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Tel Aviv: A blame game over a deadly explosion at a packed Gaza hospital has pushed the Middle East closer to all-out war and damaged efforts by US President Joe Biden to broker a deal protecting civilians from the fallout of Israel’s impending invasion of Gaza.

Hundreds of patients, staff and civilians died when an explosion ripped through the Al Ahli Arab Hospital, in the north of the Gaza Strip, on Tuesday night (Gaza time) – the most serious escalation to strike the fracturing region in the days since the deadly October 7 assault by Hamas on southern Israel.

Hamas accused the Israeli Defence Force of targeting the hospital via an airstrike, while Israel’s Prime Minister Benjamin Netanyahu said the explosion was caused by a failed rocket launch by Palestinian Islamic Jihad, a militant group based in Gaza which received funding and support from Iran.

Video showed fire engulfing the building and the hospital’s grounds strewn with torn bodies, many of them young children being treated for wounds or seeking shelter from days of airstrikes on Gaza.

Ambulances and private cars rushed about 350 casualties from the blast to Gaza’s main hospital, Al Shifa, which was already overwhelmed with injured from other strikes. The wounded were laid onto bloody floors, screaming in pain.

The scenes sparked a furious response in neighbouring countries, with protesters attempting to storm Israel’s embassy in Jordan. A building was set on fire during a demonstration near the US embassy in Lebanon as members of the crowd chanted “death to America” and “death to Israel”.

Crowds also gathered in Turkey, Iran, Yemen and the increasingly volatile West Bank, stoking fears the war between Israel and Hamas could spiral into a major regional conflict.

Terrorist group Hezbollah, which has been menacing Israel on the northern border in the days since Hamas’ attacks in the country’s south, vowed to stage a “day of unprecedented anger” against Israel on Wednesday. Like Hamas, Hezbollah is a proscribed terrorist organisation under Australian law.

Australian Prime Minister Anthony Albanese said images from the hospital explosion were “deeply distressing”.

“Every innocent life matters – whether it is Israeli or Palestinian,” he told reporters in Canberra. “We condemn any indiscriminate attacks and targeting of civilian infrastructure, including hospitals.”

The Hamas-controlled Gaza Health Ministry said up to 500 people were killed by the explosion and subsequent fire. Albanese said it was clear there had been a devastating loss of life at the hospital.

The widening regional dispute set the scene for an unpredictable and potentially dangerous visit by Biden, who was due to land in Israel on Wednesday evening (AEDT) to meet Netanyahu.

Biden, who said he was “outraged and saddened” by the explosion, has ordered his national security agencies to build a dossier of evidence on how it occurred and who was responsible.

He will meet the Israeli war cabinet and seek a sense of Israel’s plans and objectives in the days and weeks ahead, the spokesperson for the president’s national security council, John Kirby, said on Air Force One during the flight to Tel Aviv.

“He’ll be asking some tough questions, he’ll be asking them as a friend, as a true friend of Israel, but he’ll be asking some questions of them,” Kirby said.

Hamas’ attack in southern Israel on October 7 killed more than 1400 people, mostly civilians, and took about 200 captive into Gaza. Hamas militants in Gaza have launched rockets every day since, aiming at cities across Israel.

In a blow to Biden’s efforts to help civilians leave Gaza or access aid ahead of a widely expected ground invasion by Israel, an emergency summit between Biden, Jordan’s King Abdullah, Egyptian President Abdel Fattah El-Sisi, and Palestinian Authority President Mahmoud Abbas was abruptly cancelled following the hospital blast.

Wounded Palestinians in the Al Shifa hospital in Gaza City. Hundreds of civilians wounded in the Al Ahli Arab Hospital blast were rushed there.Credit: AP

Jordanian Foreign Minister Ayman Safadi told state television there was “no use in talking now about anything except stopping the war”.

The Palestinian Authority’s Health Minister, Mai Alkaila, accused Israel of “a massacre” at the hospital, while Netanyahu said responsibility did not fall on Israel’s military.

“The entire world should know: It was barbaric terrorists in Gaza that attacked the hospital in Gaza, and not the IDF,” he said. “Those who brutally murdered our children also murder their own children.”

Israeli Defence Force spokesman Daniel Hagari vowed to publish a recording of militants in Gaza blaming the explosion on a rocket misfire by Palestinian Islamic Jihad, as well as other evidence he said would prove Israel was not to blame.

Hundreds of Palestinians had taken refuge in Al Ahli and other hospitals in Gaza City in past days, hoping they would be spared bombardment after Israel ordered all residents of the city and surrounding areas to evacuate to the southern Gaza Strip.

United Nations secretary-general Antonio Guterres called for an immediate humanitarian ceasefire in Gaza “to provide sufficient time and space to help realise my two appeals and to ease the epic human suffering we are witnessing”.

“Too many lives and the fate of the entire region hang in the balance,” he said.

Ahmed Al-Mandhari, the World Health Organisation’s regional director for the Eastern Mediterranean, said patients, healthcare workers and internally displaced people were in the hospital when it was struck.

“The hospital was one of 20 in the north of the Gaza Strip facing evacuation orders from the Israeli military,” he said.

“The order for evacuation has been impossible to carry out given the current insecurity, critical condition of many patients, and lack of ambulances, staff, health system bed capacity, and alternative shelter for those displaced.”

Before the Al Ahli Arab Hospital deaths, Israeli strikes on Gaza had killed at least 2778 people and wounded 9700, according to the Gaza Health Ministry.

Nearly two-thirds of those killed were children, a ministry official said.

• Cascading violence: Tremors from the Hamas attacks and Israel’s response have reached far beyond the border. But what would all-out war in the Middle East look like?
• The human cost: Hamas’ massacre in Israel has traumatised – and hardened – survivors. And in Gaza, neighourhoods have become ghost cities.
• “Hamas metro”: Inside the labyrinthine network of underground tunnels, which the Palestinian militant group has commanded beneath war-ravaged Gaza for 16 years. The covert corridors have long provided essential channels for the movement of weapons and armed combatants.
• What is Hezbollah? As fears of the conflict expanding beyond Israel and Hamas steadily rise, all eyes are on the militant group and political party that controls southern Lebanon and has been designated internationally as a terrorist group. How did it form and what does Iran have to do with it?

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