♪ ♪ ♪ >> wherever you are around the world, thank you for joining us on cnn. i am john vause in atlanta with our ongoing coverage of israel's war with hamas. for the first time since israel declared war on hamas, a few hundred people hosting foreign passports and a few dozen seriously wounded palestinians have arrived in egypt from gaza. for weeks, many have been waiting at the rafah crossing on the border with egypt. the two other border crossings into israel remain closed. israel and egypt agreed to open the order after negotiations brokered by the u.s. and qatar, which allowed hundreds more to leave in the hundreds -- coming days. the u.s. state department believes 1000 americans and their families are stuck inside gaza, trying to get out. here is the u.s. president, joe biden. >> we are in a situation where safe passage for wanted palestinians and foreign nationals takes -- from gaza has started. the american citizens are able to exit today as part of the first group of probably over 1000. we will see more of this process going on in the coming days. working nonstop to get americans out of gaza as soon and as safely as possible. >> aid worker was one of two americans among the 361 people who left costco on wednesday. her niece spoke to cnn soon after her aunt arrived on egypt. >> i think there is still frustration from many who are still there. i don't think -- we understand the complexity of the negotiation and we were not privy to the nuances of that, and so, we just remain incredibly grateful, but we also do call upon our government to continue evacuating other dual citizens, other americans, to other also hopefully call for a cease-fire. because this is -- for the last couple of days, we were growing very desperate. we were hearing from her that there were limited foods, starting to ration, people had illnesses, and she was relatively protected given her status as an aid worker, but we know that that is not the situation everyone else is in. >> the agreement also called for dozens of wanted palestinians to be evacuated to egypt for immediate medical attention. that does not apply to wounded hamas fighters. for the second time in as many days, the jabalia refugee camp has been hit by an israeli airstrike. the idf claims a hamas count center was the target. at least 80 people were killed, according to hospital officials. u.n. human rights office says the scale of destruction and high civilian casualties, quote, could amount to war crimes. for more on the opening of the rafah crossing, here is cnn's melissa bell, reporting in from cairo. >> a tired small aisle and a wave. from one of the lucky few, finally allowed to leave gaza since the war began. these families just some of the first foreign and dual nationals finally permitted through the rafah crossing into egypt on wednesday. the result of a deal brokered by qatar between israel, hamas, egypt, and the united states, that will allow all foreign and dual nationals to leave the besieged enclave. also allowed to leave under the deal, the first palestinians, 81 of the most severely wounded, those desperate enough for urgent surgical intervention taken, one by one in a convoy of ambulances, to a field hospital set up a few miles away, and to other hospitals in northern egypt. [sirens] large crowds of foreign nationals have been massing at the border after hearing at the start of the conflict that they'd be allowed out. families desperately checking to see if they were some of those lucky enough, finally, to get through. [interpreter] i am an american living in gaza, we heard the crossing is open. unfortunately, we discovered that it was open for specific nationalities at the moment. we had to turn back, because the cellular network was down, and we weren't aware that there was a list. we hope to see our names on the list tomorrow, or the next day. >> as the only crossing from gaza to anywhere other than israel, all eyes have been on rafah, ever since the total siege of the strip was announced by israel. it is the only way in and out now, and what's gone in has been painfully little, a further 20 trucks arriving on wednesday, a drop in the ocean, said aid organizations, given the needs on the side. for some here, it's been days or even weeks of waiting and praying. with ever dwindling supplies and under the constant fear of israeli strikes, even here in the south, where civilians have been told by the idf to evacuate. nowhere in gaza in safe. so finally, for a small few, a chance to leave and live again. melissa bell, cnn, cairo. >> cnn's clare sebastian covering all of this now from london. 361 people out of about 2 million people remain stuck in gaza, clearly not a lot of people allowed out. this has taken so very long to get this rafah crossing open. what has been the issue? why has it taken so long to get these people out? >> john, three and a half weeks since the start of this war, and as melissa pointed out in her report, all eyes have been on that one crossing, given that israel has taken off the table any chance of reopening the other two crossings between gaza and israel. the negotiations from a u.s. official, were extremely delicate. hamas was insisting that as part of this wounded palestinians were allowed out. that did happen, of course. [inaudible] the u.s. officials said it took a lot of convincing to get israel to approve the list of palestinians that were allowed out. then, we have the logistical, bottlenecks, complications that egypt has to vet each palestinian, each wounded palestinian refugee that was taken out. we understand now 45 of them are receiving treatment and egyptian hospitals. that is a very small number, given that we know north of 22,000 palestinians have been injured so far in this conflict. these were assessed to be some of the most acute injuries, but those were just some of the factors and these negotiations. john, the issue of uninsured palestinian refugees getting out of the gaza strip is still not on the table, and these negotiations right now are only discussing about foreign passport holders, dual nationals that want to get out, as well as a potentially injured people. extremely delicate. separately, the qatar brokered negotiations on hostages are still ongoing, and we know that there are still significant concerns that those negotiations are complicated by the ongoing ground offensive, which is ramping up. the israeli defense minister said on wednesday that there is fierce fighting and gaza city. we understood before this from our assessment that the israeli forces were advancing relatively slowly, but just this morning as well, we saw more evidence of a barrage of rocket fire over across the city. so, certainly seems that even as the efforts to get people out are in their early stages, that ground offensive just less than an hour's drive north of that, is ramping up. >> clare, thank you. clare sebastian for us live with the very latest from london. israel has confirmed both airstrikes on the jabalia refugee camp. what remains unknown right now is a full extent of the devastation, just how many people were killed in the attacks. cnn's nada bashir has more now, reporting in from jerusalem. [sirens] >> chaos and horror at jabalia refugee camp. wounded children rushed to nearby ambulances. the latest casualties of israel's relentless aerial bombardment. this densely populated neighborhood gripped by panic and sheer disbelief. a second israeli airstrike in less than 24 hours. >> i lost my whole family, abdel al-karim says. holding a list of those killed just today. my sister's house was struck with her children inside. my brother's house too. with all of his children. there is no one left except for me and my younger brother. they were innocent. what did they do to deserve this? israel's defense force says it was targeting a hamas command and control complex in jabalia. hamas fighters are said to be among those killed. but jabalia is home to more than 100,000 civilians, according to the u. n.. and though the full extend of the civilian toll remains unclear at this stage, gaza civil defense authority has described this latest disaster as a massacre, with more casualties and fatalities added to the list of hundreds said to have been killed or wounded in tuesday's airstrike. the situation is beyond belief. many have been killed. bodies have been left burned and charred by the airstrike, this doctor says. there isn't a hospital in the world that can cope with this kind of situation. we're having to treat patients on the floor and in corridors. the scale of the destruction at jabalia is difficult to grasp. many residents are still buried beneath the blackened rubble. rescue workers and civilians dig side by side, desperate to find survivors. this house had 15 people in it, but we still haven't been able to find any of them, this man says. we have no equipment. we are digging alone. northern gaza continues to come under everyone parchment, its residents ordered by israel to evacuate southwards. but airstrikes continue to rain down across both central and southern gaza, to. and for the more 2 million palestinians living under an israeli blockade, the fear is that there is nowhere safe to turn. not up bashir, cnn, jerusalem. >> despite growing concerns over the humanitarian crisis inside gaza and a desperate need for food, fuel, water, and medical supplies, israel says there will be no letup and no pause and its military operation against hamas. at least 59 aid trucks crossed from egypt to gaza on tuesday. more than 200 have made that journey and the past ten days, according to the u.s. state department. but that is just a fraction of what cost was receiving each day before israel imposed a siege and response to the hamas attack last month. for the first time since the war began, the commissioner general of the u.s. relief and works agency, the biggest age group and gaza, has visited the territory and says conditions are even worse than he expected. >> i was shocked by the fact that everyone there was asking for food, was asking for water, we saw almost every children trying to express that they need to wait, they need to have water. >> so far, more than 60 unrwa workers have been killed in gaza since the israeli military operation began. for more now, i am joined by doctor ahmad gilbert, a political activist and clinical director of emergency medicine at the university hospital of north norway. doctor, thank you for being with us. >> thank you, good morning. >> good morning, right now for doctors and medical workers inside gaza, the focus is emergency triage. resources allocated to those who needed the vote, the most seriously wounded. what about treatment for other patients with life-threatening illnesses, those who need kidney dialysis, chemotherapy? what happens to them? >> well, if you are a patient in gaza today, you are in no way granted the treatment you need. in addition to the 22,000 wounded, you have a large number of people with myocardia infractions and kidney failure, diabetes, psychiatric problems. you have 100 part deliveries per day, many of them needing caesarean sections, many heating and computers for their babies. so, it is a huge a large medical under capacity due to the lack of water, fuel, and the large, large number of wounded. and among the wounded, i am particularly concerned about the parents and many burned children. today in shifa, they have more than 100 burned and wounded, with more than 40% burns on their body. these patients are in critical need of cleanliness, four advanced medical treatment. they will die. they don't have these facilities any longer in shifa, so it is a dire crisis. adding to the crisis is the fact that israeli forces are bombing and shooting hospitals. yesterday, the turkish hospital was bombed, which is the central cancer hospital in gaza and cancer patients and gossip will no longer receive their medication due to the destruction of the turkish hospital, yesterday. >> right now, according to human rights watch, there are 50,000 pregnant women and gaza. if they don't receive the neonatal pregnancy care which they would expect to receive at this point, what is their prognosis? what can they expect, medically, in the coming weeks and months? >> well, any woman who has been pregnant knows how nervous and how much you care for the well-being of your baby. of course, this enormous stress of being depressed and being bombed, families split and families that are losing their mothers and fathers and other family members. of course, that is an enormous risk on the pregnant woman. you will see much more premature deliveries with the medical problems for the newborn needing incubators, and you will see pregnant women who will have other types of complications. so, the fertility rate and gaza is quite high, 4 to 5 kids per woman, so these 50,000 pregnant women are very, very, sensitive and vulnerable group that should be cared specifically for. shifa is telling me that they cannot provide the needed care for the newborn, premature babies, because of lack of capacity and water and electricity. and don't forget, in shifa there are around 50,000 -- yes, 50,000, internally displaced civilians that have been seeking refuge in the hospital. and every corridor, every waiting room, every single square of the hospital is filled with these desperate internal five days after is relaunched its ground incursion in gaza, it was really serve going toward gaza city. the infantry has been spotted advancing from both ends of the strip. israeli tanks also appear to be closing in from the south. cnn geolocated this tank at strategic not serene junction. the main road. israel is moving its artillery closer to. gaza >> until recently, this field was filled with artillery positions. you can see these, mounds were howitzer guns are the types of artillery would begin. and now, with israeli forces moving closer into gaza, those artillery positions are also moving closer to support the troops on the ground. now all that remains rvs. boxes of munitions, artillery fuses, used by the forces that were here. [sound of gunfire] >> the question now is how deep israeli forces will move into gaza. >> the only way to get what hamas has built over a decade inside the gaza strip, the only way is through a ground operation. >> jeremy diamond, cnn, ashkelon, israel. >> for more now on israel's military in offensive on gaza, colonel cedric leighton is with us from washington. welcome back. >> good to see you, john. thanks for having me. >> it's always a pleasure. >> i want you to listen to part of a conversation between cnn's -- and idf -- 's about the how explosive power used on that attack. here they are. >> i've been in gaza when the idf has performed surgical strikes. the idf is more than capable of this. this is not that. why not? >> so, i don't think i really agree with what you say because the precision here is to hit the target buried underground. what we did here was to strike with the acquired or acquires or power firepower to get where he was hiding. . >> according to reporting from bloomberg bloomberg, an israeli plane flew with bombs from the united states israel. so in terms of the firepower, which would've been used? these really call these sharp ale. their precise, and used penetrate fortified structures. is that the kind of bombs would be used in this instance? and once that is destroyed, does that explain, essentially, the implosion left behind? the ground sort of imploded, leaving these huge craters there. >> yes, certainly that kind of tb volume could have been used in this particular case. there's also another possibility, in the -- 28 which the israelis have having their inventory for about a decade. he they're type of bomb, either type of g b you, guided munition, could be used and what it does is it hones in on a target, goes for, if it's program park properly, goes to the most vulnerable parts of the target, then detonates on impact, and it's designed to go underground, in some cases up 200 feet, which is clear and useful place for it to go in on a structure like the tunnels that they had put ian in gaza, that hamas is put. there >> and once it explodes, it destroys that infrastructure, which the tunnel was holding up the ground above. it so once that infrastructure is gone, doesn't explain what is left behind? >> it could. depending on how the structures above it are built and what they rest on. it is possible that if the balmy it's exactly right, then it could actually take down above ground structures, and that could indicate exactly not only where things were located but also it could manifest itself in the type of destruction that we see at the rib refugee camp in gaza. >> help us to understand the network of tunnels beneath gaza. here's part of your nationalists from just a few days ago. here we go. >> as far as the tunnels go, they are at a minimum described, it could be up to 300 miles of these, but they're all in this area right in here, particularly in the north and in the upper central part. and then there are some in the south. these are areas in which we can expect to find commanding control notes for hamas, hostages, and also resupply efforts, plus the rockets. >> so 300 miles or so, the hamas metro is almost as big as the new york subway but not as big as the london underground tube. also three different levels, senior leadership on the deepest level below ground, about 75 feet below ground. how difficult is it to target someone that far below ground? and i guess the more powerful the bombs, does that mean the more destruction above? >> yes. generally does, actually. so the more powerful the bomb, depending on the warhead and the exact nature of the grounded it impacts, it could definitely cause destruction above. but normally these bombs are designed to go underground and explode underground, and if the soil is right, it could actually limit the impact above ground. so they are designed to avoid that type of destruction that you often see above ground for a normal type of bombing raid. but yes, the structures below, especially the command structure, 75 feet or so, those are the ones that the prime targets. very difficult to reach. it becomes really indicative of the targeting process how well and how quickly those targets can be prosecuted in air force jargon. >> the idf says the reason they hit this tournament that particular moment, the tunnel beneath the refugee camp, was because of realtime information, saying a hamas leader was. they're putting that one side, is one part of that to flood the tunnels? egypt has flooded cross border tunnels with gaza, which have been used by smugglers. and it seems that actually quite effective. is that actually an option here? for gaza? >> potentially it could be. i think there might be some issues with getting enough water into a tunnel in the combat zone like gaza. egyptians had the luxury of flooding those tunnels without being shot at. the israelis would be shot at it a case like this. so it is one option that is possible. but in this particular case, the more rapid distribution of the targets calls for some kind of aerial attack or a ground mounted attack. so that could be another alternative. but it's not on feasible to flood some of the tunnels, at least. >> colonel, leighton always good to have you with us. thank. you >> thanks for having me. >> internet connections are being restored across gaza, according to net blocks, the internet monitoring site confirming communication and internet service was completely disrupted for eight hours on wednesday. cnn contacted these really military about communication blackout, but we were told no comment. monitoring groups say the internet services have been getting worse since the hamas attack on october 7th. when we come back, hundreds of people now arrived in egypt after gaza