DEIR AL-BALAH, Gaza Strip — A fragile truce between Israel and Hamas held for a fifth day Tuesday, as the militant group released more hostages to delay the expected resumption of the war. Israel came under pressure from the United States to better protect Palestinian civilians in Gaza if its offensive resumes.

The latest swap of hostages for Palestinian prisoners held by Israel got underway Tuesday evening. Israel said 10 of its citizens and 2 foreigners were freed by Hamas and had entered Egypt.

Mediators met in Qatar to try to extend the cease-fire beyond Wednesday. For the first time since it began, Israel and Hamas traded accusations of a serious violation with an exchange of fire between troops and militants in northern Gaza.

But there was no indication that it would endanger the truce or the planned exchanges of hostages held in Gaza for Palestinians imprisoned in Israel.

Israel has vowed to resume the war with “full force” to destroy Hamas once it’s clear that no more hostages will be freed under the deal.

The Biden administration has told Israel it must avoid “significant further displacement” and mass casualties among Palestinian civilians if it resumes the offensive, and that it must operate with more precision in southern Gaza than it has in the north, according to U.S. officials. The officials spoke on condition of anonymity under ground rules set by the White House.

CIA director William Burns and David Barnea, who heads Israel’s Mossad intelligence agency, were in Qatar, a key mediator with Hamas, to discuss extending the cease-fire and releasing more hostages, a diplomat said on condition of anonymity because of the sensitivity of the talks. A U.S. official confirmed Burns was in Qatar, speaking anonymously because the director’s travel plans are not publicized for security reasons.

U.S. Secretary of State Antony Blinken is set to visit the region this week, also with an eye to extending the truce.

Hamas and other militants are still holding about 160 hostages out of the 240 seized in their Oct. 7 assault into southern Israel that ignited the war. Israel has said it is willing to extend the cease-fire by one day for every 10 additional hostages that Hamas releases, according to the deal brokered by the Qatar, Egypt and the U.S. But Hamas is expected to make much higher demands for the release of captive soldiers.

Israel has vowed to end Hamas’ 16-year rule in Gaza and crush its military capabilities. That would almost certainly require expanding the ground offensive from northern Gaza to the south, where most of Gaza’s population of 2.3 million is now crowded. It’s unclear where they would go if Israel expands its ground operation, as Egypt has refused to accept refugees and Israel has sealed its border.

HOSTAGES AND PRISONERS RELEASED

The latest freed hostages – 9 women and a 17-year-old teenager – were being flown to hospitals in Israel, where they will be reunited with their families, the Israeli military said. Around 30 Palestinian prisoners are expected to be released as part of the deal negotiated by Qatar, Egypt, and the United States.

Tuesday’s release brought to 60 the number of Israelis freed under the terms of the deal between Israel and Hamas. An additional 21 hostages have been released in separate negotiations.

So far, 150 Palestinians have been released from Israeli prisons.

The Palestinian prisoners released so far have been mostly teenagers accused of throwing stones and firebombs during confrontations with Israeli forces. Some were convicted by Israeli courts of attempting to carry out deadly attacks. The prisoners are widely seen by Palestinians as heroes resisting occupation.

The freed hostages have mostly stayed out of the public eye, but details of their captivity have started to emerge.

In one of the first interviews with a freed hostage, 78-year-old Ruti Munder told Israel’s Channel 13 television that she was initially fed well in captivity but that conditions worsened as shortages took hold. She said she was kept in a “suffocating” room and slept on plastic chairs with a sheet for nearly 50 days.

Israel imposed a siege on Gaza at the start of the war and only allowed a trickle of food, water, medicine and fuel to enter prior to the cease-fire, leading to widespread shortages and a territory-wide power blackout.

Tuesday’s exchange of fire between Israeli troops and Hamas fighters in northern Gaza underscored the fragility of the truce, with the warring sides holding their positions in close proximity to each other. Each side accused the other of being the blame for the outbreak, but there was no further report of violence.

NORTHERN GAZA IN RUINS

The cease-fire has allowed residents who remained in Gaza City and other parts of the north to venture out to survey the destruction and try to locate and bury relatives.

In northern Gaza’s Jabaliya refugee camp, which Israel bombarded heavily for weeks and which troops surrounded in heavy fighting with militants, “you come across whole city blocks that have been demolished, just a pancake of concrete layered as buildings have collapsed,” said Thomas White, the Gaza director for the U.N. agency caring for Palestinian refugees.

The agency delivered six trucks of aid to the camp, including supplies for a medical center. Footage of White’s visit showed streets lined with destroyed buildings, cars, and piles of rubble.

A U.N.-led aid consortium estimates that, across Gaza, over 234,000 homes have been damaged and 46,000 completely destroyed, amounting to around 60% of the territory’s housing stock. In the north, the destruction “severely compromises the ability to meet basic requirements to sustain life,” it said.

More than 13,300 Palestinians have been killed since the war began, roughly two-thirds of them women and minors, according to the Health Ministry in Hamas-ruled Gaza, which does not differentiate between civilians and combatants. More than 1,200 people have been killed on the Israeli side, mostly civilians killed in the initial attack.

At least 77 soldiers have been killed in Israel’s ground offensive. Israel says it has killed thousands of militants, without providing evidence.

Authorities were able to reopen the dialysis department at Gaza City’s Shifa hospital after medical teams brought a small generator. Around 20 patients there had gone two or three weeks without dialysis, Dr. Mutasim Salah told Al-Jazeera TV from the hospital.

Two weeks ago, Israeli forces seized the hospital, which Israel had contended was used as a major base by Hamas, an accusation that the group and hospital staff deny.

FEARS FOR THE SOUTH

Israel’s bombardment and ground offensive have displaced more than 1.8 million people, nearly 80% of Gaza’s population, with most having sought refuge in the south, according to the U.N. Hundreds of thousands of people have packed into U.N.-run schools and other facilities, with many forced to sleep on the streets outside because of overcrowding.

Though, rain and cold winds sweeping across Gaza have made conditions even more miserable.

On Tuesday, Hanan Tayeh returned to her destroyed home in the central town of Johor al-Deek, scouring for any belongings in the wreckage.

“I came to get anything for my daughters. Winter has come, and I have nothing for them to wear,” she said. “It is cold, we are homeless.”

The cease-fire has allowed increased aid of 160 to 200 trucks a day into Gaza, bringing desperately needed food, water and medicine, as well as fuel for homes, hospitals and water treatment plants. Still, it is less than half what Gaza was importing before the fighting, even as humanitarian needs have soared.

Juliette Toma, a spokesperson for the U.N. agency for Palestinian refugees, said people come to shelters asking for heavy clothes, mattresses and blankets, and that some are sleeping in damaged vehicles.

“The needs are overwhelming,” she told the Associated Press. “They lost everything, and they need everything.”

 

Keath and Jeffery reported from Cairo. Associated Press writers Aamer Madhani and Zeke Miller in Washington, Samy Magdy in Cairo, Tia Goldenberg in Tel Aviv, Isabel DeBre in Jerusalem and Jon Gambrell in Dubai, United Arab Emirates, contributed to this report.

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