In Gaza, where hopes were dashed for a ceasefire in the nearly six-month-old war in time for Ramadan last week, residents of Gaza City in the north described the most intense fighting for months around the Al Shifa hospital.

Israel claimed to have killed 90 gunmen in a battle under way there for a third day; Hamas denied fighters were present and said those killed in the hospital were civilians.

Blinken was due in Saudi Arabia on Wednesday and Cairo on Thursday to talk to regional leaders about efforts to secure a truce. In Saudi Arabia, he was expected to meet the ruling crown prince, Mohammed bin Salman.

The Israeli prime minister on Tuesday rebuffed a plea from Biden to call off plans for a ground assault of Rafah, the city on the southern edge of Gaza sheltering more than half the enclave’s 2.3 million people.

Netanyahu told lawmakers he had made it “supremely clear” to Biden in a phone call “that we are determined to complete the elimination of these battalions in Rafah, and there’s no way to do that except by going in on the ground”.

Israel says Rafah is the last major holdout of armed fighters from Hamas. Washington says a ground assault there would be a “mistake” and cause too much harm to civilians.

More than a million Gazans, ordered into Rafah earlier in the war by advancing Israeli forces, have nowhere further to flee. Israel says it has a plan to evacuate them.