposite of the intended result: You want to deal a final blow against Hamas in Rafah — but at a certain point, the world will tell you ‘no,’ and we end up on the losing end in every direction,” Eiland said in an interview.

The concerns came as Israeli troops pressed deeper into Khan Younis, a city less than 10 miles from Rafah, where they raided a hospital complex Friday and were searching inside the main building, according to the Palestine Red Crescent Society.

The Israeli military said that its intelligence had indicated Hamas was operating inside the hospital, Al-Amal, and that “a precise sweep and clear operation to locate terrorists and dismantle terrorist infrastructure in the vicinity has commenced.”

“The military personnel involved have been thoroughly instructed to prioritize the safety of civilians, patients, medical workers and medical facilities during the operation,” the military said.

The Red Crescent Society, which runs the hospital, has in recent weeks described it as being under “complete siege,” with tanks positioned around it and near-daily Israeli attacks. It said this week that more than 200 patients, staff members and rescue workers were inside the hospital.

Nebal Farsakh, a spokesperson for the Red Crescent Society, said Friday that the group was having difficulty communicating with its staff at the hospital and that its teams had stopped responding after reporting via wireless radio that Israeli forces were inside. She said that normal communication with the staff had been cut off for about a month.

The rising toll has driven U.S. officials to add pressure on Israel to scale back its military campaign, although the Biden administration has steadfastly backed Israel’s right to retaliate for the Hamas-led attack of Oct. 7, which Israeli officials say killed about 1,200 people and led to the abduction of more than 250 others.

After Biden’s criticism Thursday night of the Israeli campaign, Netanyahu’s government and opposition leaders did not immediately respond.

Analysts said the initial silence from top Israeli officials suggested that they were trying to avoid open conflict with the United States, even as relations between the Biden administration and Netanyahu appear increasingly fraught.

Michael Oren, a former Israeli ambassador to Washington, said that while Israeli officials most likely had objected to the comments, they would be reluctant to further strain the relationship as long as the United States continued to support Israel with weapons and its veto power at the U.N. Security Council.

“The president made a remark which is very painful for us and problematic for us,” Oren said in an interview, “but if he continues to provide these two essential services, nothing should be done to jeopardize that.”