NUSEIRAT REFUGEE CAMP, Gaza Strip — The United Nations relief agency for Palestinian refugees in the Gaza Strip says Israeli airstrikes hit a school that was sheltering families in central Gaza, killing six of its employees.

The U.N. agency, UNRWA, says this is the fifth time the al-Jaouni school has been hit since the start of the war. It says that some 12,000 people — mostly women and children — are taking shelter there and the manager of the UNWRA team helping people was killed in Wednesday’s strike.

First responders say 18 people died in the attack that caused the roof of a shelter to cave in. Families were left scrambling to find their loved ones amid the wreckage.

“No one is safe in Gaza,” the agency said in a statement. “No one is spared.”

António Guterres, the U.N. Secretary General, called the strikes “dramatic violations of international humanitarian law.”

“What’s happening in Gaza is totally unacceptable,” he wrote on X, formerly Twitter.

The Israeli military said Hamas was using the school as a “command and control center.”

Palestinians mourn after the Israeli strike at Nuseirat Refugee Camp on Wednesday.

Moez Salhi/Anadolu via Getty Images

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Moez Salhi/Anadolu via Getty Images

Israel’s ambassador to the United Nations, Danny Danon, responded to Guterres’ criticism by writing on X: “It is unconscionable that the UN continues to condemn Israel in its just war against terrorists, while Hamas continues to use women and children as human shields.”

UNWRA called on all parties in the conflict to “never use schools or the areas around them for military or fighting purposes” and said that “schools and other civilian infrastructure must be protected at all times.”

Sixteen people were reported killed in a previous Israeli attack on several structures in the Al-Jaouni school compound in July, which Israel said was being used by Hamas fighters.

UNRWA says Wednesday’s attack caused the highest number of staff killed in a single incident. At least 220 agency staff have lost their lives since the war began. Philippe Lazzarini, the UNRWA Commissioner-General, said humanitarian staff are being “disregarded” in the Gaza war.

“The longer impunity prevails, the more international humanitarian law and the Geneva conventions will become irrelevant,” he wrote on social media.

Gaza’s Health Ministry says more than 41,000 Palestinians have been killed and 95,125 injured in Israel’s military offensive on Gaza since Oct. 7, the day that Hamas-led militants attacked Israel, killing 1,200 people and taking 250 hostages.

Millions of Gaza residents have been displaced in the war, many of them multiple times. The population is blighted by hunger and the spread of disease.

Rubble is strewn inside the school.

Anas Baba for NPR

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Anas Baba for NPR

The World Health Organization said on Wednesday it carried out its largest medical evacuation from Gaza since the start of the war, taking 97 sick and severely injured patients and 155 companions to the United Arab Emirates for treatment. The patients were 45 children and 52 adults with a wide range of conditions, including cancer and other diseases and injuries from the conflict.

Tedros Adhanom Ghebreyesus, WHO’s director-general, said the evacuation was a “highly complex operation” that was “completed under immense time pressure to bring all patients together.”

A WHO report published Thursday found that some 22,500 people — about a quarter of those wounded in the war in Gaza — have injuries that will require rehabilitation now and for years to come. According to the report, some 3,105 and 4,050 limbs have been amputated as a result of the conflict. Many, including thousands of women and children, suffer from injured spinal cords, traumatic brain injuries or major burns.

“The huge surge in rehabilitation needs occurs in parallel with the ongoing decimation of the health system,” said Dr. Richard Peeperkorn, a WHO representative for the West Bank and Gaza. “Patients can’t get the care they need. Acute rehabilitation services are severely disrupted and specialized care for complex injuries is not available, placing patients’ lives at risk. Immediate and long-term support is urgently needed to address the enormous rehabilitation needs.” 

Gaza’s only limb reconstruction and rehabilitation center, supported by WHO, stopped functioning in December 2023 because of lack of supplies, and because specialized health workers were themselves being forced to leave the area in search of safety. The report says 39 physiotherapists have been killed.

The WHO says its latest report highlights how vast the unmet medical needs are in Gaza today.

NPR’s Ruth Sherlock reported from Rome. Anas Baba reported from Nuseirat Refugee Camp in the Gaza Strip. Hadeel Al-Shalchi contributed reporting from Tel Aviv.