DEIR AL-BALAH, Gaza Strip — More than 46,000 Palestinians have been killed in the Israel-Hamas war, Gaza’s Health Ministry said Thursday, with no end in sight to the 15-month conflict.

The ministry said a total of 46,006 Palestinians have been killed and 109,378 wounded. It has said women and children make up more than half the fatalities, but does not say how many of the dead were fighters or civilians.

The Israeli military says it has killed over 17,000 militants, without providing evidence. It says it tries to avoid harming civilians and blames Hamas for their deaths because the militants operate in residential areas. Israel has also repeatedly struck what it claims are militants hiding in shelters and hospitals, often killing women and children.

In recent weeks, Israel and Hamas have appeared to inch closer to an agreement for a ceasefire and the release of hostages. Secretary of State Antony Blinken said this week that a deal is “very close” and he hopes to complete it before handing over U.S diplomacy to the incoming Trump administration.

But he and other U.S. officials have expressed similar optimism on several occasions over the past year, only to see the indirect talks stall.

The war began when Hamas-led militants stormed into Israel on Oct. 7, 2023, killing some 1,200 people, mostly civilians, and abducting around 250. Some 100 hostages are still inside Gaza. Israeli authorities believe at least a third of them were killed in the initial attack or have died in captivity.

The war has flattened large areas of Gaza and displaced around 90% of its 2.3 million people, with many forced to flee multiple times. Hundreds of thousands are packed into sprawling tent camps along the coast with limited access to food and other essentials.

“What we are living is not a life. Nobody could bear the situation we’re experiencing for a single day,” Munawar al-Bik, a displaced woman, told The Associated Press in an interview this week.

“We wake up at night to the sounds of men crying, because of the bad situation,” she said. “The situation is unbearable. We have no energy left: we want it to end today.”

Al-Bik spoke on a dusty road in the southern city of Khan Younis next to a destroyed building. Behind her, a sea of makeshift tents filled with displaced families stretched into the distance.

On Thursday, dozens of people took part in funeral prayers outside the Al-Aqsa Martyrs Hospital in the central Gaza city of Deir al-Balah for people killed in Israeli strikes the day before.

In the hospital morgue, a man could be seen kneeling and bidding farewell to a relative before slamming a refrigerator door in an outburst of grief.

Palestinian health officials said Israeli airstrikes killed at least nine people in Gaza on Wednesday, including three infants — among them a 1-week-old baby — and two women.

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Khaled reported from Cairo.