Israeli airstrikes pummeled Gaza early Tuesday, killing at least 200 people, including many children, according to Palestinian health authorities, ending a fragile ceasefire that had paused fighting since January 19.

The barrage struck dozens of targets across northern Gaza, Gaza City, Deir al-Balah, Khan Younis, and Rafah, marking Israel’s most extensive assault since the truce began. The Israeli military vowed to press on “as long as necessary,” hinting at a potential ground offensive, a stark escalation from its prior targeted drone strikes.

Hospitals, battered by 15 months of war, were overwhelmed as bodies piled up in blood-stained sheets. The Palestinian Red Crescent reported handling 86 deaths and 134 injuries, while Nasser, Al-Aqsa, and Al-Ahly hospitals received around 85 corpses collectively.

In Rafah, 16 members of one family perished, per local authorities. Gaza’s health ministry spokesperson confirmed the toll, with witnesses describing tanks shelling southern areas, driving families northward to Khan Younis.

The Israeli Defense Forces (IDF) claimed the strikes hit mid-level Hamas commanders, leadership, and infrastructure, following consultations with the U.S., as confirmed by White House spokesperson Brian Hughes: “Hamas could have released hostages to extend the ceasefire but instead chose refusal and war.”

PM Benjamin Netanyahu’s office accused Hamas of rejecting U.S. envoy Steve Witkoff’s proposals, declaring, “Israel will, from now on, act against Hamas with increasing military strength.”

Hamas countered that Israel overturned the January ceasefire, leaving 59 hostages’ fates uncertain. The truce, mediated by Qatar, Egypt, and the U.S., had swapped 33 Israeli hostages for 2,000 Palestinian prisoners, but talks in Doha to extend it collapsed. With Gaza’s death toll nearing 48,000 per health ministry figures, and 90% of its 2.3 million residents displaced, this resumption of violence deepens a humanitarian crisis, with no immediate end in sight.