It took 10 years and three rounds of in vitro fertilization for Rania Abu Anza to become pregnant, and only seconds for her to lose her five-month-old twins, a boy and a girl.

An Israeli strike hit the home of her extended family in the southern Gaza city of Rafah late Saturday, killing her children, her husband and 11 other relatives and leaving another nine missing under the rubble, according to survivors and local health officials.

Israeli airstrikes have regularly hit crowded family homes since the start of the war in Gaza, even in Rafah, which Israel declared a safe zone in October but is now the next target of its devastating ground offensive.

The strikes often come without warning, usually in the middle of the night.