TEL AVIV — The striking by Iran of the Soroka Medical Center in Beersheba underscores the unrelenting nature of the war between Israel and Iran one week into hostilities and as all sides wait on word from Washington.

Rockets from the Islamic Republic served as brusque alarm clocks for Israelis on Thursday morning, as alerts sounded through the length and breadth of the country. Soroka, in the south of the Jewish state, is the first hospital to have sustained direct hits from Iranian ballistics. An evacuation of patients and personnel on Wednesday likely saved hundreds of lives. 

Soroka has some 1,000 beds and serves about a million residents of Israel’s southern region. Prime Minister Netanyahu vowed, “We will exact the full price from the tyrants in Tehran.” 

Images of Soroka disclose a floor that has completely collapsed and extensive damages to much of the medical complex. Early reports list 44 injured, though a search and rescue operation is under way for survivors who might be buried in the rubble. The official Telegram account of Iran’s Revolutionary Guards called Soroka a “military hospital,” but it is devoted to civilian use.     

Israel’s defense minister, Yisrael Katz, declared after the strike on the hospital that “a dictator like Khamenei, who heads a country like Iran and has made the destruction of Israel his mission, cannot continue to exist. The IDF has been instructed and knows that in order to achieve all of its goals, this man absolutely should not continue to exist.” 

Mr. Katz added that the Iranian regime is committing “war crimes.” A general and politician in the opposition, Benny Gantz, explains on X that “while Israel targets Iran’s nuclear and missile programs that threaten not only us but the whole world, Iran targets Israeli hospitals and children.”

The IDF’s targets on Wednesday included a heavy water nuclear reactor at Arak. The military explained that it “targeted the component intended for plutonium production, in order to prevent the reactor from being restored and used for nuclear weapons development.” Iranian television reports that “no radiation danger whatsoever” has been detected from the strike.

Also on Wednesday Iranian state television was briefly hacked, with protest footage and calls for resistance to the regime beamed into homes across the Islamic Republic. A logo associated with Israel’s operation, “Rising Lion,” was pinned to the corner of the screen. This came after an IDF missile struck the country’s broadcasting headquarters. The regime, in an official statement, told its citizens, “If you see unrelated images, it is due to satellite signal interference by the Zionist enemy.” 

All eyes in the Middle East are on the White House, where President Trump would only say on Wednesday in respect of joining Israel in its war with Tehran: “I may do it, I may not do it. The next week is going to be very big, maybe less than a week.” He added: “I have ideas on what to do but I haven’t made a final — I like to make the final decision one second before it’s due.” 

The Wall Street Journal reports that the 47th president has approved attack plans for Iran but that he has not yet issued his final approval. Secretary Hegseth, testifying before Congress on Wednesday, said that the Pentagon was working “to ensure everything at our disposal is available to ensure maximum force protection against any contingency.” That includes a shifting of military assets toward the region. 

As Mr. Trump weighs whether to join the fray — perhaps by unleashing America’s bunker-busting bombs on the Fordow nuclear site — Iran’s deputy foreign minister, Majid Takht-Ravanchi, told CNN on Wednesday: “If the Americans decide to get involved militarily, we have no choice but to retaliate wherever we find the targets necessary to be acted upon.” 

Iran’s missiles on Wednesday battered Israel’s central region as well as its south. A suburb of Tel Aviv, Ramat Gan, was once again hit, and this correspondent could hear the boom of intercepted rockets over Tel Aviv on both Wednesday night and Thursday morning. America’s ambassador to Israel, Mike Huckabee, explained on X: “We’re working to get military, commercial, charter flights & cruise ships for evac. If you’re offered a seat, take it.”