Palestinian health workers said Israeli airstrikes killed at least 45 people Sunday and hit tents for displaced people in the southern Gaza city of Rafah, and “numerous” others were trapped in flaming debris. Gaza’s Health Ministry said women and children made up most of the dead and dozens of wounded.

The attacks came two days after the International Court of Justice ordered Israel to end its military offensive in Rafah, where more than half of Gaza’s population had sought shelter before Israel’s incursion earlier this month. Tens of thousands of people remain in the area while many others have fled.

Footage from the scene of the largest airstrike showed heavy destruction. Israel’s army confirmed the strike and said it hit a Hamas installation and killed two senior Hamas militants. It said it was investigating reports that civilians were harmed. 

Defense Minister Yoav Gallant was in Rafah on Sunday and was briefed on the “deepening of operations” there, his office said.

The United Nations Palestinian refugee agency, UNRWA, said on Monday that reports of attacks on families seeking shelter in Rafah in the southern tip of the Gaza Strip were "horrifying".

“Information coming out of Rafah about further attacks on families seeking shelter is horrifying," UNRWA wrote on X.

"There are reports of mass casualties including children and women among those killed. Gaza is hell on earth. Images from last night are yet another testament to that."

Palestinian health and civil emergency service officials said on Sunday Israeli air strikes killed at least 35 Palestinians and wounded dozens in an area in the southern Gaza Strip city of Rafah designated for the displaced.

The Israeli military said its air force struck a Hamas compound in Rafah, and that the incident was under review.

A spokesperson with the Palestinian Red Crescent Society said the death toll was likely to rise as search and rescue efforts continued in Rafah’s Tal Al-Sultan neighborhood about two kilometers (1.2 miles) northwest of the city center.

The society asserted that the location had been designated by Israel as a “humanitarian area.” The neighborhood is not included in areas that Israel’s military ordered evacuated earlier this month.

The airstrike was reported hours after Hamas fired a barrage of rockets from Gaza that set off air raid sirens as far away as Tel Aviv for the first time in months in a show of resilience more than seven months into Israel’s massive air, sea and ground offensive.

There were no reports of casualties in what appeared to be the first long-range rocket attack from Gaza since January. Hamas’ military wing claimed responsibility. Israel’s military said eight projectiles crossed into Israel after being launched from Rafah and “a number” were intercepted, and the launcher was destroyed.

Earlier Sunday, dozens of aid trucks entered Gaza from southern Israel under a new agreement to bypass the Rafah crossing with Egypt after Israeli forces seized the Palestinian side of it earlier this month. Israel’s military said 126 aid trucks entered via the nearby Kerem Shalom crossing.

But it was not immediately clear if humanitarian groups could access the aid — including medical supplies — because of fighting. The crossing has been largely inaccessible because of Israel’s offensive in Rafah. United Nations agencies say it is usually too dangerous to retrieve the aid. The World Health Organization last week said an expanded Israeli incursion in Rafah would have “disastrous” impact.”

“With the humanitarian operation near collapse, the secretary-general emphasizes that the Israeli authorities must facilitate the safe pickup and delivery of humanitarian supplies from Egypt entering Kerem Shalom,” the spokesperson for UN chief Antonio Guterres said in a statement.

Egypt refuses to reopen its side of the Rafah crossing until control of the Gaza side is handed back to Palestinians. It agreed to temporarily divert traffic through Kerem Shalom, Gaza’s main cargo terminal, after a call between US President Joe Biden and Egyptian President Abdel Fattah El-Sisi.Egypt on Monday condemned what it called the "deliberate bombardment by Israeli forces of displaced peoples' tents" in Rafah, in strikes which Gaza's civil defence agency said killed at least 45 people.

The Egyptian Foreign Ministry issued a statement calling on Israel to "implement the measures ordered by the International Court of Justice (ICJ) concerning an immediate cessation of military operations" in Rafah.

The war between Israel and Hamas has killed nearly 36,000 Palestinians, according to Gaza’s Health Ministry, which does not distinguish between civilians and fighters in its count. Israel blames civilian deaths on Hamas because the militants operate in dense, residential areas.

Around 80 percent of Gaza’s 2.3 million people have fled their homes, severe hunger is widespread and UN officials say parts of the territory are experiencing famine.