European and Iranian officials will hold talks on Friday in Geneva.

The Israeli hospital, the Soroka Medical Center in the city of Beersheba, said it had sustained widespread damage and asked people to stay away. The hospital said the building that was hit had been largely evacuated in recent days, and that it was treating several patients with mild injuries. It is the first Israeli hospital to be hit directly since the war with Iran began last Friday, the Israeli military said.

Iran has been under a near-total internet blackout since Wednesday night, and it was not immediately possible to get further comment from the Iranian authorities.

As rescuers searched for people trapped at the medical facility, the Israeli military said it was conducting strikes on a number of targets in Iran — including an inactive reactor at Arak, to prevent the site from producing material for nuclear weapons, and a nuclear production facility in the Natanz region.

Iranian state media reported that Israeli warplanes struck the nuclear facility at Arak and said that there was no serious damage. The U.N.’s nuclear watchdog said that a “heavy water research reactor, under construction, was hit” at Arak but that it was “not operational and contained no nuclear material, so no radiological effects” were recorded.

The latest exchange of attacks came as uncertainty hung over the Middle East about whether or not President Trump would send American forces to join Israel’s sweeping campaign against Iran’s nuclear program and military.

“I have ideas as to what to do,” Mr. Trump said during an Oval Office event on Wednesday. He added, “I like to make a final decision one second before it’s due, you know, because things change.”

Here’s what else to know:

• Potential U.S. involvement: Israel has pressed Mr. Trump to use powerful American weapons to attack Iran’s underground nuclear sites, and the prospect of American involvement in the war has added to fears that it could spiral into a wider conflagration in the Middle East. The supreme leader of Iran, Ayatollah Ali Khamenei, has warned that the United States would suffer “irreparable” harm if it joined the Israeli campaign.

• Diplomatic effort: A senior Iranian foreign ministry official said that Iran would accept Mr. Trump’s offer to meet soon, hours after Ayatollah Khamenei rejected Mr. Trump’s call for an “unconditional surrender.” The official said the country’s foreign minister, Abbas Araghchi, would accept a meeting with senior American representatives to discuss a cease-fire with Israel, though Mr. Trump has indicated he wants talks to focus on Iran’s nuclear program. Read more ›

• Civilian toll: An 8-year-old girl who loved dancing in a red dress at her dentist’s office. A 28-year-old national equestrian champion. A poet one week away from her 24th birthday. A graphic designer who worked at National Geographic. Grandparents in their 80s. All are among the civilians killed during Israeli airstrikes on Iran. In Israel, Iran’s strikes have killed at least 24 people since Friday, according to the Israeli government.

• Missile interceptors: Israel has a world-leading missile interception system, but as the war drags on, Israel is firing interceptors faster than it can produce them. That has raised questions within the Israeli security establishment about whether the country will run low on air defense missiles before Iran uses up its ballistic arsenal, according to eight current and former officials.

“There was a massive boom and blast wave,” said Dr. Vadim Bankovich, head of the Orthopedics Department, whose office faces the floor of the old surgical building that took a direct hit.

Shlomi Codish, the director general of the hospital, said that much of the building had been evacuated in recent days. Mr. Codish said that all patients and medical staff had been in protected spaces when the missile struck, and that the hospital was treating several patients with minor injuries.

Iran’s Revolutionary Guards claimed it had targeted Israeli military facilities next to the hospital, according to the Fars news agency, an Iranian outlet affiliated with the Revolutionary Guards. It offered no evidence for the claim, and Israel’s military did not immediately respond to a request for comment about the claim.

When he received an alert on his cell phone warning him of incoming missile fire, Dr. Bankovich said he and his team rushed to a windowless safe space, where patients at his department were already gathering. After leaving the safe space 10 minutes later, he found cabinets toppled, ceiling panels scattered on the ground, and medical devices shattered.

“Windows blew out everywhere, even those reinforced with iron in the protected rooms,” said Dr. Bankovich, referring to the hospital’s safe rooms. He and his team had been sitting 100 feet away from the site of the missile strike. Now, the view from his office is one of destruction.

Dr. Bankovich said that his department would have to be shut down because of the damage.

“We felt the warmth of the blazes,” he said.

The strike on Soroka Medical Center came on the seventh day of the war, and was the first time a hospital has been directly hit since Iran began launching missiles and drones at Israel, in retaliation for Israel’s attacks on Iran’s nuclear infrastructure and senior military commanders.

In recent days, Iran has scaled back its missile fire, and the Israeli military has eased some of its wartime directives for civilians, signaling that it believes the threat from Iran’s missile fire has diminished. But the strike on the hospital underscored that Iran can still inflict serious damage within Israel, despite the Israeli military’s strikes on missile launchers in Iran and its advanced air defense systems, which have intercepted most projectiles midair.

Since the war began on Friday, Iranian attacks have hit several population centers — including high-rise residential buildings and a research institute — killing at least 24 people and injuring more than 800, according to Israeli health authorities.

Prime Minister Benjamin Netanyahu of Israel vowed to avenge the strike on the hospital. “We will make the tyrants from Tehran pay the full price,” he said in a post on X.

Standing in a staff parking lot carpeted with rubble and shattered glass, as damaged cars were towed away, Avichay Amrami, 38, a hospital attendant, recalled how “people were running in different directions after the strike. There was chaos.”

Concerned that the hospital building was at risk of collapse, Mr. Amrami and his co-workers immediately began evacuating patients to safer areas.

“Luckily, the floor that was hit was empty,” Mr. Amrami said.

The meeting is set to be held in Geneva, Iran’s foreign minister, Abbas Araghchi, was quoted as saying by IRNA, an Iranian state news agency.

A spokesman for Iran’s foreign ministry, Esmail Baghaei, said the meeting would focus on “the nuclear issue and the latest developments in the region.”

Huge lines of traffic have been snaking out of Tehran for days as people try to flee the city; on Wednesday the lines to get gas were actually shorter than on previous days because of the exodus, according to Shahnaz, who asked that her last name not be used because of concern over reprisals from the authorities.

At least 224 people have been killed in Iran since the start of Israel’s military assault, according to the Iranian health ministry. Israel has said it is trying to strike locations and people connected to Iran’s government and its nuclear program, and does not target Iranian civilians.

In recent days, Israel has expanded its attacks on the capital itself. The Israeli military on Monday ordered residents of an upscale neighborhood, District 3, to leave. Hours later, President Trump told the city’s entire population to “immediately evacuate.” On Tuesday, Israel issued another evacuation order for another area of Tehran.

Even the city’s landscape has been affected. Smoke obscured a mountain that towers over northern Tehran and fires still burned at the Shahran oil depot in the west of the city for days after it was hit.

“The atmosphere in Tehran is terrifying,” said Nima, 44, a former bookseller who also asked that his last name not be used.

Nima said he has hunkered down with his family because he did not know anyone to stay without outside Tehran, and said that a dearth of trustworthy media reports has added to his unease.

But his larger fear, Nima said, was that the United States could join Israel in its attack on her country. “I’m deeply uncertain about what this would mean for us here,” he said.

The International Atomic Energy Agency, a United Nations watchdog, said in a post on social media that it had information that a “heavy water research reactor, under construction, was hit” at Arak. “It was not operational and contained no nuclear material, so no radiological effects.”

Firefighting teams have managed to bring the blaze under control, and rescue teams are searching for anyone who might have been trapped and injured.

Iran’s Revolutionary Guards claimed that Iran had targeted Israeli military facilities near a hospital, according to the Fars news agency, which is affiliated with the Revolutionary Guards, though it offered no evidence to support that. The Israeli military did not immediately respond to a request for comment about the claim.

It came as part of a large barrage of Iranian missiles that also caused damage in other parts of Israel, including to tall buildings in Ramat Gan and apartment structures in Holon, both cities near Tel Aviv. More than 30 people suffered minor injuries in Ramat Gan, according to Zaki Heller, a spokesman for Israel’s Magen David Adom emergency service. In Holon, Mr. Heller said, 18 were wounded, including three people seriously.

Photos and videos taken inside the hospital and shared by the Israeli fire and rescue service showed fires, broken glass and ceiling panels scattered on the floor, and damaged elevators. Shlomi Codish, the director general of the hospital, said that the old surgical building had been directly hit, adding that the departments in the building had been evacuated in recent days.

Mr. Codish said that all patients and medical staff had been in protected spaces when the missile struck the building. The hospital said its emergency department was treating several patients with mild injuries.

The strike on the hospital highlighted how the fighting is endangering civilians in Israel and Iran. At least 24 people have been killed in Israel by Iranian attacks and at least 224 people have been killed in Iran by Israeli strikes since the war started, according to each government. Some of those killed in Iran were senior military commanders.

It also illustrated that while Israel’s air defenses have prevented the overwhelming majority of Iran’s missiles from causing serious damage, some have managed to evade interception systems.

Responding to the strikes on Thursday, the Israeli defense minister, Israel Katz, said Iran was committing “war crimes.” Under international law, it is forbidden to target medical facilities except in rare cases. During the war in Gaza, Israel has been widely condemned for repeatedly raiding and damaging health facilities that it says are used by militants.

Video broadcast on Israeli TV channels showed smoke billowing from the hospital and smoke-filled corridors.

Lia Lapidot contributed reporting to this article.

The shutdown appeared to be the result of an internal decision rather than a consequence of an Israeli strike. Earlier in the week, the Tasnim news agency, affiliated with Iran’s Revolutionary Guards, had said that Iran would disconnect from the global internet on Tuesday night, and that Iranians could still use a national internet service that allows people to message on government-approved platforms.

Experts and citizens say that the government is likely throttling internet access to prevent people from sharing information about where Israel has struck and for fear of Israeli cyberattacks.

Residents in Iran have reported severe disruptions to internet and phone services since the war began. Internet connectivity deteriorated slightly, by about ten percent, in the first five days following Israel’s initial strikes on Iran last Friday.

Iranian officials told The New York Times on Tuesday that services had been restricted in an effort to combat Israeli operatives that they said were still carrying out covert operations. The claim could not be independently verified.

Since the blackout started, reaching people by phone inside the country has become extremely difficult and many news media sites have stopped updating. The disruptions may be affecting residents’ ability to see evacuation notices, including ones that the Israeli military has posted on social media ahead of strikes inside Iran.

Iran’s state broadcaster on Tuesday urged people to delete WhatsApp from their phones, claiming that the messaging app was collecting user information to aid Israel. WhatsApp said the allegations were false.

Later on Wednesday, the hacking group posted in English, saying that it had transferred and “burned” $90 million from the exchange, meaning that it had moved the assets but was not using them. It accused Nobitex of being a tool of the Iranian regime to work around financial sanctions imposed by the United States and other nations that have designated the Islamic Revolutionary Guards Corps, a branch of the Iranian military, a terrorist group.

The hack comes as Israel and Iran trade attacks in the deadliest confrontation between the two countries in a decades-long shadow war that is now decidedly overt, after a surprise Israeli strike on Iran last week that it said was intended to dismantle Tehran’s nuclear program.

The crypto analytics firm Chainalysis, which tracks the movement of transactions online, said in a blog post on Wednesday that the Predatory Sparrow attack on Nobitex was “the first hack of this scale exclusively for geopolitical purposes.”

According to Elliptic, another company that tracks crypto transactions, at least $90 million worth of digital assets were transferred to “vanity wallets” from Nobitex early on Wednesday. The wallets, each identified by a string of numbers and letters, all had names with an expletive and the word “terrorist”; some contained I.R.G.C., the acronym for the Islamic Revolutionary Guards Corps, the company said.

Based on Elliptic’s analysis, the hackers were able to move the crypto to digital wallets that they created, but they were unable to access the assets in those wallets.

Nobitex confirmed that the assets were inaccessible to the hackers in a post on social media on Wednesday, saying that about $100 million in crypto was transferred to wallets that were used to “burn and destroy user assets.”

“The situation is now under control,” Nobitex said, adding that all external access to its servers had been “completely severed.” Nobitex pushed back on claims it was associated with the Iranian regime, saying it had “always operated as an independent private business.”

Cryptocurrency exchanges have long faced criticism from finance experts and law enforcement authorities, as well as from some U.S. lawmakers, because they do not have many of the same transparency and compliance requirements as traditional financial institutions. Because crypto is anonymous, borderless and moves through intermediaries that operate in regulatory gray spaces, critics have said for years that terrorists use it for fund-raising.

Elliptic, which the authorities have used to track the movement of digital assets online, noted in its post that Nobitex “has been linked to the Revolutionary Guards, and Iranian government figures in the past.” Elliptic also said that open source investigations had identified relatives of Iran’s supreme leader, Ayatollah Ali Khamenei, and Revolutionary Guards-linked business partners as connected with Nobitex.

Elliptic said it had also identified “the use of Nobitex by sanctioned Revolutionary Guards operatives accused of ransomware operations and targeting critical infrastructure,” including Ahmad Khatibi Aghda, who is on the F.B.I.’s “most wanted” list for suspected cybercrimes and Amir Hossein Nickaein Ravari, also on that list, accused of computer crimes. Both have sent bitcoin to Nobitex accounts, according to Elliptic.

Chainalysis said its data showed that Nobitex hosted wallets for entities tied to the Iranian-backed Houthi militia in Yemen, and wallets that the Israeli authorities have identified as tied to Hamas, which is also backed by Iran.

On Wednesday, internet access was interrupted in Iran, compounding Nobitex’s woes. Nobitex said that “the simultaneous occurrence of national internet disruptions and emergency conditions” had slowed its ability to restore user access.

On Tuesday, Predatory Sparrow also claimed responsibility for a cyberattack on Bank Sepah, a major Iranian bank. The hackers accused the bank of being associated with the Revolutionary Guards and of financing terrorism using money from the accounts of the Iranian people. The Fars News Agency, an outlet affiliated with the Revolutionary Guards, reported a cyberattack on that bank on Tuesday and warned account holders of a disruption to its online and remote services.

Iranians online and on the ground indicated that they were having at least some problems accessing their accounts online or at A.T.M.s.

Predatory Sparrow has previously claimed responsibility for a number of sophisticated attacks against Iranian targets, including IRIB, the state broadcasting company. In 2022, Iranian state-sponsored actors were thought to be responsible for a cyberattack in Albania, associated with Albania’s sheltering of Mujahedeen Khalq, a secretive Iranian dissident group, and a logo stamped on confidential Albanian documents leaked by the attackers featured an eagle preying on the logo of Predatory Sparrow inside a Star of David.

Mr. Takht-Ravanchi also said that Israel’s surprise attack on Iran last Friday, which came just before a new round of nuclear negotiations with the United States was set to take place, was a “betrayal” of Iran’s trust. Now that Iran’s cities have come under Israeli bombardment, he said, Tehran will negotiate with no one.

“Although we have always promoted diplomacy, we cannot negotiate under threats,” Mr. Takht-Ravanchi said. “We cannot negotiate while our people are under bombardment every day. We are not begging for anything, we are just defending ourselves.”

Mr. Takht-Ravanchi suggested that the Iranian government was prepared to weather a long fight, as it did when attacked by Saddam Hussein’s Ba’athist-ruled government in the 1980s, when the still-new Islamic Republic was internationally isolated.

“We have an experience of eight years of war against Saddam’s aggression back in the ’80s, and now we are defending ourselves against the Israeli regime, which is being helped by Americans,” he said. “All the world was behind Saddam at that time, and we were the ones who resisted.”

Israel has said it does not target Iranian civilians, but hundreds have died in the violence. Every day since the war began, a new face, a new name, a new story of a life that ended violently and abruptly has emerged. The Ministry of Health has not updated casualty numbers since Sunday, when it said at least 224 people had been killed and nearly 2,000 injured, including women and children. Those figures are expected to grow in the coming days.

In interviews with more than 50 residents of Tehran, Shiraz, Isfahan, Ahvaz, Mashhad, Sanandaj, Amol, Ghazvin, Semnan, Karaj, Neishabour, and Tabriz, doctors, families and friends described the toll of the strikes. The New York Times also reviewed scores of videos, photos and testimonies documenting civilian casualties, injuries and the destruction of residential buildings.

The Israel Defense Forces have said the attacks on Iran are targeted assassinations of military commanders, government officials and nuclear scientists. But missiles and drones have also hit high-rise buildings and multistory apartment complexes where civilians also reside. Dr. Hossein Kermanpour, the spokesman for the Ministry of Health, said 90 percent of casualties were civilians, not military.

In Tehran, the frequency of the Israeli strikes has completely upended daily life. The constant thud of air defense systems, the loud boom of explosions and the wailing sirens of ambulances and fire trucks have replaced the sounds of a metropolis typically buzzing with traffic, street music and the Muslim call to prayer.

Photos and videos show rescue crews rummaging through piles of debris. A father clutches his small baby in a white onesie drenched in blood. A man bleeding from the head leans against a motorcycle as a passerby tends his wound. The body of a small child, covered in gray dust, peeks out from the rubble.

“There’s a lot of focus on the military targets but not much is being said about the many civilian casualties, in fact nothing is being said about them, which are much higher than the targeted killings,” said Jila Baniyagoub, a prominent journalist and women’s rights activist in Tehran.

Four physicians, including the director of a major hospital in Tehran, said that emergency rooms were overwhelmed. The Ministry of Health announced on Monday that all medical staff members around the country were required to remain in their posts because of the acute need.

“This is unlike anything we’ve experienced before,” said Ali, a 43-year-old engineer in Tehran and father of two small children who asked that his last name not be published for fear of retribution from Iranian officials for speaking publicly. He said deaths and casualties were hitting closer to home everyday and that a friend’s sister had been killed when a building collapsed on her after a targeted strike.

Parnia Abbasi, the poet, graduated from college with a degree in English and landed a coveted job at the National Bank of Iran, where her mother had spent her career as a bank clerk until retirement. Her father was a public-school teacher. Ms. Abbasi once spoke at a panel for young poets and told the audience that she looked “at all my life events as stories I could write.”

About six months ago, her parents realized a lifelong dream of purchasing a three-bedroom apartment in the Orkideh Complex, a compound of high-rise apartment buildings on Sattarkhan Street in central Tehran. On Friday morning, the building collapsed after it was hit by an Israeli missile.

The Abbasi family, including Parham, Ms. Abbasi’s younger brother, were killed.

“They had bought this house six or seven months ago under great financial pressure so that the children could have their own rooms. The love between this family was the envy of everyone. They were always together,” said Hassan, a relative of the Abbasis’ in Tehran, who asked that his last name not be published because of fears for his safety.

Tara Hajimiri, 8, loved folk dance and gymnastics. A video of her wearing a red dress as she danced her way into the chair at her dentist’s office went viral on social media. She and 60 residents were killed in a massive strike on an apartment building on Patrice Lumumba Street on Saturday.

Reza, a 59-year-old computer engineer, said that his aunt and uncle, a couple in their 80s, were killed in an airstrike while they were sleeping on Saturday night. The force of the explosion toppled the building, he said.

The man had Parkinson’s disease, said Reza. “It’s so sad that innocent civilians are being impacted by this war. They were loving grandparents.”

The damage to the building was so extensive that rescue workers have not yet retrieved the bodies. The family was informed to consider the couple dead. Reza said the couple’s adult children go to the site every day, waiting for the bodies to be pulled from the rubble.

Saleh Bayrami, a veteran graphic designer for magazines like National Geographic and media companies, was driving home from a meeting on Sunday. He stopped at a red light at Quds Square, near the bustling Tajrish market in the northern part of Tehran. An Israeli missile landed on a major sewage pipe in the square, exploded into a ball of fire and killed him, according to colleagues and news reports.

Ava Meshkatian, a colleague who sat next to him at work, wrote a tribute to Mr. Bayrami on her Instagram page, describing him as kind, friendly and always smiling. “We have to write these things for others to read. For others to know, God only knows how devastated I am,” she wrote.

Mehdi Poladvand, a 27-year-old member of a youth equestrian club and a national champion, spent the last day of his life on Friday at a racetrack in Karaj competing in a race.

Iranian news media described him as a rising talent who had won numerous championship titles in provincial competitions and national cups. He was killed along with his parents and sister when their apartment building was struck by an Israeli missile, his friend Arezou Malek, a fellow equestrian, told local Iranian media.

At cemeteries across Iran, somber funeral services are being held daily, sometimes as missiles fly overhead. The coffin of Niloufar Ghalehvand, 32, a Pilates instructor, was covered with the flag of Iran, according to videos shared on social media by the sporting club where she worked. A small crowd wearing black can be seen standing around the coffin.

“We will always remember you,” read a message from the sports club. “No to War.”

The Iranian official said Foreign Minister Abbas Araghchi would accept such a meeting to discuss a cease-fire with Israel and Iran’s nuclear program.

Mr. Araghchi said this week that Iran would return to diplomacy if Israel halted its attacks, and that Mr. Trump could force an end to the conflict with one phone call to Israel’s prime minister, Benjamin Netanyahu.

Since the 1979 revolution that installed a theocratic government in Iran, no U.S. vice president or president has met with Iranian officials, and even meetings with U.S. cabinet officers have been rare.

Before war with Israel broke out last week, Iran and the United States were in the midst of negotiations, mediated by Oman, and had exchanged written proposals for frameworks of a deal addressing Iran’s nuclear program, though they remained far apart.

On Friday, two days before a scheduled meeting between Mr. Araghchi and Mr. Trump’s special envoy, Steve Witkoff, Israel began airstrikes in Iran, with the stated intention of destroying its nuclear program and preventing it from obtaining a nuclear weapon. The talks with the United States in Oman were called off.

Mr. Netanyahu has appealed to Mr. Trump to join the war, and to use powerful weapons Israel does not have to destroy Iran’s underground nuclear sites. Mr. Trump has mused publicly this week about the possibility of bombing Iran, and even of killing Mr. Khamenei. On Wednesday, he said he still had not made up his mind how to proceed, but also said it was not too late for diplomacy.

Mr. Khamenei, in a televised address on Wednesday from a safehouse bunker, dismissed the idea of negotiations and said, “They cannot impose either war or peace on the Islamic Republic of Iran.”

He downplayed the impact of the war, claiming that “ordinary life” goes on in his country. But many Iranians say their lives have been upended, with tens of thousands of people having fled Tehran and many struggling to find safe shelter, food and clean water.

A new diplomatic effort has taken shape in hopes of brokering a cease-fire before the conflict draws in others in the region, or the United States. European, Turkish and Arab foreign ministers and heads of state have been talking with both Iran and the United States.

Iran’s mission to the United Nations requested an emergency meeting of the Security Council on Wednesday. The meeting is scheduled for Friday morning.

It was not immediately clear when evacuation flights and cruise ships arranged by the State Department would depart or how many passengers would be involved. In a post on social media, Mr. Huckabee directed Americans seeking to leave Israel to enroll in the State Department’s Smart Traveler program to receive information.

The announcement was the first from the State Department indicating that the United States would help evacuate its citizens from Israel since the country began a surprise attack on Iran on Friday. Israeli strikes have killed at least 224 people in Iran, according to Iran’s Health Ministry, and retaliatory strikes by Iran have killed at least 24 people in Israel, according to the Israeli government.

The State Department had warned of extreme risk in traveling to Israel and authorized some family members and nonessential personnel to depart. But since Friday, the American Embassy in Jerusalem has had little guidance for people trying to leave. “We have no announcement about assisting private U.S. citizens to depart at this time,” the embassy said in a statement on Tuesday, adding it was aware that third parties were helping to arrange some travel but that it was unable to endorse them.

Several countries have helped evacuate their citizens from Iran in recent days, largely through land routes into neighboring countries. India’s Foreign Ministry said that its embassy had evacuated 110 Indian students from northern Iran on Tuesday, helping them travel by road to Yerevan, the Armenian capital, to await flights to New Delhi. A spokesman for China’s Foreign Ministry, Guo Jiakun, said on Wednesday that the Chinese Embassy and consulate in Iran had coordinated the evacuation of nearly 800 Chinese citizens from the country and that around 1,000 others were still to be relocated and evacuated.

The State Department warned U.S. citizens not to travel to Iran in March and does not maintain a diplomatic presence there. President Trump’s travel ban fully barring its citizens from entering the U.S. went into effect on June 9, before the latest conflict began.

Robert Reichelscheimer, an American lawyer who has been visiting Jerusalem with his wife since Thursday, described Mr. Huckabee’s announcement as a long-awaited “acknowledgment that we are here” after what he said had been multiple attempts to reach the U.S. Embassy, as well as senators back home in New York, with no luck.

“I don’t expect them to come and rescue me the next day, while missiles are flying,” he said. “But I do expect the federal government to keep me abreast of what steps are being taken.”