Israeli air strikes in Gaza martyred at least 300 people, Palestinian health authorities said, as attacks hit dozens of targets early on Tuesday, ending a weeks-long standoff over extending the ceasefire that halted fighting in January.

Strikes were reported in multiple locations, including northern Gaza, Gaza City and the Deir al-Balah, Khan Younis and Rafah in central and southern Gaza Strip. Palestinian health ministry officials said many of the martyred were children.

The Israeli military, which said it hit dozens of targets, said the strikes would continue for as long as necessary and would extend beyond air strikes, raising the prospect that Israeli ground troops could resume fighting.

The Israeli strikes in Gaza were far wider in scale than the regular series of drone strikes the military has said it has conducted against individuals or small groups and follows weeks of failed efforts to agree an extension to the truce agreed on January 19.

In hospitals strained by 15 months of bombardment, piles of bodies in white plastic sheets smeared with blood could be seen stacked up as casualties were brought in.

The Palestinian Red Crescent said its teams dealt with 86 killed and 134 wounded, but others were brought to overwhelmed hospitals by private cars.

Officials from Nasser Hospital in Khan Yunis, Al-Aqsa Hospital in the central Gaza Strip and Al-Ahly Hospital in Gaza City, which have all been extensively damaged in the war, said that altogether they had received around 85 dead. Authorities also reported separately that 16 members of one family in Rafah, in southern Gaza had been killed.

A spokesperson for the Gaza health ministry said the death toll was at least 300.

Hamas said Israel had overturned the ceasefire agreement, leaving the fate of 59 hostages still held in Gaza uncertain.

Israeli Prime Minister Benjamin Netanyahu’s office accused Hamas of “repeated refusal to release our hostages” and rejecting proposals from U.S. President Donald Trump’s Mideast envoy Steve Witkoff.

“Israel will, from now on, act against Hamas with increasing military strength,” it said in a statement.

In Washington, a White House spokesperson said Israel had consulted the U.S. administration before it carried out the strikes, which the military said targeted mid-level Hamas commanders and leadership officials as well as infrastructure belonging to the Palestinian group.

“Hamas could have released hostages to extend the ceasefire but instead chose refusal and war,” White House spokesperson Brian Hughes said.

In Gaza, witnesses contacted by Reuters said Israeli tanks shelled areas in Rafah in the southern Gaza Strip, forcing many families who had returned to their areas after the ceasefire began to leave their homes and head northward to Khan Younis.