In spectacular fashion, Israel has upended peace talks and brought to a dramatic end the ceasefire that had paused 15-months of carnage and devastation to the embattled Gaza Strip,.

Israeli fighter jet pilots swarmed over Gaza in the early hours of Tuesday morning bringing renewed terror to the more than 2 million displaced Palestinians, already starved of food, electricity and water.

The death toll prior to Tuesday's attacks was already approaching 50,000 most of them women and children. Israeli pilots took out more than 100 people in the opening salvos of Tuesday's bombing blitz, many of them children, according to health officials quoted by Reuters news agency. At last count according to Gazan health officials, the death toll has soared to 326, however the number is expected to be higher once bodies are retrieved from the rubble.

"It's been absolutely horrific. Nothing close to anything I've experienced before...multiple explosions within just a span of a few minutes back-to-back," Dr. Razan Al-Nahhas at the Al-Ahli Hospital in Gaza City, told CNN Tuesday.

An IDF official said the Israeli military was targeting the group's "mid-ranking military commanders, leadership officials and terrorist infrastructure." But at her hospital, Al-Nahhas said the majority of those killed were women and children.

"I just was taking care of a seven-year-old boy who was gasping and taking his final breaths and begging me to try to save him, because they're telling me that his entire family was killed. Multiple siblings, parents. But the majority of cases that we've seen tonight are children," she said.

"In accordance with the political echelon, the IDF and ISA are currently conducting extensive strikes on terror targets belonging to the Hamas terrorist organization in the Gaza Strip," the Israel Defense Forces said in a statement Tuesday.

Officials say hundreds of targets were hit and the campaign will likely extend beyond air strikes.

The surprise attack was sanctioned by U.S. President Donald Trump, with the White House announcing that the administration was consulted prior. The White House in fact issued a statement strongly supporting the attacks despite being during the Muslim holy month of Ramadan. 

"As President Trump has made clear, Hamas, the Houthis, Iran, all those who seek to terrorise not just Israel but the U.S., will see a price to pay, and all hell will break loose," White House Press Secretary Karoline Leavitt told Fox News.

"The Houthis, Hezbollah, Hamas, Iran and Iranian-backed terror proxies should take President Trump very seriously when he says he's not afraid to stand for law-abiding people and stand up for the U.S. and our friend and ally Israel."

"We call on the mediators to assign full responsibility on Netanyahu and Israel for violating the cease-fire agreement," Hamas said in a statement Tuesday. The group called on the Arab League for support, while also asking the UN Security Council to intervene.

The U.S. meantime is continuing its attacks on Yemen's Houthis following their threat to resume their attacks on Israeli ships in the Red Sea if it did not reverse its decision to block all humanitarian aid to Gaza. Within days of that threat President Trump launched a bombing campaign on targets in Yemen which have killed scores of people. This despite the fact that the Houthis have not targeted any ships since the Gaza ceasefire began.

(File photo).