In the latest violence to undermine the ceasefire in Gaza, health officials said Israeli tank shelling and airstrikes killed 20 Palestinians, including four children, on Wednesday.

Among the dead was a medic who rushed to help victims of a strike in the southern city of Khan Younis and was then killed by a second attack on the same location, health officials said.

Other strikes hit Gaza City in the north, where health officials said a five-month-old boy was killed. The attacks come three days after Israel reopened Gaza’s main border crossing with Egypt, a major step in the US-backed truce.

The Israeli military claimed it had launched the strikes in response to gunmen opening fire against Israeli troops operating near its armistice line with Hamas. It said an Israeli soldier was severely injured by the fire.

Wednesday’s attacks bring the number of Palestinians killed since the border reopened to 28, according to a tally from Gazan health officials.

On Saturday, before its reopening, Israeli strikes killed more than 30 Palestinians in Gaza. The military said it launched those strikes after gunmen emerged from a tunnel in a Gaza area under Israeli control.

Patient crossings at Rafah halted

Palestinian patients preparing to cross through the newly opened Rafah border crossing to Egypt were told that Israel had postponed the passage of patients through the border.

A few hours later, the patients were told to prepare again to cross the border.

A spokesperson for the Red Crescent said patients had arrived at a hospital in Khan Younis in preparation for crossing Rafah for treatment, only to be informed that Israel had postponed the evacuations.

“They called the patients and said today there is no travel at all, the crossing is closed,” Raja’a Abu Teir, a Palestinian patient who was set to be evacuated, told Reuters at the hospital, where several patients were waiting in ambulances.

An Egyptian security source told Reuters that efforts were being made to reopen the crossing, and that Israel had cited security issues in the Rafah area as the reason for the closure.

The Israeli agency that controls access to Gaza, COGAT, claimed in a statement on Wednesday that Rafah crossing remained open, adding that it had not received the necessary coordination details from the World Health Organisation (WHO) to facilitate the crossing.

The WHO did not immediately respond to a Reuters request for comment.

Reopening the crossing was one of the requirements under the October ceasefire that set out the first phase of United States President Donald Trump’s plan to stop fighting between Israel and Hamas.

Sixteen patients from Gaza and 40 of their escorts crossed into Egypt on Tuesday, Gazan medics told Reuters.

A Hamas police source told Reuters that at least 40 people crossed from Egypt to Gaza late on Tuesday.

In January, Trump declared the start of the second phase of the ceasefire, where the sides would negotiate the shattered enclave’s future governance and reconstruction.

Key issues like the withdrawal of Israeli forces from over 50 per cent of Gaza, which they currently occupy, and the disarmament of Hamas remain unresolved, while the fragile ceasefire has been marked by near-daily violence.

Since the start of the ceasefire, Israeli fire has killed at least 530 people, most of them civilians, according to Gaza health officials. Palestinian fighters have killed four Israeli soldiers in the same period, according to Israeli authorities.

Israel’s two-year relentless onslaught on the Gaza Strip killed more than 71,000 Palestinians, according to Gazan health authorities, displaced most of its population, and left much of the strip in ruins.

Israel faced tremendous international criticism over the resulting humanitarian crisis in Gaza, with Amnesty International, Human Rights Watch and experts declaring its actions in Gaza as a “genocide”, which Tel Aviv rejects.

The Oct 7, 2023 Hamas attack that triggered the offensive killed around 1,200 in Israel, according to Israeli tallies.