The missile did not explode overhead but on the ground. From https://www.theguardian.com/world/2023/oct/18/al-ahli-arab-hospital-piecing-together-what-happened-as-israel-insists-militant-rocket-to-blame

Marc Garlasco, a former Pentagon chief of high value targeting during the Iraq war in 2003, told the Guardian: “The number [of casualties] is astronomically high, an absolute high range of all time if true.

“The crater is not consistent with an airstrike, it is more likely to be a weapon that failed and released its payload over a wide area.

“The crater and surrounding damage is also not consistent with a JDAM aerial bomb. The hole on the ground occurred from kinetic energy.”

The JDAM, or joint direct attack munition, is a precision-guided air-to-surface weapon system that is part of the Israeli arsenal provided by the US.

Israel has said it used 6,000 bombs in the first six days of the conflict, more than the US used in a year during its operations in Afghanistan and double what the US-led coalition used against Islamic State in Iraq and Syria in a month.

Justin Bronk, the senior research fellow for airpower and military technology at RUSI in London, said that while the results were not conclusive, no crater or obvious shrapnel pattern consistent with standard JDAM bombs was visible in images of the aftermath.

“If this is the extent of the damage then I’d say an airstrike looks less likely than a rocket failure causing an explosion and fuel fire,” he added.