Israel kept pounding the shattered Gaza Strip on Tuesday while Yemen's pro-Palestinian Houthi movement vowed to defy a U.S.-led naval mission and keep hitting Israeli targets in the Red Sea.

Israel's campaign to eradicate Hamas terrorists behind an Oct. 7 massacre has left the coastal enclave in ruins, brought widespread hunger and homelessness, and killed nearly 20,000 Gazans, according to a Palestinian tally.

Under foreign pressure to avoid killing innocents, Israel's Prime Minister Benjamin Netanyahu says the war will not stop until a remaining 129 hostages are freed and Hamas is obliterated after its fighters' slaying of 1,200 Israelis.

The conflict has spread beyond Gaza into the Red Sea where Yemen's Iran-aligned Houthi group has been attacking vessels with missiles and drones. That has prompted the creation of a multinational naval operation to protect commerce in the area, but the Houthis said they would carry on anyway.

"Our position will not change in the direction of the Palestinian issue, whether a naval alliance is established or not," Houthi official Mohammed Abdulsalam told Reuters, saying only Israeli ships or those going to Israel would be targeted.

"Our position in support of Palestine and the Gaza Strip will remain until the end of the siege, the entry of food and medicine, and our support for the oppressed Palestinian people will remain continuous."

Announcing the naval operation, Defense Secretary Lloyd Austin said in Bahrain joint patrols would be held in the southern Red Sea and Gulf of Aden which encompass a major East-West global shipping route. "This is an international challenge that demands collective action," he said.

British maritime security firm Ambrey said on Tuesday it received information of a potential boarding attempt 17 miles west of Yemen's Aden port city, adding that the attack was unsuccessful and all crew were safe.

Some freight firms are re-routing around Africa.

Deaths Mount

In Gaza, Israel's latest missiles hit the southern Rafah area, where hundreds of thousands of Palestinian refugees have amassed in recent weeks, killing at least 20 people and wounding dozens of others, according to local health officials.

Residents said they had to dig in the rubble with bare hands.

"This is a barbarian act," said Mohammed Zurub.

Among the dead was Palestinian journalist Adel Zurub and several members of his family, medics said. That raised the number of Palestinian journalists killed to 97, according to the Hamas-run government media office.

Another strike killed 13 people and wounded about 75 in northern Jabalia, Gaza health ministry spokesperson Ashraf Al-Qidra told Reuters.

One Jabalia resident, who asked not to be named, said he thought refugees were being punished for refusing to comply with Israeli orders to leave the area.

"There is no food, no water, no medicine and no hospitals to take the wounded and patients too. People die in their homes and in the streets," he added.

Israel says it warns of strikes in advance so civilians can escape, and it accuses Hamas of hiding in residential areas.

In the ground war, where Israel has lost 132 soldiers, tanks advanced further into the southern city of Khan Younis and shelled a market area but met heavy resistance, residents said.

Thousands of Hamas fighters, based in tunnel networks, are waging guerrilla-style war against the Israeli soldiers.

"The IDF (Israel Defense Forces) is continuing to operate against Hamas terrorist infrastructure and operatives in the Gaza Strip," the Israeli military said in a statement.

The Hamas terrorist-run Gaza health ministry said Monday that 19,453 Palestinians had been killed and 52,286 wounded since Oct. 7.

U.N. officials voiced disbelief about the situation in Gaza's hospitals, which lack supplies and safety.

"I'm furious that children who are recovering from amputations in hospitals are then killed in those hospitals," said James Elder, spokesperson for the U.N. children's agency, saying Nasser Hospital, the largest operational one left in the enclave, had been shelled twice in the past 48 hours.