UN agency leaders saying “enough is enough” demanded a humanitarian ceasefire on Monday nearly a month into Gaza’s war, as health authorities in the enclave said the death toll from Israeli strikes now exceeded 10,000.

Israel has rebuffed mounting international pressure for a ceasefire, saying hostages taken by Hamas during their rampage in southern Israel on Oct 7 should be released first.

“An entire population is besieged and under attack, denied access to the essentials for survival, bombed in their homes, shelters, hospitals and places of worship. This is unacceptable,” the UN chiefs said in a joint statement.

“We need an immediate humanitarian ceasefire. It’s been 30 days. Enough is enough. This must stop now.”

The 18 signatories include the UN High Commissioner for Human Rights Volker Turk, World Health Organization head Tedros Adhanom Ghebreyesus, and UN aid chief Martin Griffiths.

The reported number of fatalities in Israeli strikes on Gaza since Oct. 7 has now surpassed 10,000, with the health ministry in the Hamas-controlled enclave saying at least 10,022 Palestinians were killed including 4,104 children.

A Reuters journalist in Gaza said an overnight bombardment by air, ground and sea was one of the most intense since Israel began its offensive following the Oct. 7 attack in which Hamas killed 1,400 people and seized more than 240 hostages.

Israel, which says its forces have encircled Gaza City, faces mounting pressure over civilian casualties. A US diplomatic push in the region is intended to reduce risks of the conflict escalating.

The health ministry in Gaza said dozens of people were killed by the Israeli air strikes in Gaza City and further south in Gaza neighbourhoods such as Zawaida and Deir Al-Balah. Hamas-affiliated Al-Aqsa TV quoted medical sources as saying at least 75 Palestinians were killed and 106 hurt in the attacks.

Palestinian health officials said eight people were killed in an air strike overnight on Gaza City’s Rantissi cancer hospital. Israel’s military said it was looking into the report.

The Israeli army said its strikes hit “tunnels, terrorists, military compounds, observation posts, and anti-tank missile launch posts”. Ground troops killed several Hamas fighters while taking a militant compound containing observation posts, training areas and underground tunnels, it said.

Gaza border officials said the Rafah crossing has resumed operations to allow foreign passport holders and critically wounded Palestinians into Egypt. Hundreds of foreign nationals and wounded were allowed to leave Gaza for Egypt last week but no such exits have been reported since Nov 3.

Blinken in Turkey, CIA chief may visit Israel

Turkish Foreign Minister Hakan Fidan told his US counterpart Antony Blinken in a meeting in Ankara that a ceasefire needed to be declared urgently in Gaza, a Turkish foreign ministry source said.

Blinken made an unannounced visit to the West Bank on Sunday to meet Palestinian Authority President Mahmoud Abbas, who joined international calls for an immediate ceasefire. Blinken reiterated U.S. concerns that a ceasefire could aid Hamas and Israeli Prime Minister Benjamin Netanyahu ruled one out for now.

US CIA Director William Burns was also set to visit Israel on Monday to discuss the war and intelligence with officials, the New York Times reported. Burns also will make stops in other regional states, it quoted an unnamed US official as saying.

The CIA did not respond to Reuters’ request for comment.

Israel said 31 soldiers had been killed since it began expanded ground operations in Gaza on Oct. 27, fighting thousands of Hamas fighters who believe they can hold off Israel’s advance from a warren of tunnels under the enclave.

Israel has called on civilians in north Gaza - the heart of Hamas’ forces - to evacuate for their own safety and announced that it would enable free passage on a southbound highway for four hours every day.

However, UN monitoring showed that less than 2,000 did so on Sunday, citing fear, heavy damage to roads and lack of information due to limited communications, a UN humanitarian briefing said.

Lieutenant-Colonel Jonathan Conricus, an Israeli military spokesperson, showed reporters what he said was aerial footage of Hamas tunnels and rocket sites at two hospitals in northern Gaza, saying this showed Israel was not responsible for “what’s happening now in northern Gaza”.

A Hamas statement called on UN Secretary General Antonio Guterres to form a committee to visit Gaza hospitals to verify Israel’s “false narrative” that Hamas uses hospitals as sites.

On average, a child is killed and two are injured every 10 minutes during the war, the UN relief agency for Palestinians said. The agency’s shelters in south Gaza are overcrowded and unable to take new arrivals, and many displaced people are sleeping in the streets, the UN humanitarian office said.

‘Torn-apart flesh’

Telecoms provider Paltel said services were resuming after they were disconnected from the Israeli side on Sunday.

US Central Command, which covers the Middle East, said on X a nuclear missile submarine had arrived in the region - an unusual announcement seen by some analysts as a message to Iran, an Israeli foe.

The Iranian foreign minister Hossein Amirabdollahian told state TV the US has sent a message to Iran in the past three days saying it sought a ceasefire in Gaza, but in practice Iran had seen only US “support of genocide in Gaza.”

People searched for victims or survivors at the Maghazi refugee camp in Gaza, where the health ministry said Israeli forces had killed at least 47 people in strikes early on Sunday.

“All night I and the other men were trying to pick the dead from the rubble. We got children, dismembered, torn-apart flesh,” said Saeed al-Nejma, 53. Asked for comment, the Israeli military said it was gathering details.

In a separate attack, 21 Palestinians from one family were killed in strikes, the health ministry said. Israel’s military declined to comment.

Reuters could not independently verify these accounts.

Tensions increased with Lebanon after an Israeli strike on a car in the south of the country killed three children and their grandmother, Lebanese authorities said.

Israel said it hit “terrorist targets of Hezbollah in southern Lebanon” in response to a missile attack against tanks that killed an Israeli citizen. Hezbollah said it responded by firing rockets at Kiryat Shmona town in northern Israel.