The World Court on Thursday unanimously ordered Israel, accused by South Africa of genocide in Gaza, to take all necessary and effective action to ensure basic food supplies to the enclave’s Palestinian population and halt spreading famine.

But Gaza’s Hamas rulers said a ceasefire was needed to halt the humanitarian crisis.

The order from the International Court of Justice came as Israeli forces and Palestinian fighters battled in close combat around Gaza’s Al Shifa Hospital, where the armed wings of Hamas and Islamic Jihad said they attacked Israeli soldiers and tanks with rockets and mortar fire.

Judges at the court said the people in the coastal enclave face worsening conditions.

“The court observes that Palestinians in Gaza are no longer facing only a risk of famine (...) but that famine is setting in,” the judges said in their order.

The new measures were requested by South Africa as part of its case that accuses Israel of state-led genocide in Gaza.

Senior Hamas official Basem Naim said the ruling did not go far enough and Israel must be ordered to end its military offensive to halt the suffering.

“We welcome any new demands to end this humanitarian tragedy in Gaza and especially in the northern Gaza Strip, but we hoped the court ordered a ceasefire as an absolute solution to all the miseries our people in Gaza are living through,” Naim told Reuters.

The U.N. Security Council voted on Tuesday to demand an immediate ceasefire and the immediate and unconditional release of all hostages. The United States abstained from, but did not veto, the vote.

There was no immediate comment from Israel’s Foreign Ministry on the World Court ruling. Israel has said it is making efforts to expand access for humanitarian groups to Gaza overland, through air drops and by ship.

Israeli leaders have said Hamas can end the war by surrendering, freeing all hostages it holds in Gaza and handing over for trial those involved in the Oct. 7 attack.

The Israeli army said it continued to operate around the Al Shifa Hospital complex in Gaza City after storming it more than a week ago. Its forces had killed around 200 gunmen since the start of the operation “while preventing harm to civilians, patients, medical teams, and medical equipment”, it said.

In a televised statement, chief Israeli military spokesperson Rear Admiral Daniel Hagari said troops operating at the hospital killed Raed Thabet, a Hamas quartermaster whom he described as one of the group’s 10 most senior members.

Shortages of food, water and medicine

Gaza’s health ministry said wounded people and patients were being held inside an administration building in Al Shifa that was not equipped to provide them with healthcare. Five patients had died since the Israeli raid began due to shortages of food, water and medical care, the Hamas-run ministry said.

Ismail Al-Thawabta, the director of the Gaza Hamas-run government media office, said the Israeli army was carrying out “field killings and executions against hundreds of civilians”, when asked about the army statement.

“Everyone inside the Shifa complex are civilians, and there are no military personnel inside the compound,” he told Reuters.

Al Shifa, the Gaza Strip’s biggest hospital before the war, had been one of the few healthcare facilities even partially operational in north Gaza before the latest fighting. It had also been housing displaced civilians.

Unverified footage on social media showed its surgery unit blackened by flames and nearby apartments on fire or destroyed.

The armed wings of the Hamas and Islamic Jihad militant groups said in a statement they “bombed, with a barrage of mortar shells, gatherings of Israeli soldiers in the vicinity of the Al-Shifa Complex” in a joint operation.

Israel says it is targeting Hamas militants who use civilian buildings, including apartment blocks and hospitals, for cover. Hamas denies doing so.

At least 32,552 Palestinians have been killed and 74,980 wounded in Israel’s military offensive in the Gaza Strip since Oct. 7, the territory’s health ministry said on Thursday.

Thousands more dead are believed to be buried under rubble and more than 80% of Gaza’s 2.3 million population is displaced, many at risk of famine.

The war erupted after Hamas militants broke through the border and rampaged through communities in southern Israel, killing 1,200 people and abducting 253 hostages according to Israeli tallies.

Two more hospitals besieged

In Rafah, where more than a million people have been sheltering, health officials said an Israeli airstrike on a house killed at least 12 people.

Israel says it plans a ground offensive into Rafah, in the far south of the enclave, where it believes most Hamas fighters are now sheltering. Its closest ally and main arms supplier the United States opposes such an assault, arguing it would cause too much harm to civilians who have sought refuge there.

Israeli forces also continued to blockade Al-Amal and Nasser hospitals in Khan Younis, in southern Gaza, while several other areas came under Israeli fire, residents said.

The Palestinian Red Crescent said seven people working for the organisation arrested in a raid on Al-Amal hospital on Feb. 9 had been released after 47 days in Israeli prisons.

Among them was the director of ambulance and emergency services in the Gaza Strip, Mohammed Abu Musabeh. Eight members of the association were still being detained, it said in a statement.

Israel said soldiers from its Commando Brigade had arrested dozens of Palestinian militants in the Al-Amal area and discovered explosives and dozens of Kalashnikov-type weapons.

The World Health Organization said Al-Amal Hospital had ceased to function due to fighting, leaving just 10 of 36 hospitals in the Gaza Strip partially operational.