Israel will continue its offensive in Gaza “with full force” and will refuse any temporary ceasefire that does not include the release of more than 240 hostages held by Hamas, Benjamin Netanyahu has said, rejecting US calls for a pause in the fighting. Earlier on Friday, the US secretary of state, Antony Blinken, flew into Israel to urge the Israeli prime minister to temporarily stop its military offensive to allow aid into the territory amid rising concerns over civilian casualties as the fighting intensifies. The Hamas-controlled health ministry reported on Friday evening that an airstrike had hit a convoy of ambulances outside Gaza’s largest hospital. The report could not immediately be independently verified but an Agence France-Presse journalist at the scene reported seeing several bodies beside a damaged ambulance. The Israel Defence Forces (IDF) said they carried out an airstrike on an ambulancethey said was being used by Hamas, adding that “a number of Hamas terrorist operatives” were killed in the strike. Blinken was in the Middle East for the second time in less than a month trying to avert regional escalation of the conflict but also to balance Washington’s strong support for Israel over the deadly Hamas attack of 7 October with growing concern about civilian casualties inflicted by Israel. US officials have said they hope a pause in the fighting will allow humanitarian aid to reach desperate civilians in Gaza and help negotiations to free the hostages seized by Hamas during the attack. Obtaining their liberty is a key objective of the Israeli offensive. So far, four have been freed by Hamas and one rescued by Israeli forces. Blinken told reporters at a press conference in Tel Aviv: “A number of legitimate questions were raised in our discussions today, including how to use any period of pause to maximise the flow of humanitarian assistance, how to connect the pause to the release of hostages, how to ensure that Hamas doesn’t use these pauses or arrangements to its own advantage.” However, Netanyahu said in a later televised statement: “I made clear that we are continuing full force and that Israel refuses a temporary ceasefire which does not include the release of our hostages.” The Israeli offensive on Gaza followed terrorist attacks launched by Hamas into Israel which killed 1,400 people, mostly civilians massacred in their homes and at a music festival. Israeli strikes on Gaza since then have killed at least 9,227 Palestinians, including 3,826 children, the health ministry said on Friday. In a separate statement, the ministry said Israel had targeted a convoy of ambulances leaving al-Shifa hospital in Gaza City. “We have informed the Red Cross in accordance with the international law about moving a convoy carrying injured people in ambulance vehicles from al-Shifa hospital,” Ashraf al-Qudra, the health ministry spokesman, said. “At the gate of the hospital and then at the Ansar square, the occupation targeted the convoy in more than one location outside al-Shifa hospital.” Israel’s military said it had identified and hit an ambulance “being used by a Hamas terrorist cell” in the battle zone. It said a number of Hamas fighters had been killed in the strike and accused the group of transferring both militants and weapons in ambulances. It gave no evidence to support its assertion that the ambulance was linked to Hamas but said in a statement it intended to release additional information. Earlier Lt Col Richard Hecht, an IDF spokesperson, said Israeli forces had moved deeper into Gaza City and were engaged in “very, very close quarters combat” as they sought to destroy bases, launchpads and tunnels used by Hamas to instigate attacks. Though the fighting in Gaza has remained the main focus of the IDF, clashes with the powerful Lebanon-based militant group Hezbollah have escalated along Israel’s northern border. In his first public statement since the start of the conflict, Hassan Nasrallah, the leader of Hezbollah, told a rally in Beirut that “all options” were open for an expansion of the Israel-Hamas conflict into Lebanon and said “we can resort to them at any time”. The fighting on the Lebanon-Israel border would “not be limited” to the scale seen until now, he added. In recent weeks, Hezbollah has fired rockets across the border daily, mainly hitting military targets in northern Israel, but it has a substantial arsenal capable of hitting anywhere in Israel and many thousands of experienced fighters. “Some say I’m going to announce that we have entered the battle,” Nasrallah said on Friday. “We already entered the battle on October 8.” He argued that Hezbollah’s cross-border strikes had distracted elite Israeli forces that would otherwise be focused on Hamas in Gaza. Washington has sent two aircraft carriers to the eastern Mediterranean in an effort to deter Hezbollah, and its patron Iran. Israeli officials have said their response to any major attack by Hezbollah would be “very very severe”, but both sides appear to be carefully calibrating their levels of violence and rhetoric to avoid a full-scale confrontation. Hecht said: “We are powerfully deployed in the north. We are looking at Nasrallah’s speech today. Our message to Lebanon is: don’t sacrifice your future for Hamas and that you have a choice to make. We are in defensive mode.” Blinken told reporters in Tel Aviv that the US had been clear that it was determined there should not be a second or third front in the conflict. On Friday, the IDF named five of its own soldiers killed while fighting in Gaza, bringing the total who have died on the ground there over the last week to 23. In the latest fighting, Israeli forces “uncovered and neutralised active combat tunnels”, the IDF said, describing fighters blowing up and booby-trapping parts of the network, and sharing video footage of attacks. Israel claimed that a Hamas battalion commander, Mustafa Dalul, who it said led forces in Gaza City, was killed overnight. IDF officials have claimed that 130 Hamas fighters were killed on Thursday but have not give a total for those it believes have been killed in the war. Asked how Israel would know it had reached its goal of destroying Hamas, Hecht said it would be when Hamas’s “leadership is gone, their military capabilities are gone”, so there could never be a repeat of the 7 October attacks.