At least 274 Palestinians were killed and hundreds more were wounded in the Israeli raid that rescued four hostages held by Hamas, Gaza's Health Ministry says.
The military on Sunday said its forces came under heavy fire during the complex daytime operation deep inside the territory.
The killing of so many Palestinians, including women and children, in an operation that Israelis celebrated as a stunning success because all four hostages were rescued alive, showed the heavy cost of such operations, on top of the already soaring toll of the eight-month-long war ignited by Hamas' October 7 attack.
Scores of hostages are believed to be held in densely populated areas or inside Hamas' labyrinth of tunnels, making such operations extremely complex and risky. A similar raid in February rescued two hostages while leaving 74 Palestinians dead.
The complex raid deep into Nuseirat, a built-up refugee camp in central Gaza dating back to the 1948 Arab-Israeli war, was the largest rescue operation since October 7, when Hamas and other militants stormed across the border, killing some 1200 people, mostly civilians, and taking around 250 hostage.
Israel launched a massive offensive in response that has killed over 36,700 Palestinians, according to the ministry, which does not differentiate between civilians and combatants in its counts.
It said nearly 700 people were wounded in Saturday's raid. The ministry did not say how many of the casualties were women and children, but Associated Press reporters saw several being treated at the Al-Aqsa Martyrs Hospital in the nearby town of Deir al-Balah in the aftermath of the raid.
Israelis celebrated the return of Noa Argamani, 26; Almog Meir Jan, 22; Andrey Kozlov, 27; and Shlomi Ziv, 41, after Israeli forces raided two locations at once while under fire.
Argamani had been one of the most widely recognised hostages after being taken, like the three others, from a music festival. The video of her abduction showed her seated between two men on a motorcycle as she screamed, "Don't kill me!"
Her mother, Liora, who has brain cancer, had released a video pleading to see her daughter. Israel's Channel 13 said Argamani was moved to the hospital where her mother is treated.
In Gaza, medics described scenes of horror and chaos as wounded people poured into nearby hospitals that were already struggling to treat the wounded from days of heavy Israeli strikes in the area.
"We had the gamut of war wounds, trauma wounds, from amputations to eviscerations to trauma, to TBIs (traumatic brain injuries), fractures, and obviously, big burns," said Karin Huster of Doctors Without Borders, an international charity working in the Al-Aqsa Martyrs Hospital, one of the facilities that received dead and wounded.
"Kids completely grey or white from the shock, burnt, screaming for their parents. Many of them are not screaming because they are in shock."
The Israeli military said it had attacked "threats to our forces in the area," and that a special forces officer was killed in the rescue operation.
Israel's military spokesman, Rear Admiral Daniel Hagari, told reporters on Saturday that the hostages were being held in two apartments, about 200 metres away from each other, in the heart of the Nuseirat camp.
He said the forces had trained repeatedly on a model of the apartment buildings.
Hagari said the forces moved in simultaneously in broad daylight on both apartments, believing this ensured the best element of surprise.
But he said the rescuers came under heavy fire as they moved out, including from gunmen firing rocket-propelled grenades from within the neighbourhood.
He said the military responded with heavy force, including from aircraft, to extract the rescuers and freed hostages.
Israel's Foreign Minister Israel Katz lashed out at critics of the operation in a post on X.
"Only Israel's enemies complained about the casualties of Hamas terrorists and their accomplices," He said.
Of the 250 hostages abducted on October 7, about half were released in a weeklong ceasefire in November.
About 120 hostages remain, with 43 pronounced dead. Survivors include about 15 women, two children under 5 and two men in their 80s.
Saturday's operation brought the total number of rescued hostages to seven, including one who was freed shortly after the October attack. Israeli troops have recovered the bodies of at least 16 others, according to the government.
The latest rescue lifted some spirits in Israel as divisions deepened over the best way to bring hostages home.
Many Israelis urge Netanyahu to embrace a ceasefire deal US President Joe Biden announced last month, but far-right allies threaten to collapse his government if he does.
Civilians flee in Rafah as Israel pushes ahead with its offensive
Netanyahu, whose support has fallen, rushed to the hospital to greet the freed hostages and his office released a stream of photos and videos of him meeting the families.
But thousands of Israelis again gathered on Saturday evening for the latest anti-government demonstration and calls for a ceasefire agreement.
It was unclear what effect the rescue might have on apparently stalled ceasefire efforts.
US Secretary of State Antony Blinken will return to the Middle East next week, seeking a breakthrough.
International pressure is mounting on Israel to limit civilian bloodshed in its war in Gaza. Palestinians also face widespread hunger because fighting and Israeli restrictions have largely cut off the flow of aid.
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