JERUSALEM (AP) — The courtyard of al-Ahli hospital, where thousands of Palestinians had sought shelter or medical treatment, is now a blackened expanse of charred cars, stretchers coated in ash and shredded dolls.

That’s all that remains after an explosion on Tuesday turned it into an inferno, tearing apart men, women and children, and burning people alive. Images of the aftermath ignited protests across the region, threatening to broaden the war between Israel and Hamas.

Mohammed al-Hayek had stepped away to fetch some coffee, making his way through the crowd of displaced people who were singing, praying or sleeping after fleeing to the Gaza City hospital in fear of Israeli airstrikes. Seeking the warm drink on a cold night saved his life.

“I returned to find them torn in pieces,” al-Hayek said of his five cousins. He pointed to the mound of debris where they had been sitting, to their blood on the walls.

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“This is where Shahir was. This is where Mutasim was,” he said of the young men in their early 20s.

There were conflicting claims of who was responsible for the blast.

Israel has been launching waves of airstrikes and Palestinian militants have been firing rockets into Israel since the wide-ranging Hamas incursion on Oct. 7 ignited the fifth, and deadliest, war between the sides.

Officials in Hamas-ruled Gaza quickly said an Israeli airstrike had hit the hospital. Israel denied it was involved and released live video, audio and other evidence it said showed the blast was caused by a rocket misfired by Islamic Jihad, another Palestinian militant group. Islamic Jihad denied responsibility.

The Associated Press has not independently verified any of the claims or evidence released by the parties.

Dr. Fadhil Naim, an orthopedic surgeon, was taking a short rest between operations when he heard a loud crash at about 7 p.m. Tuesday. At first he ignored it, thinking it was another airstrike nearby.

Then the wounded began streaming into the operating ward, screaming for help.

“They were alive, and they died in our arms because there wasn’t enough of us to save everyone,” he said.

He didn’t realize the full scale of devastation until later, when he stepped outside into the courtyard and saw that it was filled with corpses.

Saeb al-Jarz, 27, was tending to his mother at Shifa, Gaza’s largest hospital, just a few miles (kilometers) away, when he felt the ground shake and heard the blast. He raced to al-Ahli to see what had happened.

He remembers the scene in fragments: Flames lapping cars and hospital walls, victims stumbling around in horror, a courtyard littered with body parts, sheets with soccer ball and flower patterns draped over corpses.

He saw a little girl being carried away by a rescue worker, holding a doll and calling out for her mother.

“I was so, so scared,” he said.

The wounded flooded into Shifa, which was already packed with patients. On Wednesday, officials said the hospital was running out of fuel to power its emergency generators after Israel cut off fuel shipments as part of the siege, forcing Gaza’s only power plant to shut down.

The death toll from the blast was in dispute Wednesday, even among Palestinians.

The Hamas-run Health Ministry initially said 500 had died, then revised that number to 471, without providing a list of names. The staff at al-Ahli said only that the toll was in the hundreds. Mohammed Abu Selmia, the director of Shifa, said he thought the toll was closer to 250.

But in Gaza, nearly everyone blames Israel. Ten days of fighting have killed over 3,000 Palestinians, according to the Health Ministry. More than 1,400 people have been killed on the Israeli side, the vast majority civilians killed in the initial Hamas onslaught. Some 200 were taken into Gaza as captives.

Israel has vowed to crush Hamas, threatening a war like no other. It has ordered the evacuation of over a million Palestinians — around half of Gaza’s population — from north to south of the territory it has completely sealed off. Israeli officials say they are trying to separate civilians from Hamas, which they accuse of using Palestinians as human shields.

Many Palestinians have crowded into hospitals, hoping they will be spared. Al-Ahli, an 80-bed hospital founded in 1882 and run by a branch of the Anglican Communion, was seen as especially secure because of its international connection.

“I am tortured when I think, why did those kids have to be killed?” said Suhaila Tarazi, the general director of al-Ahli. “This was not just a hospital, but a safe space for everyone to take refuge — Christians, Muslims, Jews, it doesn’t matter. Now it is neither.”

The Anglican Bishop of Jerusalem, Hosam Naoum, said the hospital received at least three Israeli military orders to evacuate before Tuesday’s explosion. The warnings by phone began Sunday, after Israeli shelling hit two floors of the hospital, wounding four medics, he said.

The staff at al-Ahli, like those of other hospitals across Gaza, refused the evacuation orders, saying that it would endanger the patients to try to move them, violating the medical vow to do no harm.

On Wednesday, shell-shocked families who survived the blast packed up their mattresses and other belongings and headed out into the streets to look for safety in a war-torn land with one less sanctuary.

“The explosion points to the madness and futility of the current fighting,” said the Rev. Canon Nicholas Porter, from an American fundraising arm for the Anglican church.

“It is the poor, the sick, and the innocent who seem to be paying the price.”

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