President Biden departed Tuesday for the Middle East on a high-stakes mission to ease the Palestinian humanitarian crisis and reiterate support for Israel. The trip went ahead even as the White House announced that meetings with key Arab leaders had been scrapped after a blast that killed hundreds of people at a Gaza Strip hospital.

Unrelenting violence, death and destruction cast an ominous pall over Biden’s trip to Israel, heightened the perilous security situation on the ground and complicated the president’s precarious balancing act between diplomacy and politics, probably scuttling the first steps toward easing the crisis.

Smoke rises in Gaza, seen from the Israeli city of Sderot.

Smoke rises in Gaza, seen from the Israeli city of Sderot.

(Mostafa Alkharouf / Anadolu via Getty Images)

It was already a daring venture — a U.S. president traveling into an active war zone — but Biden and his senior advisors calculated that it would take his influence to break an impasse over Israeli and Egyptian unwillingness to open channels of humanitarian aid into the Gaza Strip, where more than 2 million Palestinians have run out of water, most food and medicine, and electricity.

Biden was scheduled to meet in Amman, Jordan, with leaders from Israel, Jordan, Egypt and the Palestinian Authority. But hours before he left Washington, those meetings were canceled and any potential achievements of the mission were endangered by the massive hospital explosion in Gaza.

Gaza Health Ministry officials said Tuesday that a major hospital sheltering wounded and displaced civilians was hit by an Israeli airstrike that quickly engulfed the compound in flames. The Israeli military said it was investigating, but blamed the explosion on a failed missile launch by Islamic Jihad, a smaller militant faction allied with Hamas, positioned near the hospital.

News of the carnage angered Palestinians across the region, including in areas that had been relatively quiet until now. Demonstrations in the West Bank spread into neighboring Jordan.

Palestinian Authority President Mahmoud Abbas decided late Tuesday to boycott the Biden meeting, his office said. Abbas has no ruling position in Gaza but oversees the larger West Bank.

That then forced cancellation of a gathering in Jordan with King Abdullah II and Egyptian President Abdel Fattah Sisi, according to a White House official.

“The president sent his deepest condolences for the innocent lives lost in the hospital explosion in Gaza,” the official said.

U.S. government officials have grown increasingly concerned about the soaring civilian death toll in Gaza, and Biden’s trip offered a chance for the personal diplomacy he has prioritized in his administration. But the specter of a ferocious ground invasion that Prime Minister Benjamin Netanyahu plans to launch to destroy Hamas threatens to tie Biden’s presidential legacy to the disaster that could unfold.

Biden offered “unequivocal” support for Israel and its “right to defend itself” following the Oct. 7 attacks by Hamas militants in southern Israel that killed about 1,400 people, mostly Israeli civilians. About 200 others, including several U.S. citizens, were kidnapped and are being held hostage, Hamas and Israel say, in the most devastating attack in Israel’s history.

President Biden waves from jet's doorway

President Biden waves as he boards Air Force One at Andrews Air Force Base, Md., en route to Israel.

(Jess Rapfogel / Associated Press)

But Biden has had to nuance the kind of support offered, advisors say, because of resistance among many Arab allies who are more sympathetic to Palestinians and who urge priorities that include humanitarian aid and a de-escalation in violence on all sides.

“It’s no surprise that President Joe Biden feels a need to travel to Israel and meet the leadership,” said Jon Alterman, head of the Middle East program at the Center for Strategic and International Studies. “He will reiterate to the Israelis that he is completely with them. … And then, he will ask hard questions. What comes next? How will a new leadership emerge? … In Biden’s mind, the way Israel fights in the coming weeks and months will have a profound effect on Israel’s fortunes, as well as American ones.”

One of Biden’s goals was to force Egypt and Israel to open the Rafah border crossing on the southern end of the Gaza Strip abutting Egypt, where thousands of Palestinians are crowding on the Gazan side in hopes of escape or at least access to aid. On the Egyptian side, trucks laden with food and supplies idle, awaiting an opening. Both countries made promises to allow access but have not followed through, and it seems less likely now after explosions in Gaza that either country would be amenable.

Chaotic scenes from the Ahli Arab Hospital in Gaza City — darkness illuminated by flames — showed a steady stream of badly wounded and burned victims being pulled from rubble and rushed to another hospital where the injured were being lined up in hallways. Palestinian officials said at least 500 people may have been killed, with doctors among those who died. Ghassan abu Sittah, a British-Palestinian doctor, told the BBC that the blast knocked him to the ground as he was operating.

Several thousand Palestinians were taking refuge there. Over the weekend, Israel ordered around a million Palestinians in the northern Gaza Strip to evacuate for their safety, but in reality, few have anywhere to go and there is an unsettling sense that nowhere is safe.

Bodies of Palestinians killed in a massive blast at Ahli Arab Hospital lie at Shifa Hospital in Gaza City.

Bodies of Palestinians killed in a massive blast at Ahli Arab Hospital lie at Shifa Hospital in Gaza City.

(Mohammad Abu Elsebah / picture alliance via Getty Images)

The Palestinian Health Ministry, which in Gaza is controlled by Hamas, blamed the attack on Israeli airstrikes, which Israel denied. Israeli government advisor Mark Regev said Israel does not target hospitals and blamed Islamic Jihad, which in turn denied responsibility.

The Pentagon said it could not verify who was responsible for the blasts at the hospital, which is fully funded by the Church of England. A deliberate attack on a medical facility would be considered a war crime.

“This administration has been very clear about the law of war,” Pentagon spokeswoman Sabrina Singh said. “The law of war must be upheld.”

Israeli airstrikes on Gaza have already killed about 3,000 people, mostly civilians and including families, U.N. workers and at least 17 journalists.

Separately on Tuesday, the United Nations said an Israeli airstrike hit a U.N. school in central Gaza where Palestinians were sheltering. At least six people were killed and many more injured, including U.N. staff, the organization said.

Before the conflagration at the hospital and waves of destruction that followed, Biden’s trip to Israel and Jordan was seen as a way to “move in a less escalatory direction,” said Bilal Saab, director of the Defense and Security Program at the Middle East Institute. Hours of “war Cabinet” sessions at the White House and a presidential visit represent “war management and communication of the limits of U.S. support,” he said.

“That’s why we moved all these military assets to the [the region]: to reassure the Israelis but also support our diplomatic effort,” Saab said. “We’re finally walking and chewing gum at the same time.”

With Tuesday’s question over who is behind the attack on the Gaza hospital and the prospect of an imminent ground invasion, Biden is “in the middle of all of this,” said Aaron David Miller, a veteran former Middle East envoy now at the Carnegie Endowment for International Peace.

“That’s never a good place to be. He needs to be realistic about his expectations,” Miller said. “His trip will not be deemed a success if they can’t come to a resolution of what to do about Rafah, which is the only entry point for humanitarian assistance. At minimum, he’s got to achieve that and I think that will have been worth his travel.”

He also needs to have “a hard conversation” with Israeli leadership about what a ground campaign would look like, Miller added.

“He’s built up enough currency and trust over the course of the last week to have the conversation, but it’s unclear whether he’s prepared to have it,” Miller said.

In Israel, Biden will be greeted by enormous billboards that read, “Thank you, Mr. President.” His full-throated support for Israel has earned him accolades in a nation until recently agitated by protests over domestic legislative reform issues but now suddenly united.

But that same deference may weaken one of Biden’s other stated missions — to prevent the war from spreading into other countries that are unfriendly to Israel.

Iran, which advocates for the destruction of Israel and backs not only Hamas, but other militias in the region such as Lebanon’s Hezbollah, dispatched its foreign minister through the region even as U.S. Secretary of State Antony J. Blinken was immersed in similar shuttle diplomacy.

“Time is running out very fast,” Hossein Amir-Abdollahian said on Iranian state television. “If the war crimes against the Palestinians are not immediately stopped, other multiple fronts will open and this is inevitable.”

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