PORT-AU-PRINCE, Haiti (AP) — A heavily armed gang surrounded a hospital in Haiti on Wednesday, trapping women, children and newborns inside until police rescued them, according to the director of the medical center, who pleaded for help via social media.

The Fontaine Hospital Center in the capital of Port-au-Prince is considered an oasis and a lifeline in a community overrun by gangs that have unleashed increasingly violent attacks against each other and residents. People who live in the capital’s sprawling Cite Soleil slum are routinely raped, beaten and killed.

The hospital founder and director, Jose Ulysse, told The Associated Press that gangs were torching homes around the hospital and preventing people inside from leaving. He said it appeared that none of the gang members entered the hospital.

Ulysse said members of Haiti’s National Police force responded to his call for help and arrived with three armored trucks to evacuate 40 children and 70 patients to a private home in a safer part of the city. Among those delicately evacuated were children on oxygen, he said.

“Gangs are in total control of the area,” he said.

A spokesman for the National Police did not immediately return a message seeking comment.

Ulysse identified those responsible as members of the Brooklyn gang, led by Gabriel Jean-Pierre, best known as “Ti Gabriel.” Jean-Pierre also is the leader of a powerful gang alliance known as G-Pep, one of two rival coalitions in Haiti.

The Brooklyn gang has some 200 members and controls certain communities within Cite Soleil, including Brooklyn. They are involved in extortion, hijacking of goods and general violence, according to a recent United Nations report.

“The G-Pep coalition and its allies strongly reinforced cooperation and diversified their revenues, in particular by committing kidnapping for ransom, which has enabled them to strengthen their fighting capacity,” the report stated.

When the AP visited the Fontaine Hospital Center earlier this year, Ulysse said in an interview that gangs had targeted him personally twice.

Gangs across Haiti have continued to grow more powerful since the July 2021 assassination of President Jovenel Moïse, and the number of kidnappings and killings keeps rising.

Earlier this year, at least 20 armed gang members burst into a hospital run by Doctors Without Borders and snatched a patient from an operating room. The criminals gained access after faking a life-threatening emergency, the organization said.

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Associated Press Writer Dánica Coto in San Juan, Puerto Rico, contributed to this report.

KHAN YOUNIS, Gaza Strip (AP) — Israeli troops on Wednesday stormed into Gaza’s largest hospital, searching for traces of Hamas inside and beneath the facility, where newborns and hundreds of other patients have suffered for days without electricity and other basic necessities as fighting raged outside.

Details from the day-long raid remained sketchy, but officials from Israel and Gaza presented different accounts of what was happening at Shifa Hospital in Gaza City: The Israeli army released video showing soldiers carrying boxes labeled as “baby food” and “medical supplies,” while health officials talked of terrified staff and patients as troops moved through the buildings.

After encircling Shifa for days, Israel faced pressure to prove its claim that Hamas had turned the hospital into a command center, using the patients, staff and civilians sheltering there to provide cover — part of Israel’s broader accusation that Hamas, which has been designated a terrorist organization by the United States and European Union, uses Palestinians as human shields. Wednesday evening, Israel released video of weapons it said it found in one building, but so far its search showed no signs of tunnels or a sophisticated command center.

Hamas and Gaza health officials deny terrorists operate in Shifa — a hospital that employs some 1,500 people and has more than 500 beds, according to the Palestinian news agency. Palestinians and rights groups say Israel has recklessly endangered civilians as it seeks to eradicate Hamas.

As Israel tightens its hold on northern Gaza, leaders have talked of expanding the ground operation into the south to root out Hamas. Already, most of Gaza’s 2.3 million people have crowded into the territory’s south, where a worsening fuel shortage threatened to paralyze the delivery of humanitarian services and shut down mobile phone and internet service.

The war between Israel and Hamas erupted after the terrorist group killed some 1,200 people and seized around 240 captives in an Oct. 7 attack that shattered Israelis’ sense of security.

Israeli airstrikes have since killed more than 11,200 people, two-thirds of them women and minors, according to the Palestinian Health Ministry in Ramallah, which coordinates with the ministry branch in Hamas-ruled Gaza. Another 2,700 have been reported missing, with most believed to be buried under the rubble. The ministry’s count does not differentiate between civilian and militant deaths.

ISRAELI RAID INTO SHIFA

Israeli forces launched their raid into the large Shifa compound around 2 a.m. and remained on the grounds after nightfall Wednesday, with tanks stationed outside and snipers on nearby buildings, Munir al-Boursh, a senior official with Gaza’s Health Ministry inside the hospital, told The Associated Press. It was not possible to independently assess the situation inside.

Al-Boursh said that for hours, the troops ransacked the basement and other buildings, including those housing the emergency and surgery departments, and searched the grounds for tunnels. Troops questioned and face-screened patients, staff and people sheltering in the facility, he said, adding that he did not know if any were detained.

“Patients, women and children are terrified,” he said by phone to The Associated Press.

Neither the Palestinians nor the military reported any clashes inside the hospital. The military said its troops killed four militants outside the hospital at the start of the operation. Throughout days of fighting in the surrounding streets, there has been no report of militants firing from inside Shifa.

The Israeli military said it was carrying out a “precise and targeted operation against Hamas in a specified area in the hospital,” and that its soldiers were accompanied by medical teams bringing in incubators and other supplies.

It added that forces were also searching for hostages. The plight of the captives, who include men, women and children, has galvanized Israeli support for the war. Families and supporters of the hostages are holding a protest march from Tel Aviv to Jerusalem.

The video released by the military from inside Shifa showed three duffel bags it said it found hidden around an MRI lab, each containing an assault rifle, grenades and Hamas uniforms, as well as a closet that contained a number of assault rifles without ammunition clips. A laptop was also discovered and taken for study. The Associated Press could not independently verify the Israeli claims that the weapons were found inside the hospital.

“These weapons have absolutely no business being inside a hospital,” Lt. Col. Jonathan Conricus, a military spokesman, said in the video, adding that he believed the material was “just the top of the iceberg.” The military said the search was continuing, but it did not immediately show any sign of tunnels or an extensive military center.

The raid drew condemnation from U.N., Jordan and the West Bank’s Palestinian Authority, which called it a violation of international law.

At one point, tens of thousands of Palestinians fleeing Israeli bombardment were sheltering at the hospital, but most left in recent days as the fighting drew closer. The fate of premature babies at the hospital has drawn particular concern.

The Health Ministry said 40 patients, including three babies, have died since Shifa’s emergency generator ran out of fuel Saturday.

There was no immediate word on the condition of another 36 babies the ministry said earlier were at risk of dying because there is no power for incubators.

Hours before Israel’s raid, the United States said its own intelligence indicated militants have used Shifa and other hospitals — and tunnels beneath them — to support military operations and hold hostages.

Under international humanitarian law, hospitals can lose their protected status if combatants use them for military purposes. But civilians must be given ample time to flee, and any attack must be proportional to the military objective — putting the burden on Israel to show it was a big enough military target to justify the siege against it.

A TRICKLE OF FUEL FOR AID WORKERS

About two thirds of the territory’s 2.3 million people have fled their homes — and most are now squeezed into the southern part of the narrow coastal strip.

Conditions there have been deteriorating, as bombardment continues to level buildings. Residents say bread is scarce and supermarket shelves are bare. Families cook on wood fires for lack of fuel. Central electricity and running water have been out for weeks across Gaza.

After refusing to allow fuel into Gaza since the war’s start, saying it would be diverted to Hamas, Israeli defense officials early Wednesday let in some 24,000 liters (6,340 gallons).

The fuel will only be used for the U.N. agency for Palestinian refugees, known as UNRWA, to continue bringing limited supplies of food and medicine from Egypt for the more than 600,000 people sheltering in U.N.-run schools and other facilities in the south.

The fuel cannot be used for hospitals or to desalinate water, said Thomas White, UNRWA’s director in Gaza. The amount is equivalent of “only 9% of what we need daily to sustain lifesaving activities,” he said.

The Palestinian telecom company Paltel, meanwhile, said it was relying on batteries to keep Gaza’ mobile and internet network running, and that it expected services to halt later Wednesday. Gaza has experienced three previous mass communication outages since the ground invasion.

LOOKING SOUTH

Israeli troops have extended their control across northern Gaza. The military says Israeli forces took control of the Shati refugee camp, a densely built district, and are moving about freely in the city as a whole.

The military says its forces have found weapons and Hamas fighters in government buildings, schools and residential buildings. Israel says it has killed several thousand fighters while 46 of its own soldiers have been killed in Gaza.

Defense Minister Yoav Gallant said Wednesday the ground operation will eventually “include both the north and south. We will strike Hamas wherever it is.” Prime Minister Benjamin Netanyahu echoed the plans, saying Israel’s goal is “a complete victory over Hamas in the south and the return of our hostages.”

Israel told residents of northern Gaza to evacuate south, saying it wanted to get civilians out of the path of its ground assault, and hundreds of thousands fled. If Israeli troops move south, it is not clear where Gaza’s population can flee, with Egypt refusing a mass transfer onto its soil.

Magdy and Jeffery reported from Cairo. Associated Press writers Wafaa Shurafa in Dair al-Balah, Gaza, and Amy Teibel in Jerusalem contributed to this report.

WOODSIDE, Calif. (AP) — U.S. President Joe Biden and China’s Xi Jinping emerged Wednesday from their first face-to-face meeting in a year vowing to stabilize their fraught relationship and showcasing modest agreements to combat illegal fentanyl and re-establish military communications. But there were still deep differences on economic competition and global security threats.

The two leaders spent four hours together – in meetings, a working lunch and a garden stroll – intent on showing the world that while they are global economic competitors they’re not locked in a winner-take-all faceoff.

“Planet Earth is big enough for the two countries to succeed,” Xi told Biden.

The U.S. president told Xi: “I think it’s paramount that you and I understand each other clearly, leader-to-leader, with no misconceptions or miscommunications. We have to ensure competition does not veer into conflict.”

Their meeting, on the sidelines of the annual Asia-Pacific Economic Cooperation conference, has far-reaching implications for a world grappling with economic cross currents, conflicts in the Middle East and Europe, tensions in Taiwan and more.

They reached expected agreements to curb illicit fentanyl production and to reopen military ties, a senior U.S. official said after the meeting ended. Many of the chemicals used to make synthetic fentanyl come from China to cartels that traffic the powerful narcotic into the U.S., which is facing an overdose crisis.

Top military leaders will resume talks, increasingly important particularly as unsafe or unprofessional incidents between the two nations’ ships and aircraft have spiked, said the official who spoke on condition of anonymity to discuss the agreements ahead of Biden’s remarks.

The U.S. official described a significant back and forth between the two leaders over Taiwan, with Biden chiding China over its massive military build-up around Taiwan and Xi telling Biden he had no plans to invade the island.

Biden, the official said, said the U.S. was committed to continuing to help Taiwan defend itself and maintain deterrence against a potential Chinese attack, and also called on China to avoid meddling in the island’s elections next year. The official described the Taiwan portion of the talks as “clear-headed” and “not heated.”

Biden also called on Xi to use his influence with Iran to make clear that Tehran, and its proxies, should not take steps that would lead to an expansion of the Israel-Hamas war.

During the exchange on Iran, Biden did most of the talking and Xi mostly listened, according to the U.S official. Foreign Minister Wang Yi has assured the U.S. that the Chinese have communicated concerns to Iran on the matter. But the official said the U.S. has not been able to ascertain how seriously the Iranians are taking concerns raised by Beijing.

According to a statement released by China Central Television, the state broadcaster, Xi was most focused on Taiwan and the U.S. sanctions and restrictions against Chinese products and businesses.

Xi urged the U.S. to support China’s peaceful unification with the self-governed island, calling Taiwan “the most important and most sensitive issue” in the bilateral relations. He also raised Beijing’s concerns over export controls, investment screenings, and sanctions imposed by the U.S., which he said “have severely harmed China’s legitimate interests.”

“We hope the U.S. side can seriously treat China’s concerns and take actions to remove unilateral sanctions and provide a fair, just, non-discriminatory environment for Chinese businesses.”

Xi said he and Biden also agreed to establish dialogues on artificial intelligence and stressed the urgency for the two countries to cope with the climate crisis, the state broadcaster reported.

Both leaders acknowledged the importance of their relationship and the need for better coordination. But their differences shone through: Xi indicated he wants better cooperation — but on China’s terms. And he sought to project strength to his domestic audience in the face of U.S. policies restricting imports from China and limiting technology transfers to Beijing.

Biden, meanwhile, will also spend time this week in California working to highlight new alliances in the Indo Pacific and efforts to boost trade with other regional leaders.

Xi, speaking through an interpreter, declared it “an objective fact that China and the United States are different in history, culture, social system and development.”

The presidents and their respective aides on trade, the economy, national security and regional diplomacy gathered across from one another at a single long table, the culmination of negotiations between the two leaders’ top aides over the past several months. It was Biden and Xi’s first conversation of any kind since they met last November in Bali.

They’re seeking to build back to a stable baseline after already tense relations took a nosedive following the U.S. downing of a Chinese spy balloon that had traversed the continental U.S., and amid differences over the self-ruled island of Taiwan, China’s hacking of a Biden official’s emails and other matters.

For Biden, Wednesday’s meeting was a chance for the president to do what he believes he does best: in-person diplomacy.

“As always, there’s no substitute for face-to-face discussions,” he told Xi. With his characteristic optimism, Biden sketched a vision of leaders who manage competition “responsibly,” adding, “that’s what the United States wants and what we intend to do.”

Xi, for his part, was gloomy about the state of the post-pandemic global economy. China’s economy remains in the doldrums, with prices falling due to slack demand from consumers and businesses.

“The global economy is recovering, but its momentum remains sluggish,” Xi said. “Industrial and supply chains are still under the threat of interruption and protectionism is rising. All these are grave problems.”

The relationship between China and the U.S. has never been smooth, he said. Still, it has kept moving forward. “For two large countries like China and the United States, turning their back on each other is not an option,” he said.

More pointedly, Xi also suggested it was not up to the U.S. to dictate how the Chinese manage their affairs, saying, “It is unrealistic for one side to remodel the other, and conflict and confrontation has unbearable consequences for both sides.”

Robert Moritz, global chairman for the consulting firm PricewaterhouseCoopers, said business leaders are hoping for signs of more cooperation and a firmer commitment to free trade between the world’s two largest economies following the Biden-Xi talks.

“What we are looking for is a de-escalation and a bringing of the temperature down,” Mortiz said during a CEO summit being held in conjunction with the annual Asia-Pacific Economic Cooperation forum that has brought together leaders from 21 member economies.

“Discussion isn’t good enough, it’s the execution on getting things done” that will matter, he said.

The Biden-Xi meeting and broader summit events attracted protests around San Francisco, but the demonstrations were kept at distance. A large crowd loudly condemning Xi marched from the Chinese Consulate toward the summit venue at the Moscone Center nearly two miles away. Speakers implored the Biden administration to stand up to Xi and China’s human rights violations.

Late Wednesday, Xi was to address American business executives at a $2,000-per-plate dinner that will be a rare opportunity for U.S. business leaders to hear directly from the Chinese leader as they seek clarification on Beijing’s expanding security rules that may choke foreign investment.

Foreign companies operating in China say that country’s tensions with Washington over technology, trade and other issues and uncertainty over Chinese policies are damaging the business environment and causing some to reassess their plans for investing in the giant market.

Even before Biden and Xi met, there were some signs of a thaw: The State Department on Tuesday announced that the U.S. and China — two of the world’s biggest polluters — had agreed to pursue efforts to triple renewable energy capacity globally by 2030, through wind, solar and other renewables.

There were also light moments between the two leaders who have logged much time together over the last decade. Biden asked Xi to extend his early birthday wishes to Xi’s wife, who will be celebrating next week. Xi thanked the president for reminding him. The Chinese leader said that he’s been so busy working he had forgotten the big day was nearing.

Biden and Xi held their talks at Filoli Estate, a bucolic country house and museum about 25 miles (40 kilometers) south of San Francisco. The event was carefully staged, Biden first to arrive at the grand estate, then Xi. After their handshake and smiles they sat down with aides for talks that lasted more than two hours.

Next came a working lunch with inner-circle members from both administrations. They ate ravioli, chicken and broccolini, with almond meringue cake and praline buttercream for dessert.

Before they parted, the two strolled the property along a red brick path through impressive topiary and knotted gothic trees. Asked by reporters how the meeting went, the president said “well” and flashed a thumbs up.

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Long and Tang reported from San Francisco. Associated Press journalists Zeke Miller, Sagar Meghani and Josh Boak in Washington and Michael Liedtke and Janie Har in San Francisco contributed to this report.

LONDON (AP) — The British government said Wednesday it will still try to send some migrants on a one-way trip to Rwanda, despite the U.K. Supreme Court ruling that the contentious plan is unlawful because asylum-seekers would not be safe in the African country.

In a major blow to one of Prime Minister Rishi Sunak ‘s key policies, the country’s top court ruled that asylum-seekers sent to Rwanda would be “at real risk of ill-treatment” because they could be returned to the conflict-wracked home countries they’d fled.

Sunak, who has pledged to stop migrants reaching Britain in small boats across the English Channel, said the ruling “was not the outcome we wanted” but vowed to press on with the plan and send the first deportation flights to Rwanda by next spring.

He said the court had “confirmed that the principle of removing asylum-seekers to a safe third country is lawful,” even as it ruled Rwanda unsafe.

Sunak said the government would seal a legally binding treaty with Rwanda that would address the court’s concerns, and would then pass a law declaring Rwanda a safe country.

Sunak suggested that if legal challenges to the plan continued, he was prepared to consider leaving international human rights treaties — a move that would draw strong opposition and international criticism.

Britain and Rwanda signed a deal in April 2022 to send migrants who arrive in the U.K. as stowaways or in boats to the East African country, where their asylum claims would be processed and, if successful, they would stay.

Britain’s government argues that the policy will deter people from risking their lives crossing one of the world’s busiest shipping lanes, and would break the business model of people-smuggling gangs. No one has yet been sent to the country as the plan was challenged in the courts.

Opposition politicians, refugee groups and human rights organizations say the plan is unethical and unworkable. Charity ActionAid U.K. called the Supreme Court ruling a vindication of “British values of compassion and dignity.” Amnesty International said the government should “draw a line under a disgraceful chapter in the U.K.’s political history.”

Announcing the unanimous decision, President of the Supreme Court Robert Reed said Rwanda had a history of misunderstanding its obligations toward refugees and of “refoulement” — sending claimants back to the country they had sought protection from.

The judges concluded “there is a real risk that asylum claims will not be determined properly, and that asylum-seekers will in consequence be at risk of being returned directly or indirectly to their country of origin.”

“In that event, genuine refugees will face a real risk of ill-treatment,” they said.

The U.K. government has argued that while Rwanda was the site of a genocide that killed more than 800,000 people in 1994, the country has since built a reputation for stability and economic progress.

Critics say that stability comes at the cost of political repression. The court’s judgment noted human rights breaches including political killings that had led U.K. police “to warn Rwandan nationals living in Britain of credible plans to kill them on the part of that state.” They said Rwanda has a 100% rejection record for asylum-seekers from war-torn countries including Syria, Yemen and Afghanistan.

The Rwandan government insisted the country is a safe place for refugees.

“Given Rwanda’s welcoming policy and our record of caring for refugees, the political judgments made today were unjustified,” it said in a statement.

Rwandan opposition leader Frank Habineza, however, said Britain shouldn’t try to offshore its migration obligations to the small African country.

“The U.K. should keep the migrants or send them to another European country, not to a poor country like Rwanda. I really think it’s not right (for) a country like the U.K. to run away from their obligations,” Habineza told the AP in Kigali.

Much of Europe and the U.S. is struggling with how best to cope with migrants seeking refuge from war, violence, oppression and a warming planet that has brought devastating drought and floods.

Though Britain receives fewer asylum applications than countries such as Italy, France or Germany, thousands of migrants from around the world travel to northern France each year in hopes of crossing the English Channel.

More than 27,300 have done that this year, a decline on the 46,000 who made the journey in all of 2022. The government says that shows its tough approach is working, though others cite factors including the weather.

The Rwanda plan has cost the British government at least 140 million pounds ($175 million) in payments to Rwanda before a single plane has taken off. The first deportation flight was stopped at the last minute in June 2022, when the European Court of Human Rights intervened.

The case went to the High Court and the Court of Appeal, which ruled that the plan was unlawful because Rwanda is not a “safe third country.” The government unsuccessfully challenged that decision at the Supreme Court.

Sunak took comfort from the court’s ruling that “the structural changes and capacity-building needed” to make Rwanda safe “may be delivered in the future.” The U.K. government says its legally binding treaty will compel Rwanda not to send any migrants deported from the U.K back to their home countries.

The prime minister is under pressure from the right wing of the governing Conservative Party to take even more dramatic action to “stop the boats.” Former Home Secretary Suella Braverman, who was fired by Sunak on Monday, has said the U.K. should leave the European Convention on Human Rights if the Rwanda plan was blocked.

Sunak said at a news conference he was prepared to “revisit those international relationships to remove the obstacles in our way.”

“I will not allow a foreign court to block these flights,” he said.

Legal experts said leaving or ignoring international treaties would be an extreme move. Joelle Grogan, a senior researcher at the U.K. in a Changing Europe think tank, said leaving the European Convention would make Britain “an outlier in terms of its standards and its reputation for human rights protection.”

“The only reason in which you would leave the ECHR is if you wanted to start sending asylum-seekers to unsafe countries where they face threats to their life,” she said.

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Associated Press writer Ignatius Ssuuna in Kigali, Rwanda contributed to this report.

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Follow AP’s global migration coverage at https://apnews.com/hub/migration

KHAN YOUNIS, Gaza Strip (AP) — Palestinian authorities on Tuesday called for a cease-fire to evacuate three dozen newborns and other patients trapped inside Gaza’s biggest hospital as Israeli forces battle Hamas in the streets just outside and seize more ground across northern Gaza.

For days, the Israeli army has encircled Shifa Hospital, determined to seize the facility it says Hamas hides in, and beneath, to use civilians as shields for its main command base.

Hospital staff and Hamas deny the claim. Meanwhile, hundreds of patients, staff and displaced people are trapped inside, with supplies dwindling and without electricity to run incubators and other life-saving equipment. With refrigeration out for days, staff on Tuesday were digging a mass grave in the yard for more than 120 bodies in the morgue, health officials said. Hamas has been designated as a terrorist organization by the United States, Canada and the European Union.

Six weeks into the war, the standoff at Shifa and other hospitals comes as Israeli forces control larger swaths of Gaza City and the surrounding northern part of the Gaza Strip, saying they are driving out and killing Hamas.

Israel has vowed to crush Hamas rule in Gaza after the terrorists’ Oct. 7 surprise attack into Israel in which they killed some 1,200 people and dragged roughly 240 hostages back to Gaza. But even as its troops control more of a devastated north Gaza, the Israeli government has acknowledged it doesn’t know what it will do with the territory after Hamas’ defeat.

The onslaught – one of the world’s deadliest and most intense bombardments this century — has been disastrous for Gaza’s 2.3 million Palestinians.

More than 11,200 people, two-thirds of them women and minors, have been killed, according to the Health Ministry of the Hamas-run territory — which has been unable to update its figures since Friday, citing the difficulty of collecting information. About 2,700 people have been reported missing. The ministry’s count does not differentiate between civilian and militant deaths.

Almost the entire population of Gaza has squeezed into the southern two-thirds of the tiny territory, where conditions have been deteriorating even as bombardment there continues. About 200,000 fled the north in recent days amid the intensifying fighting, the U.N. humanitarian office said Tuesday. Tens of thousands are believed to remain in the north.

Hamas released a video late Monday showing one of the hostages, who identifies herself as 19-year-old Noa Marciano, before and after she was killed in what Hamas said was an Israeli strike. The military later declared her a fallen soldier, without identifying a cause of death.

She is the first hostage confirmed to have died in captivity. Four were released by Hamas and a fifth was rescued by Israeli forces.

PLIGHT OF HOSPITALS

Fighting has raged for days around Shifa Hospital, a complex several city blocks across at the center of Gaza City that has now “turned into a cemetery,” its director said in a statement.

The Health Ministry said 40 patients, including three babies, have died since Shifa’s emergency generator ran out of fuel Saturday. Another 36 babies are at risk of dying because there is no power for incubators, according to the ministry.

The Israeli military said it had started an effort to transfer incubators to Shifa. But they would be useless without electricity, said Christian Lindmeier, a spokesman for the World Health Organization. He said the only way to save the newborns was to move them out of Gaza.

“Another hospital under siege or under attack is not a viable solution. Nowhere is safe in Gaza right now,” he told The Associated Press. He said an evacuation would require specialized equipment and a cease-fire along the route.

The Health Ministry has proposed evacuating the hospital with the supervision of the International Committee of the Red Cross and transferring the patients to hospitals in Egypt, but has not received any response, ministry spokesman Ashraf al-Qidra said.

While Israel says it is willing to allow staff and patients to evacuate, some Palestinians who have made it out say Israeli forces have fired at evacuees. U.N. and Palestinian health officials say it is too dangerous to move the most vulnerable patients without proper ambulances and equipment.

Israel says its claims of a Hamas command center in and beneath Shifa are based on intelligence but has not provided visual evidence to support them. Denying the claims, the Gaza Health Ministry says it has invited international organizations to investigate the facility.

On Monday, the military released footage of a children’s hospital in Gaza City that its forces entered over the weekend, showing weapons it said it found inside, as well as rooms in the basement where it believes terrorists were holding hostages. The video showed what appeared to be a hastily installed toilet and ventilation system in the basement.

The Health Ministry rejected the allegations, saying the area had been turned into a shelter for displaced people.

BATTLE IN GAZA CITY

Independent accounts of the fighting in Gaza City have been nearly impossible to gather, as communications to the north have largely collapsed.

Videos released by the Israeli military show troops moving through the city, firing into buildings. Bulldozers push down structures as tanks roll through streets surrounded by rubble and partially collapsed towers.

The videos portray a battle where troops are rooting out pockets of Hamas fighters and tearing down wherever they find them. The military says it is also gradually dismantling the group’s tunnel network.

Israel says it has killed several thousand fighters, including important mid-level commanders, while 46 of its own soldiers have been killed in Gaza. The military says Hamas has lost control in the north, and in recent days Hamas rocket fire into Israel — constant throughout the war — has waned. Details of the Israeli account and the extent of Hamas losses, however, could not be independently confirmed.

One Israeli commander in Gaza, identified only as Lt. Col. Gilad, said in a video that his forces near Shifa Hospital had been seizing government buildings, schools and residential buildings where they found weapons and eliminated fighters. After each was cleared, “the location was demolished,” he said.

The army said it had captured Gaza’s legislature building — about two blocks from Shifa — the Hamas police headquarters and a compound housing Hamas’ military intelligence headquarters. The captured buildings carry high symbolic value, though it was unclear what their strategic value is. Hamas is believed to be positioned in underground bunkers.

Israeli news sites showed pictures of soldiers holding up the Israeli flag and military flags in celebration inside some of the buildings.

DETERIORATING CONDITIONS IN THE SOUTH

Israel has urged civilians in the north to flee south, but southern Gaza is not much safer. Israel carries out frequent airstrikes throughout Gaza, hitting what it says are militant targets but often killing women and children.

Some 1.5 million Palestinians, more than two thirds of Gaza’s population, have fled their homes, and U.N.-run shelters in the south are severely overcrowded.

People stand in line for hours for scarce bread and brackish water. Trash is piling up, sewage is flooding the streets and taps run dry because there is no way to power water systems. Israel has barred fuel imports since the start of the war, saying Hamas would use it for military purposes.

At a tent camp outside a hospital in the central town of Deir al-Balah, people trudged through mud as they stretched plastic tarps over flimsy tents.

“All of these tents collapsed because of the rain,” said Iqbal Abu Saud, who had fled Gaza City with 30 of her relatives. “How many days will we have to deal with this?”

The U.N. agency for Palestinian refugees, which is struggling to provide basic services to over 600,000 people sheltering in schools and other facilities in the south, said it may run out of fuel by Wednesday, forcing it to halt most aid operations. It said it could no longer import limited supplies of food and medicine through Egypt’s Rafah crossing, Gaza’s only link to the outside world.

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Jeffery and Keath reported from Cairo. Associated Press writer Amy Teibel in Jerusalem, Wafaa Shurafa in Deir al-Balah, Gaza Strip; Samy Magdy in Cairo. contributed to this report.

Full AP coverage at https://apnews.com/hub/israel-hamas-war.

Revved-up climate change now permeates Americans’ daily lives with harm that is “already far-reaching and worsening across every region of the United States,” a massive new government report says.

The National Climate Assessment, which comes out every four to five years, was released Tuesday with details that bring climate change’s impacts down to a local level. Unveiling the report at the White House, President Joe Biden blasted Republican legislators and his predecessor for disputing global warming.

“Anyone who willfully denies the impact of climate change is condemning the American people to a very dangerous future. Impacts are only going to get worse, more frequent, more ferocious and more costly,” Biden said, noting that disasters cost the country $178 billion last year. “None of this is inevitable.”

Overall, Tuesday’s assessment paints a picture of a country warming about 60% faster than the world as a whole, one that regularly gets smacked with costly weather disasters and faces even bigger problems in the future.

Since 1970, the Lower 48 states have warmed by 2.5 degrees (1.4 degrees Celsius) and Alaska has heated up by 4.2 degrees (2.3 degrees Celsius), compared to the global average of 1.7 degrees (0.9 degrees Celsius), the report said. But what people really feel is not the averages, but when weather is extreme.

With heat waves, drought, wildfire and heavy downpours, “we are seeing an acceleration of the impacts of climate change in the United States,” said study co-author Zeke Hausfather of the tech company Stripe and Berkeley Earth.

And that’s not healthy.

Climate change is ”harming physical, mental, spiritual, and community health and well-being through the increasing frequency and intensity of extreme events, increasing cases of infectious and vector-borne diseases, and declines in food and water quality and security,” the report said.

Compared to earlier national assessments, this year’s uses far stronger language and “unequivocally” blames the burning of coal, oil and gas for climate change.

The 37-chapter assessment includes an interactive atlas that zooms down to the county level. It finds that climate change is affecting people’s security, health and livelihoods in every corner of the country in different ways, with minority and Native American communities often disproportionately at risk.

In Alaska, which is warming two to three times faster than the global average, reduced snowpack, shrinking glaciers, thawing permafrost, acidifying oceans and disappearing sea ice have affected everything from the state’s growing season, to hunting and fishing, with projections raising questions about whether some Indigenous communities should be relocated.

The Southwest is experiencing more drought and extreme heat – including 31 consecutive days this summer when Phoenix’s daily high temperatures reached or exceeded 110 degrees – reducing water supplies and increasing wildfire risk.

Northeastern cities are seeing more extreme heat, flooding and poor air quality, as well as risks to infrastructure, while drought and floods exacerbated by climate change threaten farming and ecosystems in rural areas.

In the Midwest, both extreme drought and flooding threaten crops and animal production, which can affect the global food supply.

In the northern Great Plains, weather extremes like drought and flooding, as well as declining water resources, threaten an economy dependent largely on crops, cattle, energy production and recreation. Meanwhile, water shortages in parts of the southern Great Plains are projected to worsen, while high temperatures are expected to break records in all three states by midcentury.

In the Southeast, minority and Native American communities — who may live in areas with higher exposures to extreme heat, pollution and flooding — have fewer resources to prepare for or to escape the effects of climate change.

In the Northwest, hotter days and nights that don’t cool down much have resulted in drier streams and less snowpack, leading to increased risk of drought and wildfires. The climate disturbance has also brought damaging extreme rain.

Hawaii and other Pacific islands, as well as the U.S. Caribbean, are increasingly vulnerable to the extremes of drought and heavy rain as well as sea level rise and natural disaster as temperatures warm.

The United States will warm in the future about 40% more than the world as a total, the assessment said. The AP calculated, using others’ global projections, that that means America would get about 3.8 degrees (2.1 degrees Celsius) hotter by the end of the century.

Hotter average temperatures means weather that is even more extreme.

“The news is not good, but it is also not surprising,” said University of Colorado’s Waleed Abdalati, a former NASA chief scientist who was not part of this report. “What we are seeing is a manifestation of changes that were anticipated over the last few decades.”

The 2,200-page report comes after five straight months when the globe set monthly and daily heat records. It comes as the U.S. has set a record with 25 different weather disasters this year that caused at least $1 billion in damage.

“Climate change is finally moving from an abstract future issue to a present, concrete, relevant issue. It’s happening right now,” said report lead author Katharine Hayhoe, chief scientist at the Nature Conservancy and a professor at Texas Tech University. Five years ago, when the last assessment was issued, fewer people were experiencing climate change firsthand.

Surveys this year by The Associated Press-NORC Center for Public Affairs Research show that.

In September, about 9 in 10 Americans (87%) said they’d experienced at least one extreme weather event in the past five years — drought, extreme heat, severe storms, wildfires or flooding. That was up from 79% who said that in April.

Hayhoe said there’s also a new emphasis in the assessment on marginalized communities.

“It is less a matter … of what hits where, but more what hits whom and how well those people can manage the impacts,” said University of Colorado’s Abdalati, whose saw much of his neighborhood destroyed in the 2021 Marshall wildfire.

Biden administration officials emphasize that all is not lost and the report details actions to reduce emissions and adapt to what’s coming.

By cleaning up industry, how electricity is made and how transport is powered, climate change can be dramatically reduced. Hausfather said when emissions stops, warming stops, “so we can stop this acceleration if we as a society get our act together.”

But some scientists said parts of the assessment are too optimistic.

“The report’s rosy graphics and outlook obscure the dangers approaching,” Stanford University climate scientist Rob Jackson said. “We are not prepared for what’s coming.”

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Borenstein reported from Kensington, Maryland, and Webber from Fenton, Michigan.

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Follow AP’s climate and environment coverage at https://apnews.com/hub/climate-and-environment and follow Seth Borenstein and Tammy Webber on Twitter at http://twitter.com/borenbears and https://twitter.com/twebber02

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Associated Press climate and environmental coverage receives support from several private foundations. See more about AP’s climate initiative here. The AP is solely responsible for all content.

WELLINGTON, New Zealand (AP) — Comedian John Oliver has succeeded in his campaign to have what he describes as a weird, puking bird with a colorful mullet win New Zealand’s Bird of the Century contest.

He managed to elbow out the iconic national bird, the kiwi.

Conservation group Forest and Bird on Wednesday announced that Oliver’s favored water bird, the pūteketeke, had won after Oliver went all-out in a humorous campaign for the bird on his HBO show “Last Week Tonight.” The North Island brown kiwi came in second.

Vote checkers in New Zealand were so overwhelmed by Oliver’s foreign interference they had to postpone naming the winning bird for two days.

Usually billed Bird of the Year, the annual event is held to raise awareness about the plight of the nation’s native birds, some of which have been driven to extinction. This year, the contest was named Bird of the Century to mark the group’s centennial.

Oliver discovered a loophole in the rules, which allowed anybody with a valid email address to cast a vote.

Oliver had a billboard erected for “The Lord of the Wings” in New Zealand’s capital, Wellington. He also put up billboards in Paris, Tokyo, London, and Mumbai, India. He had a plane with a banner fly over Ipanema Beach in Brazil. And he wore an oversized bird costume on Jimmy Fallon’s “The Tonight Show.”

“After all, this is what democracy is all about,” Oliver said on his show. “America interfering in foreign elections.”

Forest and Bird didn’t immediately release the final vote tally Wednesday but said the group received more than 350,000 verified votes, more than six times the previous record of 56,700 votes in 2021.

They said Oliver’s “high-powered” campaign temporarily crashed their voting verification system.

“It’s been pretty crazy, in the best possible way,” Chief Executive Nicola Toki told The Associated Press before the winner was announced.

New Zealand is unusual in that birds developed as the dominant animals before humans arrived.

“If you think about the wildlife in New Zealand, we don’t have lions and tigers and bears,” Toki said. Despite nearly nine of every ten New Zealanders now living in towns or cities, she added, many retain a deep love of nature.

“We have this intangible and extraordinarily powerful connection to our wildlife and our birds,” Toki said.

The contest has survived previous controversies. Election scrutineers in 2020 discovered about 1,500 fraudulent votes for the little spotted kiwi. And two years ago, the contest was won by a bat, which was allowed because it was considered part of the bird family by Indigenous Māori.

This year, the organizers said they eliminated more fraudulent votes, including 40,000 cast by a single person for the eastern rockhopper penguin.

Toki said that when the contest began in 2005, they had a total of 865 votes, which they considered a great success. She said the previous record vote count was broken within a couple of hours of Oliver launching his campaign.

Toki said Oliver contacted the group earlier this year asking if he could champion a bird. They had told him to go for it, not realizing what was to come.

“I was cry laughing,” Toki said when she watched Oliver’s segment.

Oliver described how the pūteketeke, which number less than 1,000 in New Zealand and are also known as the Australasian crested grebe, eats its own feathers before vomiting them back up.

“They have a mating dance where they both grab a clump of wet grass and chest bump each other before standing around unsure of what to do next,” Oliver said on his show, adding that he’d never identified more with anything in his life.

Some in New Zealand pushed back against Oliver’s campaign. One group put up billboards reading: “Dear John, don’t disrupt the pecking order,” while others urged people to vote for the kiwi. Oliver responded by saying the kiwi looked like “a rat carrying a toothpick.”

“For the record, all of your birds are great, and it would be an honor to lose to any of them when the results are announced on Wednesday,” Oliver said on his show. “The reason it is so easy for me to say that is that we aren’t going to lose, are we? We are going to win, and we are going to win by a lot.”

SAN FRANCISCO (AP) — President Joe Biden said on the eve of his much-anticipated meeting with China’s Xi Jinping that his goal for the talks is simply to try to get U.S.-Chinese communications back on stable ground after a tumultuous year.

Biden said Tuesday shortly before departing for San Francisco to meet Xi and attend this year’s Asia-Pacific Economic Cooperation forum that the nations must get “on a normal course corresponding” once again even as they have sharp differences on no shortage of issues.

“Being able to pick up the phone and talk to one another if there’s a crisis. Being able to make sure our militaries still have contact with one another,” Biden told reporters at the White House. “We’re not trying to decouple from China, but what we’re trying to do is change the relationship for the better.”

The long complicated U.S.-Chinese relationship has come under heavy strain over the last year, with Beijing bristling over new U.S. export controls on advanced technology; Biden ordering the shooting down of a Chinese spy balloon after it traversed the continental United States; and Chinese anger over a stopover in the U.S. by Taiwanese President Tsai Ing-wen earlier this year, among other issues. China claims the island as its territory.

Chinese state media that Xi had departed earlier Tuesday to make his way to San Francisco.

Biden will also be looking to use this week’s summit of Asia-Pacific leaders to show world leaders the United States has the gumption, attention span and money to focus on the region even as it grapples with a multitude of foreign and domestic policy crises.

Biden’s meeting with Xi on Wednesday is the main event of his four-day visit to San Francisco, where leaders from the 21 economies that make up APEC are gathering for their annual summit. The White House wants to demonstrate to APEC’s leaders that Biden can remain focused on the Pacific while also trying to keep the Israel-Hamas war from exploding into a broader regional conflict and to persuade Republican lawmakers to continue to spend billions more on the costly Ukrainian effort to repel Russia’s nearly 21-month old invasion.

“President Biden this coming week will be doing a lot more than just meeting with President Xi,” White House national security adviser Jake Sullivan told reporters in Washington on Monday. He added that Biden would put forward his economic vision for the region, make the case that the U.S. is “the very eminent driver” for sustainable economic growth in the Asia-Pacific, and hold the region out as critical to U.S. economic growth.

White House officials say they are cognizant that fellow APEC nations want to see better dialogue between the U.S. and China because it reduces the risk of regional conflict. At the same time, they also know that others in the region are concerned that the Pacific is too often seen through a prism in which the dominant power centers in Washington and Beijing make decisions for the region without engagement from less powerful nations.

To that end, the White House is expected to unveil new initiatives to advance clean economy investments and develop anti-corruption and taxation policies through its Indo-Pacific Economic Forum, an economic strategy announced last year aimed at countering Beijing’s commercial strength in the region.

The strategy, known by the acronym IPEF, was designed to foster trade and demonstrate American commitment to the region, after then-President Donald Trump announced in 2017 that the U.S. was withdrawing from the Trans-Pacific Partnership, or TPP, an Obama-era trade deal with 12 countries.

“The U.S. is really aiming to use APEC as a way to demonstrate its lasting economic commitment to the region overall,” said Neils Graham, associate director for the Atlantic Council GeoEconomics Center.

Much of the APEC’s membership is “tepid, at best” on IPEF, said Joshua Kurlantzick, a senior fellow for Southeast Asia at the Council on Foreign Relations. While TPP fell apart under Trump, the region has seen major trade deals sealed in recent years involving China, Japan, South Korea and other major regional economies. APEC members have some interest in aspects of IPEF, such as efforts aimed at bolstering supply chain resilience and the clean energy economy, but want to see Biden create further access to U.S. markets.

Biden during his presidency has declined to pursue new comprehensive free-trade agreements with other countries. Administration officials quietly argue that while such pacts promote global commerce they are viewed suspiciously by Americans and some in Congress as a vehicle for sending factory jobs overseas.

Biden on Monday welcomed Indonesian President Joko Widodo, a fellow APEC leader, to the White House for talks before both travel to San Francisco. The Oval Office visit came at a somewhat awkward moment as Widodo, the leader of the world’s most populous Muslim country, has been fiercely critical of Israel’s operations in the Gaza Strip.

Biden, meanwhile, has been unapologetic in standing staunchly by Israel and backing its right to defend itself following the Oct. 7 attacks by Hamas militants that left 1,200 dead. Israel’s retaliatory operations in Gaza have killed more than 11,000, sparking outrage from a slew of world leaders. The Indonesian president, in a speech at Georgetown University on Monday, lamented that “human life seems meaningless” as Israel prosecutes its operations.

Their differences on the Israel-Hamas war notwithstanding, Biden made clear during his sit-down with Widodo that he’s looking to improve ties with the Southeast Asian power on combating the climate crisis and other issues.

The White House effort to herd APEC members to sign on to a summit-concluding joint declaration, a fixture at most international summits, could be complicated by diverging views among members on the Israel-Hamas and Ukraine wars.

“We’re certainly working for having a strong consensus statement in APEC, for the leaders to be able to release at the end of the week,” said Ambassador Matt Murray, the senior U.S. official for APEC.

Among close allies expected to be in San Francisco are Japanese Prime Minister Fumio Kishida, South Korean President Yoon Suk Yeol and Philippine President Ferdinand Marcos, Jr.

Historically frosty relations between South Korea and Japan have rapidly thawed over the last year as they share concerns about China’s assertiveness in the Pacific and North Korea’s persistent nuclear threats.

Biden is expected to remind Xi about the U.S. commitment to the Philippines, following a recent episode in which Chinese ships blocked and collided with two Philippine vessels off a contested shoal in the South China Sea, according to a senior administration who spoke on the condition of anonymity to preview some of Biden’s agenda.

The Philippines and other neighbors of China are resisting Beijing’s sweeping territorial claims over virtually the entire sea.

Biden enters the Xi meeting feeling buoyed by the U.S. economy’s strong performance. While the majority of U.S. adults believe the economy is weak, Biden has managed to prove wrong a large swath of economists who predicted that millions of layoffs and a recession might be needed to bring down inflation. The Labor Department said Tuesday that consumer prices rose at an annual pace of 3.2% annually, down from a June 2022 peak of 9.1%. Meanwhile, employers keep hiring and the unemployment rate has held below 4% for nearly two years.

Biden also noted that China is “in trouble right now economically.”

Beijing released economic data last month that shows prices falling due to slack demand from consumers and businesses. The International Monetary Fund recently cut growth forecasts for China, predicting economic growth of 5% this year and 4.2% in 2024, down slightly from its forecasts in July.

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Long reported from Washington. Associated Press writers Josh Boak, Chris Megerian, Darlene Superville and Zeke Miller in Washington contributed to this report.

KHAN YOUNIS, Gaza Strip (AP) — Battles between Israel and Hamas around hospitals forced thousands of Palestinians to flee from some of the last perceived safe places in northern Gaza, stranding critically wounded patients, newborns and their caregivers with dwindling supplies and no electricity, health officials said Monday.

The Israeli military has urged Palestinians to flee south on foot through what it calls safe corridors. But its stated goal of separating civilians from Hamas terrorists has come at a heavy cost: More than two-thirds of Gaza’s 2.3 million people have fled their homes. Hamas has been designated as a terrorist organization by the United States, Canada and the European Union.

Thousands fled Gaza’s Shifa Hospital over the weekend as Israeli troops encircled it, and doctors said gunfire and explosions raged all around it Monday. Israeli troops appear to be only a few blocks away from the facility.

Hundreds of patients and displaced people remain in the hospital, officials say. Shifa “is not functioning as a hospital anymore,” World Health Organization Director-General Tedros Adhanom Ghebreyesus said.

U.S. President Joe Biden said Monday that Shifa “must be protected.”

“It is my hope and expectation that there will be less intrusive action,” Biden said in the Oval Office.

After power went out for Shifa’s incubators days ago, the Health Ministry in Hamas-ruled Gaza released a photo on Monday it says shows about a dozen premature babies wrapped in blankets together on a bed to keep them at a proper temperature. Otherwise, “they immediately die,” said the health ministry’s director general, Medhat Abbas, who added that four of the babies had been delivered by cesarean section after their mothers died.

The Red Cross was attempting Monday to evacuate some 6,000 patients, staff and displaced people from a second hospital, Al-Quds, after it shut down for lack of fuel, but it said its convoy had to turn back because of shelling and fighting.

Both sides have seized on the plight of hospitals, particularly Shifa’s, as a symbol of the larger war, now in its sixth week. The fighting was triggered by Hamas’ Oct. 7 surprise attack into Israel, whose response has led to thousands of deaths — and much destruction — across Gaza.

For Palestinians, Shifa evokes the suffering of civilians. For weeks, staff running low on supplies have performed surgery there on war-wounded patients, including children, without anesthesia. Up until days ago, tens of thousands of people driven from their homes by airstrikes lived in and around the complex, hoping it would be safe.

Israel says Hamas shields itself among civilians, and that the hospital, Gaza’s largest, is a prime example. It says Hamas has a command center in and beneath the medical compound and released maps showing where it says they are located in the complex. But it has provided little evidence.

Both Hamas and Shifa hospital staff deny the Israeli allegations.

The Palestinians accuse Israel of firing recklessly toward hospitals, while Israel accuses Hamas of using the hospitals for cover. On Monday, Israel released a video showing what it said was a militant with an RPG launcher entering Al-Quds hospital. An Israeli tank was stationed nearby.

Israeli officials recently released photos and footage showing what they described as gunmen firing from inside another hospital and the opening of tunnel next to it, though staff said it was the entrance to the facility’s underground fuel tank. They also have shared footage of militants operating in residential neighborhoods and positioning rockets and weapons near schools, hospitals and mosques.

International law gives hospitals special protections during war. But hospitals can lose those protections if combatants use them to hide fighters or store weapons, according to the International Committee of the Red Cross.

Still, there must be plenty of warning to allow evacuation of staff and patients, and if harm to civilians from an attack is disproportionate to the military objective, it is illegal under international law. In an editorial published Friday in Britain’s The Guardian newspaper, International Criminal Court prosecutor Karim Khan said the attacker must meet a high burden of proof to show that a hospital has lost its protections.

After the exodus of people from Shifa over the weekend, about 650 patients and 500 staff remain in the hospital, along with around 2,500 displaced Palestinians sheltering inside the complex, said Mohammed Zaqout, the director of hospitals in Gaza.

The Health Ministry said 32 patients, including three babies, have died since Shifa’s emergency generator ran out of fuel Saturday. It said 36 babies, as well as other patients, are at risk of dying because life-saving equipment can’t function.

Goudat Samy al-Madhoun, a healthcare worker, said he was among around 50 patients, staff and displaced people who made it out of Shifa and to the south Monday, including a woman who had been receiving kidney dialysis. He said those remaining in the hospital were mainly eating dates.

Al-Madhoun said Israeli forces fired on the group several times, wounding one man who had to be left behind. The dialysis pateint’s son was detained at an Israeli checkpoint on the road south, he said.

The military said it placed 300 liters (79 gallons) of fuel several blocks from Shifa, but Hamas prevented staff from reaching it. The Health Ministry disputed that, saying Israel refused its request that the Red Crescent bring them the fuel rather than staff venturing out for it. The fuel would have provided less than an hour of electricity, it said.

The U.S. has pushed for temporary pauses to allow wider distribution of badly needed aid. Israel has agreed only to daily windows during which civilians can flee northern Gaza along two main roads. It continues to strike what it says are militant targets across the territory, often killing women and children.

Tens of thousands of people remain in the north.

Saib Abu Hashish said he has been trapped in his family home along with 27 others in Gaza City. They haven’t left the house in three days, he said, and are running out of food and water. He said their neighbors attempted to flee but Israeli forces fired on them.

“We want to leave but we can’t because of the bombing,” he said by phone. “If we survive the bombing, we will die from hunger.”

Those who make it south face a host of other difficulties. U.N.-run shelters are overflowing, and the lack of fuel has paralyzed water treatment systems, leaving taps dry and sending sewage into the streets. Israel has barred the import of fuel for generators.

As of last Friday, more than 11,000 Palestinians, two-thirds of them women and minors, have been killed since the war began, according to the Health Ministry in Gaza, which does not differentiate between civilian and militant deaths. About 2,700 people have been reported missing.

Health officials have not updated the toll, citing the difficulty of collecting information.

At least 1,200 people have died on the Israeli side, mostly civilians killed in the initial Hamas attack. Palestinian militants are holding nearly 240 hostages seized in the raid, including men, women, children and older adults. The military says 44 soldiers have been killed in ground operations in Gaza.

About 250,000 Israelis have evacuated from communities near Gaza, where Palestinian militants still fire barrages of rockets, and along the northern border, where Israel and Lebanon’s Hezbollah militant group repeatedly trade fire, including on Monday.

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This story has been corrected to show that the Israeli military says 44, not 48, soldiers have been killed in ground operations in Gaza.

Jeffery reported from Cairo. Associated Press writers Amy Teibel in Jerusalem, Samy Magdy in Cairo and Bassem Mroue in Beirut contributed to this report.

Full AP coverage at https://apnews.com/hub/israel-hamas-war.

WASHINGTON (AP) — In the early days and hours after the horrific Hamas attack on Israeli civilians on Oct. 7, President Joe Biden spoke with stark declarations and unqualified support for the longtime U.S. ally.

Now, a month on, that unambiguous backing has given way to the complexities and haunting casualties of the war, and the Biden administration is imploring Israel to rein in some of its tactics to ease civilian suffering in Gaza.

As condemnation of the conflict has grown around the world, stoking anti-Israel sentiment, the Democratic president is also confronting the limits of the U.S. ability to direct the outcome — not only about the war, but what comes after it.

“There’s no going back to the status quo as it stood on October the 6th,” Biden said three weeks after the attack. But even if Israel is successful in crippling or eradicating Hamas, there will also need to be a shift in Washington, where successive U.S. administrations have sought to manage the Middle East conflict and where the political will has been lacking to devise ways to end it. Hamas has been designated as a terrorist organization by the United States, Canada and the European Union.

And yet the path forward is uncertain, at best. “It’s entirely unclear if there is a ‘morning after,’” said Shibley Telhami, the Anwar Sadat Professor for Peace and Development at the University of Maryland. He noted this could be “an extended period of violence at a different scale for many, many months or years to come.”

“But if there is something possible, they can’t just put a plan on the table,“ he added. “They have to take new American positions of their own, that are transformative, that are different, that are like something we have not seen.”

Telhami said after his staunch support for Israel, the president would need to take equally dramatic steps to secure buy-in from Palestinians to bring about a political resolution to the conflict, starting with reining in Israeli settlements in the West Bank that Palestinians view as infringing on their future state.

In recent weeks, U.S. officials have held internal discussions and talks with allies on post-Hamas governance in Gaza, and resurrected talk of working toward a two state solution, with, as Biden expressed Sunday to Qatar’s emir, Sheikh Tamim bin Hamad Al Thani, a “future Palestinian state where Israelis and Palestinians can live side by side with equal measures of stability and dignity.”

Yet there has been little progress on how to get there, and some in the Biden administration have grown increasingly worried that the mounting death toll in Gaza will make that aim even more difficult.

U.S. Secretary of State Antony Blinken, who last week appeared to criticize Israel for not doing enough to minimize harm to civilians among whom Israel says Hamas seeks shelter, has called for a return to unified Palestinian governance over the West Bank and Gaza under the beleaguered Palestinian Authority. The internationally recognized group lost control over Gaza to Hamas in 2007, and is viewed skeptically among its own populace for perceived cooperation with Israel.

Jake Sullivan, Biden’s national security adviser, on Sunday went further, laying out a vision of what the U.S. sees as a path forward, but one that still has no buy-in from key players in the region.

In an interview on CBS’ “Face the Nation,” Sullivan said that “the basic principles of the way forward are straightforward.” That path, he said, included “no reoccupation of Gaza, no forcible displacement of the Palestinian people. Gaza can never be used as a base for terrorism in the future and Gaza’s territory should not be reduced.”

The Palestinian Authority has openly dismissed that notion. “We are not going to go to Gaza on an Israeli military tank,” Prime Minister Mohammad Shtayyeh told PBS recently.

“The Palestinian Authority is saying it doesn’t want to take on the task that the Biden administration is pushing unless it gets some kind of real commitment to a major diplomatic initiative leading to a two-state outcome,” said Nathan Brown, professor of political science and international affairs at George Washington University.

Within the Democratic Party, there are also clear signs of discord. Nearly half of Democrats disapprove of how President Joe Biden is handling the Israel-Hamas conflict, according to a new poll from The Associated Press-NORC Center for Public Affairs Research — showing a deep divide within his party over the war.

In Congress, so far there is no consensus about Biden’s proposal to pass an aid package that includes assistance to Israel, Ukraine and Taiwan, and additional money to address issues at the southern border of the U.S.

There are also emerging signs of division between the U.S. and Israeli positions on the war’s endgame, with Prime Minister Benjamin Netanyahu insisting that Israel will retain security control over Gaza for the long term, a stance the White House has rejected, and ruling out alternatives like an international monitoring force.

“The only force right now that can guarantee that Hamas, that terrorism is not – does not reappear and take over Gaza, again, is the Israeli military,” Netanyahu told NBC’s “Meet the Press.” “So overall, military responsibility will have to be in Israel.”

And in an interview with CNN’s “State of the Union,” Netanyahu appeared to rule out returning Gaza to the Palestinian Authority, saying whatever group takes over must “demilitarize” and “de-radicalize Gaza.”

“There has to be a reconstructed civilian authority,” he said of the Palestinian Authority. “There has to be something else.”

More than 1,200 Israelis, mostly civilians, were killed when Hamas fighters launched a surprise attack on Israeli border communities, in the deadliest day for Jews since the Holocaust. Nearly 240 — including children and the elderly — remain captive in Gaza, Israeli officials say. Israel’s war to “destroy” Hamas in Gaza has killed more than 11,000 people, the Health Ministry in Hamas-run Gaza says, though it doesn’t differentiate between civilians and fighters. The U.S. believes thousands of women and children are among the dead.

Until Hamas’ attack, Biden’s administration had largely relegated the region on the back burner, as it focused first on a pivot to Asia then on responding to Russia’s invasion of Ukraine. Now, Biden faces a challenge that has splintered his political support at home and the unity of U.S. allies abroad.

“Clearly, Israel has the military ability to take out Hamas,” said Senate Intelligence committee chairman Sen. Mark Warner, D-Va., on “Fox News Sunday.” “But this is also a battle about hearts and minds — hearts and minds in terms of maintaining support for Israel in this country, in the world and in the region.”