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RAFAH, Gaza Strip (AP) — Israeli forces battled Palestinian militants in Gaza’s two largest cities on Monday, with civilians still trapped in the fighting even after hundreds of thousands have fled to other parts of the besieged territory.

Israel has pledged to keep fighting until it removes Hamas from power, dismantles its military capabilities and returns all of the hostages taken by militants during Hamas’ Oct. 7 surprise attack into Israel that ignited the war.

The U.S. has provided unwavering diplomatic and military support for the campaign, even as it has urged Israel to minimize civilian casualties and further mass displacement.

The war has killed thousands of Palestinian civilians and driven nearly 85% of the territory’s 2.3 million people from their homes.

Residents said there was heavy fighting in and around the southern city of Khan Younis, where Israeli ground forces opened a new line of attack last week, and battles were still underway in parts of Gaza City and the built-up Jabaliya refugee camp in northern Gaza, where large areas have been reduced to rubble.

Radwa Abu Frayeh saw heavy Israeli strikes around the European Hospital in Khan Younis, where the U.N. humanitarian office says tens of thousands of people have sought shelter. She said a strike hit a home close to hers late Sunday.

“The building shook,” she said. “We thought it was the end and we would die.”

Hussein al-Sayyed, who fled Gaza City earlier in the war with his three daughters, is staying in a three-story home in the city with around 70 others, and said they have been rationing food for days.

“Over many days, I have eaten just one meal a day to save food for the girls. They are still young,” he said. “I don’t know where to go. No place is safe.”

Hamas is believed to have suffered heavy losses, but on Monday it fired a barrage of rockets that set off sirens in Tel Aviv. One person was lightly wounded, according to the Magen David Adom rescue service, and Channel 12 broadcast footage of a cratered road and damage to cars and buildings in a suburb.

FEARS OF PERMANENT DISPLACEMENT

With very little aid allowed into Gaza, Palestinians face severe shortages of food, water and other basic goods. Some openly worry that Palestinians will be forced out of the territory altogether in a repeat of the mass exodus from what is now Israel during the 1948 war surrounding its creation.

“Expect public order to completely break down soon, and an even worse situation could unfold including epidemic diseases and increased pressure for mass displacement into Egypt,” U.N. Secretary-General Antonio Guterres told a forum in Qatar on Sunday.

Eylon Levy, an Israeli government spokesman, called allegations that Israeli intends to drive people en masse from Gaza “outrageous and false.” But other Israeli officials have discussed such a scenario, raising alarm in Egypt and other Arab countries that refuse to accept any refugees.

At the same time, it’s not clear when or if Palestinians would be allowed to return to Gaza City and much of the north — home to some 1.2 million before the war — where entire neighborhoods have been flattened.

Palestinians in Lebanon and the Israeli-occupied West Bank observed a general strike on Monday called by activists to demand a cease-fire, after the U.S. vetoed a United Nations Security Council resolution calling for one on Friday. A similar, nonbinding vote is planned in the General Assembly on Tuesday.

HARSH CONDITIONS IN THE SOUTH

Israel says it tries to avoid harming civilians and blames their deaths on Hamas, saying it endangers residents by fighting in dense areas and positioning military infrastructure — including weapons, tunnels and rocket launchers — in or near civilian buildings.

The military said five soldiers were killed in a battle in southern Gaza on Sunday, after militants fired at them from a school and set off an explosive device. It said the troops, backed by aircraft and tanks, returned fire and killed the militants.

Forces operating in Jabaliya found a truck full of long-range rockets near a school, and a rifle, two rocket-propelled grenade launchers and explosives in a home, the army said.

Israel has urged people to flee to what it says are safe areas in the south — and the fighting in and around Khan Younis has pushed tens of thousands toward the town of Rafah and other areas along the border with Egypt. But Israel has continued to strike alleged militant targets throughout the territory. Associated Press reporters saw nine bodies brought to a local hospital on Monday after an airstrike hit a home in Rafah overnight.

The aid group Doctors Without Borders said people in the south are also falling ill as they pack into crowded shelters or sleep in tents in open areas.

Nicholas Papachrysostomou, MSF emergency coordinator in Gaza, said “every other patient” at a clinic in Rafah has a respiratory infection after prolonged exposure to cold and rain.

“In some shelters, 600 people share a single toilet. We are already seeing many cases of diarrhea. Often children are the worst affected,” he said.

With the war in its third month, the Palestinian death toll in Gaza has surpassed 17,900, the majority women and children, according to the Health Ministry in the Hamas-controlled territory. The ministry does not differentiate between civilian and combatant deaths.

Some 1,300 people have died on the Israeli side, mostly civilians killed during the Oct. 7 attack, in which Hamas and other militants also captured more than 240 people, including babies, women and older adults. More than 100 captives were released during a weeklong cease-fire late last month in exchanges for women and minors held in Israeli prisons.

Israel says Hamas still has 117 hostages and the remains of 20 people who died in captivity or during the initial attack. The Israeli toll includes 104 soldiers who have died since the start of the Gaza ground offensive in late October.

Magdy reported from Cairo. Associated Press writer Tia Goldenberg in Tel Aviv, Israel, contributed.