Israeli air strikes in Gaza killed at least 200 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.

The Palestinian militant group Hamas issued a statement accusing Israel of breaching the ceasefire.

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 dead 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 attacks were far wider in scale than the regular series of drone strikes the Israeli military has said it has conducted against individuals or small groups of suspected militants 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 200.

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 militant 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 north to Khan Younis.

Negotiating teams from Israel and Hamas had been in Doha as mediators from Egypt and Qatar sought to bridge the gap between the two sides after the end of an initial phase in the ceasefire, which saw 33 Israeli hostages and five Thais returned by militant groups in Gaza in exchange for some 2,000 Palestinian prisoners.

With the backing of the United States, Israel had been pressing for the return of the remaining 59 hostages still held in Gaza in exchange for a longer-term truce that would have halted fighting until after the Muslim fasting month of Ramadan and the Jewish Passover holiday in April.

However Hamas had been insisting on moving to negotiations for a permanent end to the war and a full withdrawal of Israeli forces from Gaza, in accordance with the terms of the original ceasefire agreement.

“We demand that the mediators hold Netanyahu and the Zionist occupation fully responsible for violating and overturning the agreement,” the group said.

Each side has accused the other of failing to respect the terms of the January ceasefire agreement, and there were multiple hiccups during the course of the first phase. But until now, a full return to the fighting had been avoided.

Israel had blocked deliveries of aid from entering Gaza and had threatened on numerous occasions to resume fighting if Hamas did not agree to return the hostages it still holds.

The army did not provide details about the strikes carried out in the early hours of Tuesday but Palestinian health authorities and witnesses contacted by Reuters reported damage in numerous areas of Gaza, where hundreds of thousands are living in makeshift shelters or damaged buildings.

A building in Gaza City, in the northern end of the strip was hit and at least three houses were hit in Deir Al-Balah in central Gaza. In addition, the strikes hit targets in the southern cities of Khan Younis and Rafah, according to medics and witnesses.

Among those killed was senior Hamas official Mohammad Al-Jmasi, a member of the political office, and members of his family, including his grandchildren who were in his house in Gaza City when it was hit by an airstrike, Hamas sources and relatives said. In all, at least five senior Hamas officials were killed along with members of their families.

Much of Gaza now lies in ruins after 15 months of fighting, which erupted on October 7, 2023 when thousands of Hamas-led gunmen attacked Israeli communities around the Gaza Strip, killing some 1,200 people, according to Israeli tallies, and abducting 251 hostages into Gaza.

The Israeli campaign in response has killed more than 48,000 people, according to Palestinian health authorities, and destroyed much of the housing and infrastructure in the enclave, including the hospital system.

Syrian troops exchanged fire with Lebanese soldiers and armed groups in northeast Lebanon overnight and into Monday in a new round of clashes along the border.

There have been frictions along the mountainous frontier in the months since Islamist rebels toppled Syria’s Bashar al-Assad, an ally of Tehran and Iran-backed Lebanese armed group Hezbollah, and installed their own institutions and army, Reuters reported.

Late on Sunday, Syria’s defence ministry accused Hezbollah of crossing into Syrian territory and kidnapping and killing three members of Syria’s new army.

Hezbollah denied any involvement. A Lebanese security source told Reuters the three Syrian soldiers had crossed into Lebanese territory first and were killed by armed members of a tribe in northeastern Lebanon who feared their town was under attack.

In retaliation for their deaths, Syrian troops shelled Lebanese border towns overnight, according to the Syrian defence ministry and the Lebanese army. Residents of the town of Al-Qasr, less than one kilometre from the border, told Reuters they fled further inland to escape the bombardment.

Lebanese President Joseph Aoun said he ordered the army to respond to sources of fire from northern and eastern borders with Syria, according to a statement by his office. Aoun said the state would not allow clashes along the border to continue.

Lebanon’s army said in a statement on Monday that it had handed over the bodies of the three killed Syrians to Syrian authorities, and that it had responded to fire from Syrian territory and sent reinforcements to the border area.

Syria’s army sent a convoy of troops and several tanks to the frontier on Monday, according to a Reuters reporter along the border. Syrian troops fired into the air as they moved through towns on the way to the border.

“Large military reinforcements were brought in to reinforce positions along the Syrian-Lebanese border and prevent any breaches in the coming days,” said Maher Ziwani, the head of a Syrian army division deploying to the border.

Separatist militants drove a vehicle laden with explosives into a paramilitary convoy, killing at least five in southwestern Pakistan, officials said on Sunday, just days after the same group hijacked a train and held hostages for 36 hours.

The Baloch Liberation Army claimed responsibility for the attack in the district of Noshki in the restive province of Balochistan, Reuters reported.

Senior Superintendent of Police for Noskhi district Hashim Momand said more than 30 paramilitary force members were also wounded.

Pakistan’s Prime Minister Shehbaz Sharif in a statement condemned the attack, which came as Pakistan deals with a growing security crisis in its regions bordering Afghanistan.

The BLA on Tuesday took over the Jaffar Express in a remote mountain pass in Balochistan province, blowing up train tracks in an attack that killed 31 soldiers and civilians, the military said.

In Khyber Pakhtunkhwa province, which lies to the north of Balochistan and also shares a border with Afghanistan, the provincial chief minister Ali Amin Gandapur condemned a series of attacks on police across the province.

He did not provide casualty numbers, but the Tehreek-e-Taliban Pakistan (TTP) militant group said there had been 16 attacks in the past 24 hours.

Pakistan’s authorities have vowed to crack down on the growing insurgencies and said they are fuelled in part by militants finding safe haven in Afghanistan, a charge the ruling Islamic Emirate deny. Militant attacks often pick up in the warmer spring period as the cold winter months recede in mountainous border regions.