More than half Gaza’s 2.3 million people are now sheltering there, many of them penned up against the border fence and living in makeshift tents.

Doctors and aid workers in Rafah are struggling to supply even basic aid and stop the spread of disease.

“No war can be allowed in a gigantic refugee camp,” said Jan Egeland, Secretary-General of the Norwegian Refugee Council, warning of a “bloodbath” if Israeli operations expand there.

Gazan children acutely malnourished

In a further sign of the war’s impact, almost one in 10 of Gazans under five are now acutely malnourished, according to initial UN data from arm measurements that show physical wasting.

The charity ActionAid said some Gazans were eating grass.

“Every single person in Gaza is now hungry, and people have just 1.5 to 2 litres of unsafe water per day to meet all their needs,” it said.

Gaza’s health ministry said at least 27,947 Palestinians had been confirmed killed in the conflict, 107 of them in the previous 24 hours, and 67,459 injured.

It has said many more could be buried under rubble from Israeli attacks since Hamas militants killed 1200 people and took 253 hostages in Israel on October 7, according to Israeli tallies.

Hours before Netanyahu’s statement, Israeli warplanes carried out new sorties in which Palestinian health officials said at least 15 people had been killed, eight of them in the Rafah area.

“We were sleeping inside and, when the strike hit, were thrown outside. After that, another rocket hit,” said Mohammed al-Nahal, an elderly Palestinian standing beside the rubble of a building that had been hit.

“It destroyed the entire home. My daughter was killed. My daughter, her husband, her son, all were martyred.”

Israel’s military said its forces had been in action in the area of Khan Younis and in northern and central Gaza to eliminate militant cells and destroy militant infrastructure.

It says it takes steps to avoid civilian casualties and accuses Hamas militants of hiding among civilians, including at schools, shelters and hospitals. Hamas has denied doing so.

Biden says Israel going ‘over the top’

The US, Israel’s main ally, has this week stepped up efforts to secure a ceasefire in Hamas-ruled Gaza, and also publicly criticised Netanyahu’s government.

“I’m of the view, as you know, that the conduct of the response in the Gaza Strip has been over the top,” Biden told reporters at the White House on Thursday.

Biden said he had been pushing for a deal to pause fighting to allow the release of hostages, increase the amount of humanitarian aid reaching Palestinian civilians, and normalise relations between Israel and Saudi Arabia.

Hamas this week proposed a ceasefire of 4-1/2 months, during which remaining hostages would go free, Israel would withdraw its troops and an agreement would be reached on an end to the war.

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Netanyahu said on Wednesday that Hamas’ terms, offered in response to a proposal drawn up by US and Israeli spy chiefs with Qatar and Egypt, were “delusional” and vowed to fight on.

Hamas says it will not agree to any deal that does not include an end to the war and an Israeli withdrawal. Israel says it will not withdraw or stop fighting until Hamas is eradicated.

Hoping to spur peace moves, US Secretary of State Antony Blinken visited the Middle East this week, and a Hamas delegation arrived in Cairo on Thursday for talks with mediators Egypt and Qatar.

Foreign ministers of several Arab states discussed Gaza on Friday at talks in Riyadh at which the United Arab Emirates called for more efforts to prevent the conflict expanding across the Middle East.