For Palestinians, the debate over who is responsible for the hospital blast obscures a broader context in which Israeli strikes have devastated whole neighborhoods, displaced hundreds of thousands of Gazans and killed thousands of others.

“You ignore all the other massacres,” said Mr. Hamad, the Hamas official.

Israel has cut almost all supply of electricity, food, water and fuel, exacerbating a humanitarian crisis in the enclave and leaving hospitals short of power and even baby formula. Scores of public institutions in northern Gaza, including hospitals like the Ahli Arab hospital, were warned by Israel to evacuate.

The World Health Organization reported on Saturday that at least 19 hospitals had been damaged since the war broke out on Oct. 7. Last week, the organization said that three hospitals had “sustained heavy damages to the point that they are no longer functioning.” At least 16 health care workers have been killed and 28 injured, according to the WHO.

“We’ve never lived through a war this intense,” said Motasem Mortaja, a Palestinian journalist who documented the aftermath of the hospital strike.

Israeli officials say their attacks are aimed at members of armed Palestinian groups and their military infrastructure, and that Hamas and its allies are to blame for civilian deaths because they construct many of their bases and rocket launchers in residential areas.

Israel also disputes the Palestinian death toll, saying that the number of people killed at the Ahli Arab hospital is lower than reported, without elaborating. American intelligence agencies have assessed that the blast killed 100 to 300 people.

The Gazan authorities declined to name any of the people killed in the blast, saying that many bodies still had yet to be identified.

The Rev. Fadi Diab, deputy chairman of the hospital’s board, said it was hard to confirm the death toll. Father Diab said the hospital administration in Gaza had told him there were between 450 and 500 displaced Gazans sheltering at the hospital site before the blast, but that it was unclear how many of them were in the parking lot when the explosion occurred.

“Could the numbers be exaggerated? It’s possible. But could the numbers also be correct? That’s also possible,” Father Diab said in a phone call. “No one is currently able to do verification,” he added.