An Iranian missile slammed into the main hospital in southern Israel early Thursday, wounding people and causing “extensive damage,” according to the medical facility. Israeli media aired footage of blown-out windows and heavy black smoke, Associated Press reported.

Separate Iranian strikes hit a high-rise apartment building in Tel Aviv and other sites in central Israel. At least 40 people were wounded, according to Israel’s Magen David Adom rescue service.

Israel, meanwhile, carried out strikes on Iran’s Iran’s Arak heavy water reactor, its latest attack on Iran’s sprawling nuclear program, on the seventh day of a conflict that began with a surprise wave of Israeli airstrikes targeting military sites, senior officers and nuclear scientists.

Iran has fired hundreds of missiles and drones at Israel, though most have been shot down by Israel’s multi-tiered air defenses, which detect incoming fire and shoot down missiles heading toward population centers and critical infrastructure. Israeli officials acknowledge it is imperfect, according to Associated Press.