US Secretary of State Antony Blinken arrived in Saudi Arabia on Wednesday, launching a tour of the Middle East to try to secure a ceasefire in the Gaza war as increasing strain showed in Washington's relationship with its ally Israel.
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.
Following his visit to Saudi Arabia on Wednesday, where he was expected to meet ruling Crown Prince Mohammed bin Salman, Blinken is due in Egypt on Thursday and Israel on Friday.
The State Department announced Blinken's planned stop in Israel only after he had arrived in Saudi Arabia. No explanation was immediately given for why it was omitted from the initial itinerary.
Recent days have seen an intensification of fighting in northern parts of Gaza captured by Israeli forces early in the war, including Al Shifa, once Gaza's biggest hospital, now one of the few even partially functioning in the north.
"We are living through similar dreadful conditions to when Israeli forces first raided Gaza City: sounds of explosions, Israeli bombardment of houses is non-stop," Amal, 27, living around a kilometre from Al Shifa hospital, told Reuters via a chat app.
On Tuesday Israeli Prime Minister Benjamin Netanyahu rebuffed a plea from US President Joe 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.
State Department spokesman Matthew Miller said one of Blinken's aims was to discuss with Israeli leaders how to defeat Hamas "including in Rafah, in a way that protects the civilian population, does not hinder the delivery of humanitarian assistance and advances Israel’s overall security."
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.
Nearly 32,000 Palestinians have been confirmed killed since October 7, according to Gaza health authorities, with thousands more dead feared lost under the rubble.
