The Health Ministry in Gaza said on Sunday that at least 274 Palestinians, including dozens of children, were killed and hundreds more injured in the Israeli raid that rescued four hostages held by Hamas, while the army claimed its forces came under heavy gunfire during the complex daytime operation deep in the area.

The large number of Palestinians killed in a raid that Israelis celebrated as an astonishing success because all four hostages were rescued alive reflects the steep cost of such operations, along with the already high casualties from the ongoing war that Hamas ignited during the October 7 attack.

The operation in the heart of Nuseirat, a refugee camp in central Gaza dating back to the Arab-Israeli War of 1948, was the biggest rescue operation since October 7, when Hamas and other militants breached the border, killing around 1,200 people, mostly civilians, and taking about 250 hostages.

Dozens of hostages are believed to be held in densely populated areas or inside a maze of Hamas tunnels, making rescue attempts extremely complicated and risky. A February raid saved two hostages and resulted in the deaths of 74 Palestinians.

The massive Israeli assault has claimed the lives of more than 36,700 Palestinians, according to the Health Ministry, which does not differentiate between civilians and fighters in its statistics. It said that 64 children and 57 women were killed in the latest raid, and 153 children and 161 women were among about 700 injured.

Scenes of horror in Gaza hospital

In Gaza, paramedics described scenes of chaos following the raid, as overcrowded hospitals were already struggling to treat injured people from the violent Israeli bombardments in the area.

Karen Hoester of Médecins Sans Frontières, an international charity working in the U.S., said at Al-Aqsa Martyrs Hospital, "We had a series of war injuries, trauma wounds, from amputations to eviscerations to traumas, to painful brain injuries, fractures, and clearly, major burns."

Graying children from shock, burned, screaming for their parents. Many of them are not screaming because they are in shock.

The Israeli army said it attacked what it claimed were "threats to our forces in the area," and that a special forces officer was killed in the rescue operation.

Israeli Army spokesperson Admiral Daniel Hagari told reporters on Saturday that the hostages were held in two apartments about 200 meters (219 yards) apart. He added that the forces moved simultaneously in both areas. He noted that rescuers faced heavy gunfire as they exited, including from militants who fired rockets. He added that the army responded with extreme force, including airstrikes.

Israeli Foreign Minister Israel Katz criticized critics of the operation in a post on X, saying: "Only Israel's enemies complained about the human losses among Hamas terrorists and their accomplices."

Within Israel, local media has focused heavily on Israeli casualties, hostages, and military efforts, with relatively little coverage of the situation of Palestinians in Gaza.

"My brother died of grief"

Israelis celebrated the return of Noa Argamani (26 years old); Almog Meir Jan, 22; Andrei Kozlov, 27; and Shlomi Zeif (41 years old).

Argamani was one of the most well-known hostages after being abducted, along with the other three hostages, from a music festival. Her mother, Liora, who is in the late stages of brain cancer, posted a video pleading to see her daughter.

Argamani's father told the army radio that the reunion with her mother was "extremely difficult," as Liora "was unable to express her feelings and could not say what she was waiting to say to Noa."

Dina, aunt of Meir Jan, said his father died on Friday, just hours before the operation. She told Israeli public radio "Kan": "My brother died of grief."

Dr. Itai Bisach at Sheba Hospital, where the released hostages were being treated, said none of them had suffered serious physical injuries, and it was likely to take days before they could leave the hospital. He told reporters that they lost friends and family, and staff were "helping them reconstruct the infrastructure of their lives."

There are still about 120 hostages, with 43 confirmed dead, after approximately half of them were released in a week-long ceasefire in November. Israeli forces recovered the bodies of at least 16 people, according to the government. Among the survivors are about 15 women, two children under five, and two men in their eighties.

However, Hagari admitted on Saturday that the army cannot conduct operations to rescue everyone.

What lies ahead

The recent rescue operation boosted morale in Israel amid deep divisions over the best way to bring back the hostages. Many Israelis are urging Netanyahu to adopt a ceasefire agreement announced by U.S. President Joe Biden last month, but far-right allies threaten to topple his government if he does so. Hours after the hostages were rescued, thousands of Israelis again gathered to protest the government and call for a deal.

Defense Minister Benny Gantz, a popular centrist member of Israel's three-member war government who threatened to resign from the government if a new war plan was not adopted by Saturday, is scheduled to speak later on Sunday. Netanyahu urged him on Saturday not to resign.

U.S. Secretary of State Antony Blinken is set to return to the Middle East this week, seeking a breakthrough in ceasefire efforts. U.S. National Security Advisor Jake Sullivan told CNN that mediators Egypt and Qatar have not received any official word from Hamas regarding the proposed deal. In a separate interview with CBS, Sullivan did not mention whether Biden would meet with Netanyahu when he comes to Washington next month to address Congress.

International pressure on Israel is mounting to limit civilian bloodshed in its war in Gaza. Palestinians are also facing widespread hunger as fighting and Israeli restrictions have severely disrupted the flow of aid.