The top US diplomat Marco Rubio has said the US is “troubled” by the humanitarian situation in Gaza.

His comments came as at least 114 Palestinians were killed in Israeli air strikes on Thursday, health officials said.

Asked by the BBC if the Trump administration remained fully behind the nature of Israel’s military action given the scale of the recent Israeli attacks and its bombing of hospitals, he once again called on Hamas to surrender and release hostages and said there could be no peace so long as the group exists.

“That said, we’re not immune or in any way insensitive to the suffering of the people of Gaza, and I know that there’s opportunities here to provide aid for them,” he said.

Gaza has been under a complete Israeli blockade of all food and other humanitarian supplies for 10 weeks. Israeli forces have been intensifying their bombardment of what they say are Hamas fighters and infrastructure ahead of a planned expansion of their ground offensive in Gaza.

Rubio’s comments – made after a meeting of Nato foreign ministers in Turkey – appeared to be a reference to a controversial Israeli-American proposal to use private providers to set up aid collection points in Gaza. That plan has been rejected by the UN as unethical and unworkable.

They come as Donald Trump is visiting the region and indirect negotiations on a new ceasefire and hostage release deal between Hamas and Israel continue.

Hamas meanwhile accused Israeli Prime Minister Benjamin Netanyahu of “undermin[ing] mediation efforts by deliberate military escalation”.

An Israeli government spokesman said Israel wanted negotiations on hostage releases to succeed, but that they would take place while Hamas was under “military pressure”.

The US is Israel’s main arms supplier and the language used by Rubio is unusual. Previously he has responded to questions about Palestinian civilian casualties only by calling on Hamas to surrender. It also comes amid recent reports of a rift between Trump and Netanyahu.

In southern Gaza the streets of Khan Younis were filled with funeral processions and grieving families on Thursday morning, following what residents said were the deadliest set of air strikes in the city since Israel resumed its offensive almost two months ago.

Some 56 people, including women and children, were killed when homes and tents sheltering displaced families were bombed overnight in the city, the local Nasser hospital said.

The Israeli military said it struck Hamas and Palestinian Islamic Jihad fighters in southern Gaza.

One man told BBC Arabic’s Middle East Daily programme that Nasser hospital’s mortuary was “filled beyond capacity”, and that several bodies had to be placed in the corridor before they could be buried.

Doctors were forced to treat wounded people, including those with burns, amputations and internal bleeding, on stretchers, benches and on the floor due to a lack of beds, he said.

“Among those killed today were 36 children… Entire families have been wiped from the civil registry,” he added. “Tragically, this level of destruction has become part of daily life.”

One video shared by a local activist showed medics laying dozens of bodies on the ground at a local cemetery. An imam stood nearby leading prayers for hundreds of mourners gathered behind him in orderly rows.

Safaa al-Bayouk, a 42-year-old mother of six, said her sons Muath, who was six weeks old, and Moataz, who was one year and four months, were killed in one of the strikes.

“I gave them dinner and they went to sleep. It was a normal day… [then] the world turned upside down,” she told Reuters news agency.

Reem al-Zanaty, 13, said her uncle’s family, including her 12-year-old cousin Menna, were killed when their two homes were bombed.

“We didn’t feel or hear anything until we woke up with rubble on us,” she said. “The Civil Defence did not come. I will tell you honestly we pulled ourselves [out]. My father helped us.”

Medics said local journalist Hassan Samour, who worked for Hamas-run al-Aqsa Radio, was killed along with 11 members of his family when their home in the eastern Bani Suheila neighbourhood was struck.

In northern Gaza, the Civil Defence agency said its first responders had recovered the bodies of four people following Israeli strikes in the northern town of Beit Lahia and two others in the central town of Deir al-Balah.

Later, spokesman Mahmoud Basal reported that an Israeli strike on a home in Jabalia town had killed all five members of the Shihab family.

Palestinian news agency Wafa reported that 15 people were killed, including 11 children, when the al-Tawbah health clinic and prayer hall in the al-Fakhouri area of Jabalia refugee camp was bombed.

A graphic video posted online purportedly from the scene showed two bodies covered in debris on a street next to a badly damaged building.

“An indescribable crime, in all meanings of the word. They were safe in a medical clinic, civilians, children, women, men, something a person can’t fathom, for them to release a military missile on a medical clinic, on people and passers-by,” resident Yehya Abu Jalhoum told Reuters.

Amir Selha, a 43-year-old resident of northern Gaza, told AFP news agency: “Tank shells are striking around the clock, and the area is packed with people and tents.”

He also said Israeli military drones had dropped leaflets over his neighbourhood warning residents to move south.

The military said it had struck 130 “terror targets” throughout Gaza over the past two days, including cells of fighters, rocket launchers and infrastructure sites.

On Wednesday, Israeli strikes killed at least 80 people across the territory, including 59 in Jabalia town and refugee camp, according to hospitals and the Civil Defence.

The military said it struck Hamas and Palestinian Islamic Jihad fighters in the north on Tuesday night. It had warned residents of Jabalia and neighbouring areas to evacuate on Tuesday after rockets were launched into Israel.

Israeli evacuation orders issued on Wednesday afternoon also caused panic among residents of a crowded area of Gaza City, in the north.

The Israeli military said a hospital, a university and several schools sheltering displaced people in the Rimal neighbourhood had become “terrorist strongholds” and that it would soon attack them with “intense force”.

Separately, a US-backed organisation said it would start work in Gaza within two weeks as part of a new and heavily criticised US-Israeli aid distribution plan.

The Gaza Humanitarian Foundation said it had asked Israel to let the UN and others resume deliveries until it was set up, and also to allow it to set up aid distribution sites in the north as well as the south.

Israel’s UN envoy, Danny Danon, said he was “not familiar with those requests”, but he confirmed that the “major operation” would start very soon.

UN spokesperson Farhan Haq meanwhile reiterated that it would not participate in the plan, saying it “does not accord with out basic principles, including those of impartiality, neutrality [and] independence”.

Israel has not allowed any aid or other supplies into Gaza for 10 weeks, and an assessment by the UN-backed Integrated Food Security Phase Classification (IPC) has warned that half a million people face starvation.

Israel imposed the blockade on 2 March and resumed its offensive against Hamas two weeks later, ending a two-month ceasefire. It said it wanted to put pressure on Hamas to release its remaining 58 hostages, up to 23 of whom are believed to be alive.

The UN has said Israel is obliged under international law to ensure food and medical supplies for Gaza’s population. Israel has said it is complying with international law and there is no shortage of food.

Israel launched a military campaign to destroy Hamas in response to the group’s cross-border attack on 7 October 2023, in which about 1,200 people were killed and 251 others were taken hostage.

At least 53,010 people have been killed in Gaza since then, including 2,876 since the Israeli offensive resumed, according to the territory’s Hamas-run health ministry.