Israel launched airstrikes across the Gaza Strip early Tuesday, killing at least 404 Palestinians, including women and children, according to hospital officials. The surprise bombardment shattered a ceasefire in place since January and threatened to fully reignite the 17-month-old war.

Prime Minister Benjamin Netanyahu ordered the strikes after Hamas refused Israeli demands to change the ceasefire agreement. Officials said the operation was open-ended and was expected to expand. The White House said it had been consulted and voiced support for Israel’s actions.

The Israeli military ordered people to evacuate eastern Gaza, including much of the northern town of Beit Hanoun and other communities further south, and head toward the center of the territory, indicating that Israel could soon launch renewed ground operations.

“Israel will, from now on, act against Hamas with increasing military strength,” Netanyahu’s office said.

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The attack during the Muslim holy month of Ramadan could resume a conflict that has already killed tens of thousands of Palestinians and caused widespread destruction across Gaza. It also raised questions about the fate of the roughly two dozen Israeli hostages held by Hamas who are believed to still be alive.

A senior Hamas official said Netanyahu’s decision to return to conflict amounts to a “death sentence” for the remaining hostages. Izzat al-Risheq accused Netanyahu of launching the strikes to try and save his far-right governing coalition and called on mediators to “reveal facts” on who broke the truce. Hamas said at least four senior officials were killed in Tuesday’s strikes.

There were no reports of any attacks by Hamas several hours after the bombardment, indicating it still hoped to restore the truce.

The strikes came as Netanyahu comes under mounting domestic pressure, with mass protests planned over his handling of the hostage crisis and his decision to fire the head of Israel’s internal security agency. His latest testimony in a long-running corruption trial was canceled after the strikes.

The main group representing families of the captives accused the government of backing out of the ceasefire, saying it “chose to give up on the hostages.”

“We are shocked, angry and terrified by the deliberate dismantling of the process to return our loved ones from the terrible captivity of Hamas,” the Hostages and Missing Families Forum said in a statement.

A strike on a home in the southern city of Rafah killed 17 members of one family, including at least 12 women and children, according to the European Hospital, which received the bodies. The dead included five children, their parents, and another father and his three children.

In the southern city of Khan Younis, Associated Press reporters saw explosions and plumes of smoke. Ambulances brought wounded people to Nasser Hospital, where patients lay on the floor, some screaming. A young girl cried as her bloody arm was bandaged.

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Many Palestinians said they had expected a return to conflict when talks over the second phase of the ceasefire did not begin as scheduled in early February. Israel instead embraced an alternative proposal and cut off all shipments of food, fuel and other aid to the territory’s 2 million Palestinians to try to pressure Hamas to accept it.

“Nobody wants to fight,” Palestinian resident Nidal Alzaanin told the AP by phone from Gaza City. “Everyone is still suffering from the previous months,” he said.

Gaza’s Health Ministry said at least 404 people were killed in the strikes and more than 560 had been wounded. It revised its confirmed count after saying earlier Tuesday that 413 were dead and 660 wounded. Rescuers were still searching the rubble for dead and wounded as the strikes continued. It was among the deadliest days of the war.

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The White House sought to blame Hamas for the renewed fighting. National Security Council spokesman Brian Hughes said the militant group “could have released hostages to extend the ceasefire but instead chose refusal and war.”

An Israeli official, speaking on condition of anonymity to discuss the unfolding operation, said Israel was striking Hamas’ military, leaders and infrastructure and planned to expand the operation beyond air attacks. The official accused Hamas of attempting to rebuild and plan new attacks. Hamas militants and security forces quickly returned to the streets in recent weeks after the ceasefire went into effect.

Netanyahu’s office said the Israeli leader held security consultations with senior officials. It did not provide further details.

The strikes came two months after a ceasefire was reached to pause the war. Over six weeks, Hamas released 25 Israeli hostages and the bodies of eight more in exchange for nearly 2,000 Palestinian prisoners in a first phase of the ceasefire.

But since that ceasefire ended two weeks ago, the sides have not been able to agree on a way forward with a second phase aimed at releasing the 59 remaining hostages, 35 of whom are believed to be dead, and ending the conflict altogether.

Hamas has demanded an end to the conf;ict and full withdrawal of Israeli troops in exchange for the release of the remaining hostages. Israel says it will not end the conflict until it destroys Hamas’ governing and military capabilities and frees all hostages — two goals that could be incompatible.

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Netanyahu’s office on Tuesday said Hamas had “repeatedly refused to release our hostages and rejected all offers it received from the U.S. presidential envoy, Steve Witkoff, and from the mediators.”

Israel wants Hamas to release half of the remaining hostages in return for a promise to negotiate a lasting truce. Hamas instead wants to follow the ceasefire deal reached by the two sides, which calls for negotiations to begin on the ceasefire’s more difficult second phase, in which the remaining hostages would be released and Israeli forces would withdraw from Gaza.

A return to conflict would allow Netanyahu to avoid the tough trade-offs called for in the second phase of the agreement and the thorny question of who would govern Gaza. It would also shore up his coalition, which depends on far-right lawmakers who want to depopulate Gaza and re-build Jewish settlements there.

The conflict erupted when Hamas-led militants stormed into southern Israel on Oct 7, 2023, killing some 1,200 people, mostly civilians, and taking 251 hostages. Most have been released in ceasefires or other deals, with israeli forces rescuing only eight and recovering dozens of bodies.

Israel responded with a military offensive that killed over 48,000 Palestinians, according to local health officials, and displaced an estimated 90% of Gaza’s population. The territory’s Health Ministry doesn’t differentiate between civilians and militants, but says over half of the dead have been women and children.

The ceasefire had brought some relief to Gaza and allowed hundreds of thousands of displaced Palestinians to resume to what remained of their homes.

The released hostages, some of whom were emaciated, have repeatedly implored the government to press ahead with the ceasefire to return all remaining captives. Tens of thousands of Israelis have taken part in mass demonstrations calling for a ceasefire and return of all hostages.

Mass demonstrations are planned later Tuesday and Wednesday following Netanyahu’s announcement this week that he wants to fire the head of Israel’s Shin Bet internal security agency. Critics have lambasted the move as an attempt by Netanyahu to divert blame for his government’s failures in the Oct. 7 attack and handling of the war.

Since the ceasefire in Gaza began in mid-January, Israeli forces have killed dozens of Palestinians who the military says approached its troops or entered unauthorized areas.

Still, the deal has tenuously held without an outbreak of wide violence. Egypt, Qatar and the United States have been trying to mediate the next steps in the ceasefire.

Federman reported from Jerusalem and Magdy from Cairo. Associated Press reporters Mohammad Jahjouh in Khan Younis, Gaza Strip; Abdel Kareem Hana in Gaza City, Gaza Strip; Fatma Khaled in Cairo; and Tia Goldenberg in Tel Aviv, Israel, contributed.