Israeli airstrikes and gunfire across Gaza killed at least 38 people on Saturday, including women and children, health officials said, as global pressure mounts for a ceasefire while Israel’s leadership remains defiant about continuing its military campaign.

The attacks, which struck central and northern Gaza in the early hours, claimed the lives of families in their homes.

Nine members of a single family were killed in a house in the Nuseirat refugee camp, according to staff at Al-Awda Hospital where the victims were brought.

In Gaza City’s Tufah neighborhood, at least 11 people, more than half of them women and children, died when their house was destroyed by an airstrike, Al-Ahly Hospital officials reported. Four others were killed in the Shati refugee camp when another residential building was hit, according to Shifa Hospital.

Six more Palestinians were killed by Israeli gunfire while seeking aid in southern and central Gaza, local hospitals including Nasser and Al-Awda confirmed. The Israeli army did not immediately comment on the strikes or the shootings.

The violence follows remarks by Israeli Prime Minister Benjamin Netanyahu at the U.N. General Assembly on Friday, where he insisted that Israel “must finish the job” against Hamas in Gaza. His speech, aimed both at a divided domestic audience and the international community, prompted dozens of delegates to walk out of the assembly hall in protest.

International pressure for an end to hostilities is rising, alongside growing diplomatic isolation for Israel. A number of countries have recently recognized Palestinian statehood, a move rejected by Israel.

Gaza’s health system is on the brink of collapse, nearly two weeks into Israel’s offensive. Two clinics have been destroyed, two hospitals have shut down after damage, and remaining facilities are struggling with shortages of medicine, food, fuel, and equipment. Many patients and staff have been forced to flee, leaving only a few doctors and nurses to care for critically ill patients and children in incubators.

Aid group Doctors Without Borders suspended operations in Gaza City on Friday due to the intensified Israeli offensive, citing tanks positioned less than half a mile from its facilities and an “unacceptable level of risk” for staff.

The humanitarian situation has worsened in northern Gaza, where Israel has halted aid deliveries through its crossing since September 12 and increasingly rejected U.N. requests to transfer supplies from the south, the U.N. Office for the Coordination of Humanitarian Affairs said.

According to the Gaza Health Ministry, Israel’s campaign has so far killed more than 65,000 people and wounded over 167,000, including civilians.

The ministry reports that women and children account for roughly half of the fatalities. While part of the Hamas-run administration, its data is widely used by U.N. agencies and independent experts as a reliable estimate of casualties.

The current offensive follows a Hamas-led assault into Israel on October 7, 2023, which killed approximately 1,200 people and left 251 hostages. Forty-eight captives remain in Gaza, with Israel believing around 20 are still alive, after most others were released through ceasefires or negotiated deals.

The latest wave of violence underscores the ongoing humanitarian crisis in Gaza, even as international actors call for restraint and urgent measures to protect civilians amid the prolonged conflict.