Israeli airstrikes on Gaza City flattened three buildings and killed at least 42 people Sunday, Palestinian medics said, in the deadliest single attack in the latest round of violence. Despite the toll and international efforts to broker a cease-fire, Israeli Prime Minister Benjamin Netanyahu signaled the fourth war with Gaza’s Hamas rulers would rage on.

In a televised address, Netanyahu said the attacks were continuing at “full-force” and will “take time.” Israel “wants to levy a heavy price” on the Hamas militant group, he said, flanked by his defense minister and political rival, Benny Gantz, in a show of unity.

Hamas also pressed on, launching rockets from civilian areas in Gaza toward civilian areas in Israel. One slammed into a synagogue in the southern city of Ashkelon hours before evening services for the Jewish holiday of Shavuot, Israeli emergency services said. No injuries were reported.

In the Israeli air assault early Sunday, families were buried under piles of cement rubble and twisted rebar. A yellow canary lay crushed on the ground. Shards of glass and debris covered streets blocks away from the major downtown thoroughfare where the three buildings were hit over the course of five minutes around 1 a.m.

The hostilities have repeatedly escalated over the past week, marking the worst fighting in the territory that is home to 2 million Palestinians since Israel and Hamas’ devastating 2014 war.

“I have not seen this level of destruction through my 14 years of work,” said Samir al-Khatib an emergency rescue official in Gaza. “Not even in the 2014 war.”

Rescuers furiously dug through the rubble using excavators and bulldozers amid clouds of heavy dust. One shouted “Can you hear me?” into a hole. “Are you OK?” he asked. Minutes later, first responders pulled a survivor out. The Gaza Health Ministry said 16 women and 10 children were among those killed, with more than 50 people wounded.

Haya Abdelal, 21, lives in a building next to one that was destroyed and said she was sleeping when the airstrikes sent her fleeing into the street. She accused Israel of not giving its usual warning to residents to flee before launching such an attack.

“We are tired,” she said, “We need a truce. We can’t bear it anymore.”

The Israeli army spokesperson’s office said the strike targeted Hamas “underground military infrastructure.” As a result of the strike, “the underground facility collapsed, causing the foundation of the civilian houses above them to collapse as well, leading to unintended casualties.”

Among those reported killed was Dr. Ayman Abu Al-Ouf, the head of the internal medicine department at Shifa Hospital and a senior member of the hospital’s coronavirus management committee. Two of Abu Al-Ouf’s teenage children and two other family members were also buried under the rubble of their home.

The death of the 51-year-old physician “was a huge loss at a very sensitive time,” said Mohammed Abu Selmia, the director of Shifa.

Gaza’s health care system, already gutted by an Israeli and Egyptian blockade imposed after Hamas seized power from rival Palestinian forces in 2007, had been struggling with a surge in coronavirus infections even before the latest conflict.

Israel’s airstrikes have leveled a number of Gaza City’s tallest office and residential buildings, alleging they contain Hamas military infrastructure. Among them was the building housing The Associated Press office and those of other media outlets.

Sally Buzbee, the AP’s executive editor, on Sunday called for an independent investigation into the airstrike that destroyed the AP office the day before.

Netanyahu alleged that Hamas military intelligence was operating inside the building.

“It’s a perfectly legitimate target,” he told CBS’s Face the Nation on Sunday.

Asked if he had provided any evidence of Hamas’ presence in the building in a call Saturday with U.S. President Joe Biden, Netanyahu said, “we pass it through our intelligence people.”

Buzbee called for any such evidence to be laid out.

“We are in a conflict situation,” Buzbee said. “We do not take sides in that conflict. We heard Israelis say they have evidence; we don’t know what that evidence is.”

The AP has operated from the building for 15 years, including through three previous wars between Israel and Hamas. The news agency’s cameras, operating from its top floor office and roof terrace, offered 24-hour live shots as militants’ rockets arched toward Israel and Israeli airstrikes hammered the city and its surroundings.

READ MORE: ‘Shocking and horrifying’: Israel airstrike destroys AP office in Gaza

“We think it’s appropriate at this point for there to be an independent look at what happened yesterday — an independent investigation,” Buzbee said.

The latest outbreak of violence began in east Jerusalem last month, when Palestinians clashed with police in response to Israeli police tactics during Ramadan and the threatened eviction of dozens of Palestinian families by Jewish settlers. A focus of the clashes was the Al-Aqsa Mosque, a frequent flashpoint located on a hilltop compound revered by both Muslims and Jews.

Hamas began firing rockets toward Jerusalem on Monday, triggering the Israeli assault on Gaza.

At least 188 Palestinians have been killed in the hundreds of airstrikes in Gaza, including 55 children and 33 women, with 1,230 people wounded. Eight people in Israel have been killed in some of the 3,100 rocket attacks launched from Gaza, including a 5-year-old boy and a soldier.

Hamas and the Islamic Jihad militant group have acknowledged 20 fighters killed in the fighting. Israel says the real number is far higher and has released the names and photos of two dozen alleged operatives it says were “eliminated.”

The assault has displaced some 34,000 Palestinians from their homes, U.N. Mideast envoy Tor Wennesland told the Security Council on Sunday.

The turmoil has also spilled over elsewhere, fueling protests in the occupied West Bank and stoking violence within Israel between its Jewish and Arab citizens, with clashes and vigilante attacks on people and property.

On Sunday, a driver rammed into an Israeli checkpoint in the east Jerusalem neighborhood of Sheikh Jarrah — where the Palestinian families had been threatened with eviction — injuring six officers before police shot and killed the attacker, Israeli police said.

The violence also sparked pro-Palestinian protests in cities across Europe and the United States.

Israel appears to have stepped up strikes in recent days to inflict as much damage as possible on Hamas as international mediators work to end the fighting and stave off an Israeli ground invasion in Gaza.

The Israeli military said it destroyed the home Sunday of Gaza’s top Hamas leader, Yahiyeh Sinwar, in the southern town of Khan Younis. It was the third such attack in the last two days on the homes of senior Hamas leaders, who have gone underground.

Egypt and the U.S. were involved in cease-fire efforts, but it wasn’t clear if they were making progress, in light of Netanyahu’ statement that the campaign is continuing. The U.N. Security Council was also meeting Sunday, and Secretary-General Antonio Guterres called for an end to the “senseless cycle of bloodshed, terror and destruction.”

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Nessman reported from Atlanta. Associated Press writers Samy Magdy in Cairo, Joseph Krauss and Isaac Scharf in Jerusalem and Bassem Mroue in Beirut contributed.

Fares Akram And Ravi Nessman, The Associated Press

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