An Israeli airstrike in northern Gaza has killed at least 20 people, mostly women and children, Palestinian officials said Tuesday, as Israel wages a nearly monthlong air and ground operation in what was alreadythe most isolated and heavily destroyedpart of the territory.

The strike late Monday hit a home where several displaced families were sheltering in the town of Beit Lahiya, near the border with Israel, according to Hossam Abu Safiya, the director ofthe recently raided and barely functioningKamal Adwan Hospital, which received the casualties.

The dead included eight women and six children, according to a list provided by the Gaza Health Ministry’s emergency service.Separate strikes elsewhere in Gazaearly Tuesday killed another 10 people, according to health officials.

There was no immediate comment from the Israeli military.

Israel launched the offensive in the north after saying Hamas militants had regrouped there. The army has returned to several areas of Gaza multiple times after previous operations, as Hamas continues to carry out hit-and-run attacks on troops and fire occasional rockets into Israel.

The military has ordered the complete evacuation of Beit Lahiya, the nearby town of Beit Hanoun and the urban Jabaliya refugee camp, and has allowed almost no humanitarian aid into the area for over a month. That hasdrawn rebukes from the Biden administration, which has warned that U.S. laws might force it to curb military aid to Israel if more aid is not allowed in.

Tens of thousands of people have fled to nearby Gaza City inthe latest wave of displacementwithin the besieged territory. Around 90% of the population of 2.3 million have fled during the war, often multiple times.

The three hospitals serving the area have been largely inaccessible because of the fighting, and ambulances have stopped operating. Israeli troops raided Kamal Adwan Hospital last month, saying Hamas militants were sheltering there, allegations denied by Palestinian health officials.

The offensive has raised fears among Palestinians that Israel is implementinga surrender-or-starve planfor northern Gaza proposed by former generals, in which civilians would be ordered out, aid would be cut off and anyone remaining would be considered a fighter.

The Israeli military has denied receiving such orders, but the government has not said whether it is adopting part or all of the plan.

Palestinian officials said a separate wave of Israeli strikes early Tuesday killed 10 people, including four children and two women.

One strike hit a house in the Tufah neighborhood in Gaza City, killing two children and their parents, according to the Health Ministry’s emergency service. Two other children were wounded, it said.

In the central town of Zuweida, an Israeli airstrike hit a tent where a displaced family was sheltering, killing four people, including a mother and her two children, according to Al-Aqsa Martyrs Hospital in the nearby city of Deir al-Balah. Another strike hit a house in Deir al-Balah, killing two people, the hospital said. An Associated Press journalist counted the bodies at the hospital morgue.

The Israeli military says it only targets militants and accuses them of hiding among civilians. It rarely comments on individual strikes, which often kill women and children.

The war began when Hamas-led militants attacked southern Israel on Oct. 7, 2023, killing some 1,200 people, mostly civilians, taking another 250 people hostage. Around 100 captives are still inside Gaza, about a third of whom are believed to be dead.

Israel's retaliatory offensive has killed over 43,000 Palestinians, according to Gaza's Health Ministry, which does not distinguish between civilians and combatants in its toll but says over half of those killed were women and children.