A massive explosion at a crowded Gaza City hospital has left hundreds dead and fueled rage across the region, with Israel and Hamas trading blame over the devastating blast.

The explosion happened Tuesday at Al-Ahli Hospital in Gaza City, which was packed with wounded Palestinians and others seeking shelter. Videos from the scene showed the hospital engulfed in flames with bodies strewn across the grounds.

The Hamas-run Health Ministry reported at least 500 people were killed in the explosion. Hamas quickly labeled it a horrific massacre caused by an Israeli airstrike. However, the Israeli military insists it was due to a misfired rocket by Palestinian Islamic Jihad militants.

The competing claims come amid a dire humanitarian crisis and faltering ceasefire efforts in the week-old war between Israel and Hamas that has already claimed over 2,700 Palestinian lives. The Gaza carnage prompted Jordan to cancel a planned regional summit with U.S. President Joe Biden on Wednesday.

Biden will now only visit Israel during his Middle East trip aimed at deescalating the conflict. But the White House official says the purpose remains stopping the war and delivering urgent aid to Palestinians.

The Evacuated Hospital Turned Shelter Before Blast

Israel had ordered the evacuation of Al-Ahli Hospital and residents across Gaza City to move south. Over 350 injured Palestinians along with hundreds more civilians had sought refuge in the medical center.

With Gaza hospitals overwhelmed by war casualties and lacking critical supplies, Al-Ahli offered a desperate sanctuary. Victims flooded in after the blast, only to find floors covered with maimed bodies and scarce resources, per doctors.

Videos from minutes before show crowds in the hospital parking lot. After the massive explosion, the scene turns to chaos with mangled bodies and belongings strewn around burning vehicles.

Hamas Blames Israeli Airstrike, While Israel Points to Islamic Jihad

Hamas spokesperson Abdel-Latif al-Qanou quickly denounced the “horrific massacre” pinning blame on an Israeli airstrike. He referenced Israel’s prior order to evacuate Al-Ahli as evidence it was a deliberate target.

But military spokesman Lt. Col. Richard Hecht rejected any Israeli responsibility. He said radar and aerial footage instead track the blast to a Gaza rocket misfire by Palestinian Islamic Jihad moments earlier.

Israel intercepted the group’s communications indicating they initiated the rocket barrage. Hecht claims the explosion signature differs from Israeli strikes and occurred outside in the parking area rather than inside.

Islamic Jihad refused those accusations, pointing to the scale of damage as proof of an Israeli attack aimed at the hospital. Gaza authorities say the massive civilian toll demands an independent investigation.

Biden Middle East Trip Aims to Stop Violence and Deliver Aid

As casualties mount, the U.S. is pressing for an urgent mechanism to send food, water and medicine into Gaza while evacuating critically injured patients. Secretary of State Blinken secured an agreement with Israel’s Prime Minister for discussions.

Biden will no longer meet with leaders in Jordan and the West Bank during his visit focused on resolving the crisis. But the White House affirmed the purpose remains brokering an immediate ceasefire, funding Gaza’s humanitarian needs and reducing regional tensions.

Israel is reportedly requiring guarantees from Hamas that they won’t seize any aid entering Gaza where the U.N. says half the population has fled homes. Israel eased some restrictions Wednesday, allowing trucks with supplies to cross into Gaza for the first time since the conflict erupted.

Decimated Hospitals Struggle to Treat War Victims

Gaza’s health system hangs by a thread as deaths near 2,800 and hospitals sustain damage in strikes. Al-Ahli is among over 20 medical facilities hit. Besieged hospitals are running low on beds, medicine, equipment, fuel and staff.

Thousands rushed to Al-Shifa Hospital after the blast. But Gaza’s largest medical center was already overwhelmed having absorbed casualties from other strikes. Patients poured in faster than doctors could treat them.

“We need everything,” said Al-Shifa’s director, listing anesthesia, supplies, beds and fuel to keep generators going. He warned they have only hours before the power runs out, leaving vulnerable patients without care.

Across Gaza, rescuers continue to dig for survivors buried in rubble. The suffering deepens by the hour without water, food or electricity due to the ongoing blockade.

Israel Steps Up Bombardment of Densely-Populated Gaza

While ceasefire efforts fizzle, Israel has intensified airstrikes across the Gaza Strip, especially Khan Younis and Rafah in the south. On Tuesday, the military pounded Gaza City claiming it targeted Hamas’ infrastructure.

An Israeli missile flattened a home killing 11 family members who had fled there for safety. More shelling hit a U.N. school sheltering thousands, killing 6. Hamas also lost a top commander, among dozens killed in the crowded Bureij refugee camp.

Israel insists the strikes aim to destroy Hamas’ capabilities and stop rocket fire. But the rising toll of civilians and damage to homes, roads and utilities has drawn global criticism.

Gaza authorities estimate over 1,200 residents are buried under rubble. The dead include whole families and nearly 500 children. Palestinians staged protests in the West Bank while outrage spread across the Middle East over the hospital attack.

No End in Sight as Gaza Crisis Deepens

Over 60% of Gaza’s population has evacuated south as Israel warned residents across a 14-kilometer zone to leave. But the tiny crowded territory offers no escape from violence.

Supplies remain blocked at Gaza’s borders. Fuel to keep hospital generators running has nearly depleted. With homes destroyed, doctors say disease and infection will spread fast. The U.N. warns of an “unspeakable disaster” if conditions don’t improve soon.

Diplomatic efforts show no sign of progress. Israel has rebuffed Hamas’ ceasefire calls. Instead, Israel appears poised for a ground invasion extending the battle.

But with Israeli strikes killing so indiscriminately and no shelters left, many despair over where the bloodshed ends. Tuesday’s hospital bombing that shocked the world underscores Gaza’s agony with no end in sight.