Protests erupted across the Middle East following the deadly explosion at a Gaza hospital, with Israeli and Palestinian officials trading accusations over who was to blame as US President Joe Biden arrived in Tel Aviv.

Hundreds of people were likely killed in the blast on Tuesday at the Al-Ahli Baptist Hospital in the center of Gaza City, where thousands were sheltering from Israeli strikes, the Palestinian Health Ministry said in a statement.

Palestinian officials have blamed Israeli airstrikes for the lethal incident, but Israel has insisted it was not responsible.

In a televised news conference Wednesday, Israeli military spokesman Rear Adm. Daniel Hagari claimed a lack of structural damage at the hospital proved the Israel Defense Forces (IDF) were not involved in the explosion. He claimed IDF intelligence showed that Palestinian Islamic Jihad – a rival Islamist militant group to Hamas in Gaza – caused the explosion when one of its rockets launched at Israel misfired.

Hagari also said the IDF had intelligence of “communications between terrorists” of rockets misfiring, which included mention of the hospital.

Islamic Jihad denied Israel’s assertions describing them as “false and baseless” and claimed it does not use public facilities such as hospitals for military purposes, according to a statement Wednesday.

CNN cannot independently confirm what caused the explosion at the Al-Ahli hospital.

The blast marks a dangerous new phase in Israel’s war with Hamas, which threatens to spill over regionally, and has added to fears that the humanitarian situation in Gaza is spiraling “out of control.”

‘Unparalleled and indescribable’

Dr. Ashraf Al-Qudra, a spokesperson for the Palestinian Ministry of Health in Hamas-controlled Gaza, described “unparalleled and indescribable” scenes after the blast.

“Ambulance crews are still removing body parts as most of the victims are children and women,” Al-Qudra said. “Doctors were performing surgeries on the ground and in the corridors, some of them without anesthesia.”

Video geolocated by CNN from inside the al-Shifa Hospital, where some victims of the blast were taken, shows chaotic scenes with injured people packed into the crowded facility, doctors treating the wounded on the hospital floor and an emergency worker calling out as he carries an injured child.

Images show women crying out and terrified children covered in black dust huddled together on the hospital floor.

The Palestinian Health Ministry said that at least 471 people died and more than 300 were injured, in a statement on Wednesday.

Ghassan Abu-Sitteh, a doctor working with Médecins Sans Frontières, who was inside the hospital at the time of the blast,

Another witness, Adnan, told CNN the devastation that followed the blast was “beyond normal.”

“If you look over there on the roads, there are body parts all over it, heads and hands of people, hands and brains of children,” said Adnan, who would give only his first name. “It is truly indescribable.”

Calling the incident “unacceptable,” UN Human Rights chief Volker Turk said hospitals are sacrosanct and the killings and violence must stop.

“Words fail me. Tonight, hundreds of people were killed – horrifically – in a massive strike… including patients, healthcare workers and families that had been seeking refuge in and around the hospital. Once again the most vulnerable,” Turk said in a statement.

Anger and protest spread

The blast has added fuel to rising anger in the region over the situation in Gaza.

Protests condemning the hospital explosion have erupted in multiple cities across the Middle East and North Africa, including in Jordan, Lebanon, Iraq, Iran and Tunisia. Protests also rocked the occupied West Bank city of Ramallah as demonstrators clashed with Palestinian security forces.

There were also protests in Baghdad on Tuesday, where hundreds of protesters attempted to cross a bridge leading to the area that houses the US Embassy. The demonstrators, who were chanting anti-Israel slogans, were stopped by security forces.

In Lebanon, hundreds of protesters gathered in the square that leads to the US Embassy in Awkar, which is just north of the capital Beirut, and tried to break through security barriers, according to a CNN team there.

Protests continued on Wednesday when pro-Palestinian demonstrators had skirmishes with police near the US Embassy. Police fired tear gas and used water cannons against the protesters, according to local media and video footage released by AFP.

The US Embassy in Beirut advised Americans to avoid the Awkar area due to the protests, in a security alert on Wednesday.

Antisemitic attacks have also been on the rise. In Germany, security services are investigating after two Molotov cocktails were thrown in the direction of a Berlin synagogue in the early hours of Wednesday.

Diplomatic fallout

The fallout from the blast threatens to derail US diplomatic efforts to ease the humanitarian suffering in Gaza, where concerns are mounting over Israel’s deprivation of food, fuel and electricity to the enclave.

More than a week of Israeli bombardment has killed at least 3,478 people and injured 12,500 in Gaza, according to Palestinian authorities.

President Biden’s high-security wartime visit to Tel Aviv to meet Israeli Prime Minister Benjamin Netanyahu marks his most forceful public show of support for Israel since the brutal October 7 Hamas attacks, in which the Islamist militant group killed at least 1,400 people and took more than 150 hostages, including children and the elderly.

Biden told the Israeli leader in a meeting on Wednesday that the hospital attack “appears as though it was done by the other team, not you.”

“But there’s a lot of people out there not sure,” he added.

Biden was scheduled to visit the Jordanian capital Amman after his trip to Tel Aviv, though a White House official said the trip was “postponed.”

Jordan canceled a planned Wednesday summit between Biden and the leaders of Jordan, Egypt and the Palestinian Authority. Palestinian Authority President Mahmoud Abbas pulled out of the meeting earlier Tuesday in the immediate aftermath of the explosion.

Several nations, including Saudi Arabia, Jordan, Egypt and the United Arab Emirates have released statements condemning Israel following the explosion. Pakistan called it “inhumane and indefensible” and Palestinian observer to the UN Riyad Mansour said Israeli officials were being dishonest in blaming Islamic Jihad.

Nowhere is safe

The hospital tragedy comes as health services in Gaza are on the brink, with no fuel to run electricity or pump water for life-saving critical functions. UN agencies have warned that stores are less than a week away from running out of food stocks and that Gaza’s last seawater desalination plant had shut down, bringing the risk of further deaths, dehydration and waterborne diseases.

While the IDF has said it does not target hospitals, the UN and Doctors Without Borders say Israeli airstrikes have struck medical facilities, including hospitals and ambulances.

Conditions are dire for the 2.2 million people caught in the escalating crisis and now trapped in Gaza and those on the ground warn that nowhere is safe from relentless Israeli airstrikes and the rapidly deteriorating humanitarian situation.

Urgent calls for help are mounting and diplomatic efforts to secure a humanitarian corridor out of Gaza have ramped up in recent days.

Following Biden’s remarks in Tel Aviv, Netanyahu’s office said Israel will not block humanitarian aid going into Gaza from Egypt but it won’t not allow supplies into Gaza from its own territory until Hamas releases all hostages.

“In light of President Biden’s demand, Israel will not block humanitarian aid deliveries, as long as they consist water, food, and drugs for the civilian population in the southern Gaza Strip … and as long as the aid doesn’t reach Hamas,” the statement said.

The Rafah border crossing – the only entry point in and out of Gaza that Israel does not control – has remained extremely dangerous since the outbreak of hostilities.

On the Egyptian side of the crossing, a miles-long convoy of humanitarian assistance is awaiting entry into Gaza, Egyptian Foreign Minister Sameh Shoukry told CNN Tuesday, explaining that until then no safe passage had been granted.

He added that the crossing was bombed four times in the past few days.

The situation in Gaza is now spiraling “out of control,” World Health Organization Director-General Tedros Adhanom Ghebreyesus warned on Wednesday.

Tedros said that WHO’s supplies have been stuck at the border for four days, adding “every second we wait to get medical aid in, we lose lives.”