The southern Gazan city of Rafah has become “hell on Earth”, the head of the UN agency for Palestinian refugees has said.

According to the Hamas-controlled health ministry, at least 45 people were killed in a tent camp after an Israeli airstrike on Sunday, described by Prime Minister Benjamin Netanyahu as a “tragic mistake”.

Philippe Lazzarini, the commissioner-general of UNRWA, said some of the agency’s staff are “unaccounted for” and “many” civilians have been injured.

“Children and women living in tented plastic makeshift shelters are among the killed,” he said, adding others were “reportedly burnt to death”.

“The images from last night are testament to how Rafah has turned into hell on Earth.”

Survivors said families were about to sleep when the strike hit the Tel al Sultan neighbourhood, where thousands were sheltering after Israel began a ground offensive in the east of Rafah.

“We were praying… getting our children’s beds ready to sleep. There was nothing unusual, then we heard a very loud noise… fire erupted around us,” said Palestinian mother Umm Mohamed Al-Attar.

“All the children started screaming… the sound was terrifying, we felt like the metal was about to collapse on us, and shrapnel fell into the rooms.”

More than half of the dead were women, children, and elderly people, health officials in Gaza said, adding that because of the severe burns suffered by some of the injured, the number of dead was likely to rise.

A Red Cross field hospital operating in Rafah saw a “very high influx” of injured Palestinians.

William Schomburg, the head of the International Committee of the Red Cross delegation in Gaza, told Sky News their hospital received patients with “horrific injuries”.

“We’re talking about very heavy shrapnel wounds. We’re talking about severe burns as well as blast trauma injuries,” he said.

“Our team conducted several operations, including, tragically, some amputations.”

The Red Cross field hospital has only been up and running for a few weeks, but Mr Schomberg said there was a risk of it becoming “overloaded very quickly” if Israel continues operations in Rafah.

Israel has kept up its offensive despite a ruling by the top UN court on Friday ordering it to stop, claiming the ruling grants some scope for military action there.

In a speech in parliament, Mr Netanyahu said the strike was not meant to cause civilian casualties.

“In Rafah, we already evacuated about one million non-combatant residents and despite our utmost effort not to harm non-combatants, something unfortunately went tragically wrong,” he said.

The Israel Defence Forces had earlier said the strike was against “legitimate targets” with “precise munitions” and on the basis of “precise intelligence” – adding the incident was “under review”.

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Israel says it wants to root out Hamas fighters holed up in Rafah and rescue hostages it says are being held in the area.

Medics in Gaza said a further Israeli airstrike on a house in Rafah on Monday has killed seven people, with several others wounded.

The US urged Israel to take more care to protect civilians, but stopped short of calling for a halt to the Rafah incursion, while French President Emmanuel Macron said he was “outraged”.

German Foreign Minister Annalena Baerbock and the EU foreign policy chief Josep Borrell said the International Court of Justice ruling must be respected.

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