Arab countries blamed Israel, which has rained bombs on Gaza since the bloody October 7 attack by Hamas, and protests erupted in Muslim countries from Egypt to Pakistan while Lebanon's Iran-backed Hezbollah vowed a "day of rage".

But Biden, on a solidarity visit to meet Prime Minister Benjamin Netanyahu, voiced support for Israel's position that a misfired Islamic Jihad rocket caused the deadly carnage at Gaza's Christian-run Ahli Arab Hospital.

"I was deeply saddened and outraged by the explosion at the hospital in Gaza yesterday," Biden said about the strike that killed 471 people according to Gaza's Hamas-controlled health ministry.

"And, based on what I've seen, it appears as though it was done by the other team, not you," said the US president, referring to the armed movements Hamas and Islamic Jihad, which Washington designates "terrorist" groups.

"But there's a lot of people out there not sure, so we have to overcome a lot of things," Biden added, as protests also erupted against Israel and the United States in the occupied West Bank and Palestinian refugee camps in Lebanon.

Asked later by reporters what made him sure that Israel was not responsible for the strike, Biden replied: "The data I was shown by my defence department."

Biden has expressed "iron-clad" US support for top regional ally Israel and its military campaign -- retaliation for the killing of 1,400 people who were shot, mutilated or burnt to death in the shock cross-border attacks launched by Hamas.

"We will continue to have your back," Biden said after meeting Netanyahu's war cabinet in Tel Aviv. "As you work to defend your people, we will continue to work with you and partners across the region to prevent more tragedy to innocent civilians."

'Bloodshed must stop' 

But the horror of the hospital deaths threatened to derail his high-stakes regional visit, with Jordan cancelling a summit between King Abdullah II, Biden, Palestinian president Mahmud Abbas and Egyptian President Abdel Fattah al-Sisi.

Israel's military campaign to destroy Hamas, which is holding 199 hostages in the besieged territory, has now claimed the lives of 3,478 people, according to health officials.

Arab countries have almost universally blamed Israel for the hospital strike, either directly or through state media -- including Egypt, Jordan and the United Arab Emirates, which are among the region's few countries which have diplomatic relations with Israel.

In besieged Gaza, the hospital blast brought new horrors after 12 days of sustained bombardment that Israel says targets Hamas and which has destroyed entire city blocks. 

More than a million people have been displaced ahead of an anticipated Israeli ground offensive, according to the UN.

Overnight, after the explosion, scores of bodies cloaked in blood-stained sheets and white plastic lined the floors at the nearby the Al-Shifa hospital, where bereaved relatives tried to identify loved ones.

"As I entered the hospital, I heard the explosion. I saw a massive fire," said Gaza resident Adnan al-Naqa. "The entire square was on fire. There were bodies everywhere, children, women and elderly people."

"Hospitals are not a target," said Ghassan Abu Sittah of the charity Doctors Without Borders, who was inside the building when the compound was hit. "This bloodshed must stop. Enough is enough."

The Palestine Red Crescent Society said hundreds died including "internally displaced people seeking safe shelter".

Israeli military spokesman Daniel Hagari told a press conference that the hospital was hit by a rocket that misfired after it was launched by Islamic Jihad -- an ally of Hamas, Gaza's rulers, who have fired thousands of rockets into Israel since October 7.

"Our radar system tracked missiles fired by terrorists in Gaza at the time of the explosion and the trajectory analysis of the rockets shows the rockets were fired in close proximity to the hospital." 

Hamas replied that Israel's "outrageous lies do not deceive anyone".

The group also slammed the United States on Wednesday, accusing Israel's long-time ally of being complicit in the ongoing strikes on Gaza. 

"The continued endorsement of the Zionist narrative by the US administration makes it complicit in the occupation's massacres and the Baptist hospital massacre in Gaza," it said in a statement. 

'Spiralling out of control'  

Entire Gaza neighbourhoods have been razed and survivors are left with dwindling supplies of food, water and fuel, unable to flee the 40-kilometre (25-mile) long strip blockaded by Israel and Egypt since 2007.

"The situation in Gaza is spiralling out of control," World Health Organization chief Tedros Adhanom Ghebreyesus wrote on X, formerly Twitter. 

"We need violence on all sides to stop."

UN Secretary-General Antonio Guterres called for an "immediate humanitarian ceasefire" and warned Israel against "the collective punishment of the Palestinian people".

Biden said he was encouraging Netanyahu to ensure "life-saving capacity to help the Palestinians who are innocent and caught in the middle of this".

Inside Gaza, hundreds of Palestinians who hold US or other foreign passports have desperately hoped to escape through the Rafah border crossing with Egypt, the only way in or out of Gaza not controlled by Israel.

The Rafah crossing has remained closed during the war as Israel has struck the Palestinian side, preventing the delivery of aid piled up in long convoys of trucks waiting in Egypt.

Sisi, in a joint press conference with German Chancellor Olaf Scholz, denied Egypt was keeping the border closed and warned against any potential Israeli plan to permanently drive Palestinians out of Gaza.

Such a "forced displacement of Palestinians from Gaza into Egypt" would set a precedent for also pushing West Bank Palestinians into Jordan, Sisi said.

The effect, the Egyptian president warned, would be "eradicating the Palestinian cause" and making a future Palestinian state "impossible".

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