The Health Ministry in Hamas-ruled Gaza said on Thursday that more than 9,000 Palestinians have been killed since war broke out more than three weeks ago.

Dr. Ashraf al-Qudra, a ministry spokesperson, said 9,061 people have been killed in Gaza, including 3,760 who are under 18.

More than 1,400 people have been killed on the Israeli side, the vast majority civilians killed by Hamas in its bloody October 7 incursion into Israel.

The Health Ministry is part of the Hamas-run government but includes doctors and veteran civil servants who are not affiliated with the group. Its tolls from previous wars have held up to UN scrutiny, independent investigations and even Israel's tallies.

Israel's ground troops advanced toward Gaza City on Thursday, as the US and Arab countries intensified diplomatic efforts to ease the siege of the Hamas-ruled enclave and bring about at least a brief stop to the fighting to help civilians.

President Joe Biden suggested a humanitarian “pause” the day before, as an apparent agreement among the US, Egypt, Israel and Qatar, which mediates with Hamas, allowed hundreds of Palestinians with foreign passports and dozens of wounded to leave Gaza for the first time. Dozens more left on Thursday.

Arab countries, including those allied with the US and at peace with Israel, have expressed mounting unease with the war. Jordan recalled its ambassador from Israel and told Israel's envoy to remain out of the country until there's a halt to the war and the “humanitarian catastrophe” it is causing.

More than 3,600 Palestinian children have been killed in 25 days of fighting, and bombings have driven more than half the territory's 2.3 million people from their homes, while food, water and fuel run low.

Israeli troops pushed into Gaza in larger numbers over the weekend after three weeks of heavy airstrikes that have demolished entire neighbourhoods.

The war, the fifth and by far deadliest in Gaza, began when Hamas launched a bloody October 7 rampage into Israel, killing hundreds of men, women and children. Some 240 were captured.

The US has pledged unwavering support for Israel as it seeks to end Hamas' rule over Gaza and crush its military capabilities, even as the two allies seem to have no clear plan for what would come next.

White House officials said a pause in fighting would allow for more aid to be sent in and potentially facilitate the release of hostages. US Secretary of State Antony Blinken is expected back in the region on Friday.

The departure of Palestinians through the Rafah crossing into Egypt on Wednesday came after weeks of talks. It was first time people left Gaza other than four hostages released by Hamas and another rescued by Israeli forces. Israel has also allowed more than 260 trucks carrying food and medicine through the crossing, but aid workers say it's not nearly enough.

At least 335 foreign passport holders left Wednesday and approximately another 100 left Thursday, according to Wael Abu Omar, a spokesman for the Palestinian Crossings Authority. Seventy-six Palestinian patients, along with their companions, were also evacuated, he said.

The US has said it is trying to evacuate 400 Americans with their families.

Egypt has said it will not accept an influx of Palestinian refugees, fearing Israel will not allow them to return to Gaza after the war.

Hundreds of thousands of Palestinians remain in the path of the fighting in northern Gaza, despite Israel's repeated calls for them to evacuate to the territory's south, which is also being bombarded.

Israeli troops appear to be advancing on three main routes, according to the Institute for the Study of War, a US research group. One thrust came from Gaza's northeast corner. Another, south of Gaza City, cut across the territory, reaching the main north-south highway.

The third, from Gaza's northwest corner, has moved about 5 kilometers (3 miles) down the Mediterranean coast, reaching the outskirts of the Shati and Jabaliya refugee camps, on the edges of Gaza City. Airstrikes on Tuesday and Wednesday destroyed apartment blocks in Jabaliya, but the number of dead and wounded remained unknown. Israel said the strikes killed militants and demolished Hamas tunnels.

Palestinian militants fired antitank missiles, set off explosive devices and hurled grenades at Israeli troops during an overnight battle, the Israeli military said Thursday. It said soldiers returned fire and called in artillery, as well as strikes from a helicopter and a naval ship. The report could not be independently confirmed.

Casualties on both sides are expected to rise as Israeli troops advance toward the dense residential neighbourhoods of Gaza City. Israeli officials say Hamas' military infrastructure, including tunnels, is concentrated in the city and accuse Hamas of hiding among civilians.