Palestinian families have fled neighbourhoods on the outskirts of Gaza City as Israel unleashed heavy artillery fire at what it said was a large network of militant tunnels ahead of a possible ground invasion.

Separately, in the West Bank, Palestinian health officials said seven Palestinians were killed by Israeli army fire in several locations.

Israel has massed troops along the border and called up 9,000 reservists as fighting intensifies with the Islamic militant group Hamas, which controls the Gaza Strip.

Palestinian militants have fired some 1,800 rockets, and the Israeli military has launched more than 600 air strikes, toppling at least three high-rise apartment buildings, and has shelled some areas with tanks stationed near the frontier.

As Israel and Hamas plunged closer to all-out war despite international efforts at a ceasefire, communal violence in Israel erupted for a fourth night.

Jewish and Arab mobs clashed in the flashpoint town of Lod, even after Israel dispatched additional security forces.

The Gaza Health Ministry said the toll from the fighting has risen to 119 killed, including 31 children and 19 women, with 830 wounded.

The Hamas and Islamic Jihad militant groups have confirmed 20 deaths in their ranks, though Israel says that number is much higher.

Israeli soldiers search for a suspected Palestinian gunman as smoke rises from a fire set by Palestinians to block a road, in the village of Aqraba, near the West Bank town of Nablus
Israeli soldiers in the village of Aqraba, near the West Bank town of Nablus (Majdi Mohammed/AP)

Seven people have been killed in Israel, including a six-year-old boy and a soldier.

Of the seven Palestinians killed in the West Bank, most were killed in stone-throwing clashes in several locations, although one was killed while trying to stab an Israeli soldier, the health officials said.

About 100 were injured, most by live fire, they said.

The protests took place in several locations across the West Bank, signalling a new wave of unrest there as part of the escalation of fighting between Israel and Gaza’s Hamas rulers.

Palestinians living outside Gaza City, near the northern and eastern frontiers with Israel, fled the intense artillery bombardment on Friday.

Families arrived at the UN-run schools in the city in pick-up trucks, on donkeys and by foot, hauling pillows and pans, blankets and bread.

Israeli artillery unit
An Israeli artillery unit fires toward targets in the Gaza Strip (AP)

“We were planning to leave our homes at night, but Israeli jets bombarded us so we had to wait until the morning,” said Hedaia Maarouf, who fled with her extended family of 19 people, including 13 children.

“We were terrified for our children, who were screaming and shaking.”

In the northern Gaza Strip, Rafat Tanani, his pregnant wife and four children were killed after an Israeli warplane reduced a building to rubble, residents said.

“It was a massacre,” said Sadallah Tanani, a relative.

“My feelings are indescribable.”

Rockets fired
Rockets are launched from the Gaza Strip to Israel (AP)

Lt Col Jonathan Conricus, a military spokesman, said tanks stationed near the border fired 50 rounds.

It was part of a large operation that also involved air strikes and was aimed at destroying tunnels beneath Gaza City used by militants to evade surveillance and air strikes, which the military refers to as “the Metro”.

“As always, the aim is to strike military targets and to minimise collateral damage and civilian casualties,” he said.

“Unlike our very elaborate efforts to clear civilian areas before we strike high-rise or large buildings inside Gaza, that wasn’t feasible this time.”

The strikes came after Egyptian mediators rushed to Israel for ceasefire talks that showed no signs of progress.

Saleh Aruri, an exiled senior Hamas leader, told the satellite channel Al Araby that his group has turned down a proposal for a three-hour lull.

Rescuers search rubble
Palestinians rescuers search in the rubble for missing members of the Al-Tanani family, after their house was destroyed by Israeli air strikes in town of Beit Lahiya in the northern Gaza Strip (AP)

He said Egypt, Qatar and the United Nations were leading the truce efforts.

The fighting broke out late on Monday when Hamas fired a long-range rocket at Jerusalem in support of Palestinian protests there against the policing of a flashpoint holy site and efforts by Jewish settlers to evict dozens of Palestinian families from their homes.

Since then, Israel has attacked hundreds of targets in Gaza, causing earth-shaking explosions across densely populated areas.

Of the 1,800 rockets Gaza militants have fired, more than 400 fell short or misfired, according to the military.

The rockets have brought life in parts of southern Israel to a standstill, and several barrages have targeted the seaside metropolis of Tel Aviv, some 45 miles away from Gaza.

A hospital in Gaza
A mother comforts her son as he rests at the Shifa hospital in Gaza City after suffering wounds during an air strike (AP)

Israeli prime minister Benjamin Netanyahu vowed to continue the operation, saying in a video statement that Israel would “extract a very heavy price from Hamas”.

In Washington, US president Joe Biden said he spoke with Mr Netanyahu about calming the fighting but also backed the Israeli leader by saying “there has not been a significant over-reaction”.

He said the goal now is to “get to a point where there is a significant reduction in attacks, particularly rocket attacks” and called the effort “a work in progress”.

Israel has come under heavy international criticism for civilian casualties during three previous wars in Gaza, a densely populated area that is home to more than two million Palestinians.

Benjamin Netanyahu
Israeli prime minister Benjamin Netanyahu (AP)

It says Hamas is responsible for endangering civilians by placing military infrastructure in civilian areas and launching rockets from them.

Hamas showed no signs of backing down.

It fired its most powerful rocket, the Ayyash, nearly 120 miles into southern Israel. The rocket landed in the open desert but briefly disrupted flight traffic at the southern Ramon airport.

Hamas has also launched two drones that Israel said it quickly shot down.

Military spokesman for Hamas, Abu Obeida, said the group was not afraid of a ground invasion, which would be a chance “to increase our catch” of dead or captive soldiers.

A truck carries an Israeli artillery unit to a position in the Israeli Gaza border (AP)

The fighting cast a pall over the Muslim holiday of Eid al-Fitr, normally marked by family gatherings and festive meals. Instead, the streets of Gaza were mostly empty.

The current eruption of violence began a month ago in Jerusalem. A focal point of clashes was Jerusalem’s Al-Aqsa Mosque, built on a hilltop compound that is revered by Jews and Muslims.

Israel regards all of Jerusalem as its capital, while the Palestinians want east Jerusalem, which includes sites sacred to Jews, Christians and Muslims, to be the capital of their future state.

The violent clashes between Arabs and Jews in Jerusalem and other mixed cities across Israel has meanwhile added a new layer of volatility to the conflict not seen in more than two decades.