Israeli forces killed 91 Palestinians in Gaza in a single day, according to medics, as the military pressed its assault on Gaza City and people fled under bombardment. The deaths on [event date] included families sheltering in homes and tents, as well as people trying to escape the city in vehicles ordered south by the army.

The Al Jazeera report says 76 of the victims were in Gaza City, where the campaign has focused on residential neighbourhoods, schools turned into shelters and tents housing displaced families. One of the most painful episodes cited in the report was the strike on the family home of Dr Mohammed Abu Salmiya, the director of al-Shifa hospital, which killed at least five people including his brother, sister-in-law and their children.

Another strike hit a truck carrying Palestinians trying to flee the city, killing at least four people in the Nasr area. Medics and reporters described bodies left in the street and rescue crews unable to reach others because the situation was too dangerous. The account also says Israeli forces have used artillery, quadcopters and explosives-laden robots in an attempt to carve out space and force civilians toward southern displacement zones.

The humanitarian picture described in the report is bleak. Palestinian Civil Defence said the offensive on Gaza City, which began in August, has already pushed more than 450,000 people from the area. That exodus has left families pitching tents where there is little water, electricity or infrastructure, while aid workers say the sites designated for shelter in the south are overcrowded and undersupplied.

The wider war context is also part of the story. Hamas says the remaining captives in Gaza are spread through Gaza City and warns the assault could endanger them. In Israel, thousands protested in Tel Aviv, demanding an end to the war and a deal to secure the hostages. But the military operation continues, and the day's death toll underlines how Gaza City has become the main stage for the offensive.

The toll also underscores how the assault is changing life in Gaza City itself. Homes, shelters and streets are all being hit at once, so the line between a military target and a displacement route has nearly disappeared. For residents, there is no stable safe zone inside the city and little confidence that moving south will bring safety, since the southern areas are already crowded and struggling to absorb more people.

For hospitals and medics, the pressure is just as severe. The account of Dr Abu Salmiya's family is notable not only because of his role at al-Shifa but because it shows that even senior medical staff are not insulated from the violence around them. When the director of the city's biggest hospital is mourning relatives killed at home, it is a sign that the war is collapsing the distance between treatment, shelter and grief.

That scale of displacement also helps explain why food, water and medical care remain so hard to deliver. The report describes people sheltering wherever they can and aid workers unable to safely reach the wounded, which means the death toll is only one part of a larger emergency in which the city's entire support system is under pressure.