Vast bomb craters and rubble-filled moonscapes, buildings turned to concrete skeletons, hoarse shouts of grief and rage: The thunderous Israeli airstrikes that hit the Gaza Strip’s biggest refugee camp on Tuesday, killing or wounding hundreds, signaled a perilous new phase of Israel’s war with Hamas.

The airborne assault on Jabaliya refugee camp appeared to be among the deadliest localized bombardments since the war began Oct. 7 with devastating Hamas attacks inside Israel. Over the last five days, intensifying ground confrontations have taken hold as well, both sides said, spreading into Hamas’ formidable network of subterranean passageways.

“It was a waterfall of casualties,” Marwan Sultan, medical director of the nearby Indonesian Hospital, said of the Jabaliya strike. He described a desperate influx of wounded arriving by any available transport — cars, motorbikes, donkey carts.

Fueling a sense of confusion and panic, night swiftly fell over the scene of devastation, making the task of digging out victims even more dangerous and difficult.

“They’re using flashlights and anything else to save whoever they can,” Sultan said. He said most of the dead and injured were local people who lived in dilapidated buildings, including corrugated metal-roofed shacks that offered scant protection against the powerful blasts.

Videos on social media showed people scrabbling amid burnt-out buildings, digging frantically to try to find survivors. A young man screams over the body of a relative as people try to pull him away. Residents strain to prise up concrete rubble with bare hands.

The deadly raid in the crowded camp, home to more than 110,000 Palestinians before the war’s outbreak, threw into bloody new relief the impossibility of carrying out a full-scale assault on militant strongholds without harming and killing huge numbers of civilians in the process.

More than 8,500 people have been killed inside Gaza since the start of hostilities, according to the Hamas-run Gaza Health Ministry.

The Jabaliya strike also highlighted a dynamic that will undoubtedly continue throughout the war, for as long as it lasts: Israel trumpeting military progress while Hamas accuses it of causing unnecessary civilian carnage.

The Israeli military cast the bombing as targeting “terrorists and terror infrastructure” within the camp. It claimed to have killed a Hamas commander, Ibrahim Biari, whom it described as the head of the Central Jabaliya Battalion, and also said the raid killed a “large number” of fighters who were with him.

Overall, it said, the air raid successfully “damaged Hamas’ command and control” in the area. But a Hamas spokesman, Hazem Qassem, denied that any of the group’s commanders had even been in Jabaliya, accusing Israel of justifying “ugly crimes against civilians.”

The episode also underscored, not for the first time, the futility of Israel’s repeated calls for Gazans to abandon the coastal enclave’s densely populated north. Israeli officials say northern Gaza is Hamas’ heartland — its “center of gravity,” in the words of military spokesman Jonathan Conricus.

From the war’s earliest days, Israel’s army has told Gazans to flee south — but strikes have also hit Nusseirat, another crowded camp in southern Gaza.

As the humanitarian situation worsens daily, with food, water and fuel growing more and more difficult to find, many in the besieged enclave are refusing to leave their homes, saying there is nowhere safe to go.

In another recurring pattern, Hamas sought to magnify anger at Israel and its allies that is already reverberating through the region, saying Washington was also to blame for what it called a “massacre” in Jabaliya.

Fears of a wider regional war grew Tuesday, as Houthi rebels in the impoverished Horn of Africa country of Yemen said they had launched missiles and drones toward Israel. The Israeli military did not directly confirm the attack, but said it intercepted “aerial threats” from the Red Sea.

Israel’s military has been tight-lipped about the particulars of its deepening push into Gaza, which began Friday when Israeli troops and tanks for the first time began sustained operations inside the territory. It has acknowledged the deaths of two of its soldiers in the ground fighting.

The Palestinian interior ministry in Gaza, controlled by Hamas, said Israeli forces had reached as far as al-Karama, north of Gaza City. It also said Israeli forces were attempting to “separate” northern and southern Gaza.

The ground campaign has been slowed in part by fears for the 240 hostages Israel says are held by Hamas, seized when the militants surged through the Gaza fence on Oct. 7 and slaughtered more than a thousand civilians and hundreds of soldiers in a string of Israeli towns. It's also been slowed by the quiet urgings of U.S. officials.

White House and U.S. State Department officials declined to comment on the Jabaliya strike and on the speed with which it was roiling tensions across the Arab world.

Even before news of the attack spread, Secretary of State Antony J. Blinken and Defense Sect Lloyd J. Austin III testified before the Senate Appropriations Committee to make a push for billions of dollars in additional military aid for Israel as well as a small fraction of that for humanitarian aid to Palestinians.

Blinken said the U.S. continues to make it clear that Israel should take every step possible to avoid civilian casualties, saying it was not only a moral imperative but a strategic one as well, “for Israel’s security” and to prevent the war from spiraling out of control region wide.

But the Biden administration, along with Israel, continues to adamantly oppose a ceasefire.

As Blinken spoke, several dozen demonstrators in the chamber repeatedly interrupted, chanting “Ceasefire Now!” and “Palestinians are not animals!” They held aloft hands stained with red before being escorted one by one out of the room by Capitol police.

The administration says a ceasefire would only be used by Hamas to regroup and rearm.

“It’s a call for Israel to stop fire; I don’t think there’s anyone that actually expects that Hamas would agree to a cease-fire — a terrorist organization,” Matthew Miller, State Department spokesman, told reporters Tuesday.

So far, the ongoing fighting has not quelled Hamas’ ability to fire missiles at Israeli cities.

Hamas’ military wing, the Izzedine al Qassam Brigades, said on Telegram following the Jabaliya strike that it was hitting Tel Aviv, where sirens wailed and a series of loud booms were heard Tuesday night.

In an audio address issued later Tuesday, Qassam Brigades spokesman Abu Ubaida said Hamas was still in the beginning of its defensive operations, and vowed Gaza would be a "graveyard" for the enemies.

The Jabaliya strike also contributed to yet another volatile dynamic: spreading violence in the West Bank, where tensions and fatalities have spiked since the start of the war between Israel and Hamas.

Clashes erupted late Tuesday between Palestinian protesters and Israeli police in East Jerusalem, and hundreds demonstrated in the West Bank cities of Jenin and Ramallah.

Hamas' sometime rival Fatah called for a general strike Wednesday, dubbing it a "day of rage."

Israel has mounted a drive to root out Palestinian resistance groups, even as extremist Jewish settlers increase efforts to expand in territories Palestinians hope will be part of a future state.

More than 120 Palestinians in the West Bank have been killed since Oct. 7 and more than a thousand arrested, Palestinian officials say.

But spiraling violence has also undermined support within the West Bank for the Palestinian Authority, whose security coordination with Israel draws widespread scorn.

"If we had 10,000 martyrs and lose the West Bank, if Hamas endures we would still be happy," said Abu Ahmad, a 21-year-old fighter with the militant group Islamic Jihad in the northern West Bank town of Jenin.

"No matter how much we lose, we still rise."