GAZA — Yet again, tens of thousands of people in Gaza are on the move, as the Israeli military issues fresh evacuation orders for a number of areas in Gaza City.

Over the past 10 days, the Israel Defense Forces (IDF) has issued instructions for hundreds of thousands of people in Khan Younis in the south, Shujaya in central Gaza and the several neighborhoods of Gaza City to leave.

The effect has been to increase the total number of displaced people in Gaza, from 1.7 million in May to an estimated 1.9 million now, according to the UN. Approximately nine out of 10 people in Gaza are now estimated to be internally displaced, many of them multiple times.

“Mass displacement has been predominantly driven by evacuation orders issued by the Israeli military, extensive destruction of both private and public infrastructure, restricted access to essential services, and the persistent fear of ongoing hostilities,” according to the most recent assessment by the UN Office for the Coordination of Humanitarian Affairs (OCHA).

It’s unclear how many people in Gaza City have heeded the latest evacuation order. Many civilians are wary of leaving whatever shelter they have for an uncertain journey to an even more uncertain fate living on the streets or in the overcrowded, unsanitary tent villages that pop up with each evacuation order.

The IDF has said that evacuation orders are necessary so that civilians don’t get caught up in its renewed operations in areas where Hamas is seeking to re-establish a presence. The IDF insists it goes to great lengths to avoid civilian casualties.

Hamas has said the evacuations threaten to return negotiations for a ceasefire and hostage deal to “point zero.”

Khader Al Za’anoun, a journalist with Wafa, the official Palestinian news agency, told CNN that late on Sunday people in the Tuffah, Old City and Daraj neighborhoods had been instructed to move to “known shelters in the west of Gaza City.”

But he said the large-scale evacuation came amid drone- and air-strikes.

“It was terrifying, people were running, some were in wheelchairs, everyone in panic not knowing where to go. The heavy bombardments were close, and the smoke was filling the skies,” Al Za’anoun told CNN after reaching the port area.

The strikes continued all night, along with repeated gunfire in areas where people were sheltering.

“I decided to wait until the morning and not move due to the dangerous situation,” Al Za’anoun said.

But at dawn airstrikes targeted a high-rise building close to where he and his family and many other displaced people were taking shelter.

“At that moment, to protect the lives of my family, I decided to leave the place and evacuate to the port area in the west of the city in a journey full of danger.”

Al Za’anoun send photographs of his family walking through ruined streets as he dragged a pushchair with their remaining possessions.

The IDF confirmed to CNN that the evacuation order for parts of Gaza City was the third in the past 10 days.

OCHA estimates that about 80,000 people were living in the Shujaya area when the order to evacuate came on June 27. A further 250,000 people living in eastern Khan Younis and Rafah were placed under an evacuation order by the Israeli authorities on July 1.

On that day, the IDF said that people in 71 residential blocs in eastern Khan Younis and Rafah must immediately evacuate westwards to what it defines as a “humanitarian zone” in Al Mawasi.

OCHA said the area included medical points, primary health centers and 14 field kitchens, as well as a sewage treatment center. It said the internally displaced “moved toward western Khan Younis and Deir al-Balah, which are already overcrowded and lack basic services, critical infrastructure, shelter materials and spaces to accommodate the new influx of IDPs.”

OCHA and other agencies say the evacuation orders have had a major impact on the few operational hospitals in Gaza.

On July 2, the Israeli authorities clarified that the European Hospital in Khan Younis was not included in the evacuation order.

It was too late. Most medical staff and patients had left. A UN staffer – Jonathan Whittall – reported from the hospital: “There are no patients, there’s no equipment, and it’s no longer functional.”

The director general of the World Health Organization, Tedros Ghebreyesus, said on X it was “devastating to see the 650-bed-capacity hospital out of service at a time when access to health care is urgently needed.”

The International Red Cross team at the hospital – which has carried out more than 3,000 surgeries there since the conflict began – also left.

Many of those who left the European hospital crowded into the nearby Nasser Medical Complex, which reached full capacity.

The WHO and other agencies were able to move much of the equipment from the European Hospital to Nasser, including ventilators and anaesthesia machines. But medical staff were left wondering if and when they would have to move yet again.

Now, one of the main hospitals in Gaza City – the Al Ahli Baptist – has also closed its doors. The Episcopal Church in Jerusalem, which runs Al Ahli, said that after several drone strikes in the immediate area on Sunday, the hospital was included in the “red zone” for evacuation.

“As a result,” the church said on Facebook on Monday, “all vulnerable people sheltering in the grounds, the staff and all patients had to leave the safety of the grounds ... Our hospital is now out of operation at a time when its services are in very significant demand.”

Archbishop Hosam Naoum said the diocese protested the closure in the strongest possible terms and appealed to Israeli authorities to allow it to reopen. CNN has reached out to the IDF for an update on the hospital’s status.

OCHA said that “At present, only 15 of Gaza’s 36 hospitals remain functional, albeit partially, and most are only partially accessible to patients.”

After the latest evacuation order, CNN filmed in the main route out of Gaza City – al-Rasheed street – toward what the IDF has described as “safe areas.” It was virtually empty. A CNN stringer in Gaza City, himself now displaced, said that many people had taken backstreets for fear of being targeted on the main road.

Saleh was one young man who was trying to go in the opposite direction, into Gaza City, describing himself as “fed up with this war, fed up with everything.” But he and a few others with him encountered Israeli tanks and infantry.

“We ran away from them, but there was a sniper who started shooting at us. The soldiers dismounted from the tank, and we kept running while the tanks pursued us.”

Saleh received a gunshot wound to the stomach but escaped to the coast where he said he took cover until the tanks left the area.

Besides the obvious dangers in moving from one part of Gaza to another, the constant displacements make it harder for aid agencies to target the provision of food. The World Food Programme said Monday that “almost half a million people in Gaza face catastrophic levels of hunger. Due to unreliable access and limited stocks, families often don’t receive the full rations and frequency they need.”

OCHA said that the evacuation orders complicate the logistical challenge of distributing aid. It said that between July 1 and 4, only one of 13 planned humanitarian assistance missions coordinated with the Israeli authorities to northern Gaza was facilitated, with the others impeded or cancelled. The situation in the south was better, with 43 out of 55 missions facilitated by the Israeli authorities.

The Norwegian Refugee Council says that as people fled Khan Younis last week many spent the first night sleeping in the open, next to their belongings.

“Others walked very long distances, carrying their children and anything they could bring with them,” said Maysa Saleh, an NRC Education Officer in Deir al-Balah.

“Everything is tightening around them ... the first question every morning is the same: what are we going to eat today?”

“Tents have also virtually run out,” Saleh said. “The other day, I saw a tent made out of empty fabric rice sacks sewn together.”

“There are so many children scattered around the streets, you walk around and see children living there because that’s their home now.”

The NRC echoes OCHA’s estimate that some 250,000 people have fled Khan Younis “mainly to overcrowded western areas and Deir al-Balah.”

It said evacuation orders “lack assurances of safety, adequate accommodation, or return once hostilities end for those forced to relocate.”

UNRWA’s senior communications officer Louise Wateridge described her journey through Khan Younis on Monday in a post on X.

“Makeshift shelters as far as you can see, families collecting water, children searching through trash for things to eat, sell or burn to cook on,” she wrote. — CNN