Israel’s attack in the southern Gaza city of Rafah has expanded from airstrikes to ground operations, new satellite images obtained by CNN from Planet Labs show. The images, which bear a striking resemblance to the early stages of Israel’s ground invasion of Gaza last year, show the Israel Defense Forces (IDF) are active outside of the immediate border crossing area between Egypt and Gaza, which Israel took control of on Monday evening. The images, which span from May 5 to 7, suggest some buildings have been bulldozed and show what appear to be mustering areas for IDF vehicles. Some of the IDF forces have penetrated more than a mile inside the Palestinian enclave from the Rafah crossing gate, the images also show. The build-up comes despite intense international pressure on Israel not to move in on Rafah. On Wednesday, US President Joe Biden for the first time said he would halt some shipments of American weapons should Israeli Prime Minister Benjamin Netanyahu order a major invasion of the city. These Israeli ground operations follow a series of airstrikes on Rafah that have completely destroyed several buildings in the past 24 hours, and killed at least four people, according to a local hospital. Satellite images suggest these strikes are continuing, with one picture showing smoke still rising from one location. People could be seen running through the streets of Rafah in the aftermath of a strike on Wednesday in other footage obtained by CNN. Several carried children in their arms, some apparently bleeding and unconscious, towards Al Kuwaiti hospital. CNN footage also showed panicked children arriving in ambulances without their parents and one barely responsive child with a heavily bandaged arm being carried on a stretcher. Two body bags were also visible outside the hospital. Four people were killed and around two dozen injured by Israeli airstrikes in the Tal Al Sultan neighborhood in western Rafah on Wednesday, the hospital said. CNN has reached out to the Israeli military for comment on the incident. Rafah has become the central focus of Israel’s war in Gaza, as Netanyahu faces growing pressure from the extreme wing of his coalition to launch a full-scale ground operation in the city to destroy Hamas, while the more moderate wing has urged him to prioritize securing a ceasefire-for-hostages deal. During nearly seven months of war, more than 1 million Palestinians have fled to Rafah, where Hamas is believed to have regrouped after Israel’s destruction of much of the strip’s north. Gazans began fleeing the densely populated city on Monday after Israel’s military issued a call for residents in the east of Rafah to “evacuate immediately.” In the satellite images, some areas in Rafah show the tell-tale signs of being razed by bulldozers and other heavy machinery – vehicle tracks and large swaths of disturbed earth. The new operations shown by the satellite images resemble the initial ground invasion of Gaza back in October 2023, and in other parts of the enclave since then: When the IDF moved into northern Gaza, it carried out a series of airstrikes shortly before moving ground forces in. Once IDF ground forces did move in, armored bulldozers worked with tanks and other military vehicles to bulldoze and raze buildings. The IDF said in a statement on Wednesday that it was conducting a “precise counterterrorism operation in specific areas of eastern Rafah,” which included “targeted raids.” It also claimed to have “eliminated terrorists and uncovered terrorist infrastructure, as well as underground shafts in several locations in the eastern Rafah area.” The IDF has released footage of its 401st Brigade Combat team conducting “operational raids on suspicious buildings” near to where it said its soldiers had been fired on by Hamas militants. The IDF said that during the operation it “eliminated about 30 terrorists and destroyed large amounts of terrorist infrastructure in the region.” CNN previously confirmed through hospital sources in Rafah that at least 35 people had died in Rafah since Monday evening, including seven women and nine children. More than 34,600 people have been killed in Gaza since October, according to Palestinian authorities in Gaza. Aid agencies have been warning Israel against launching a full-scale ground invasion of Rafah, saying “any ground operation would mean more suffering and death” for the 1.2 million displaced Palestinians sheltering in and around the city, OCHA spokesperson Jens Laerke told journalists in Geneva. Northern Gaza is already experiencing a “full-blown famine” which is rapidly spreading across the strip, the World Food Programme warned over the weekend. — CNN