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'It is bloody, it is ugly': US warns Palestinian civilians will be 'hurt' in Gaza

US national security spokesperson says "prudent contingency planning" is under way to evacuate Americans from Middle East if Israel's war in Gaza spills over across the region and warns "it's going to be messy" in the besieged enclave.

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A Palestinian man carries shrouded body of a baby, killed in Israeli strikes, from the Al Najar Hospital morgue to be buried in Gaza on October 24, 2023. / Photo: AA

The US is developing a plan to evacuate Americans from the Middle East in case Israel's war on besieged Gaza spreads into a broad regional conflict, US officials have said, adding "innocent civilians are going to be hurt" in the "messy" war.

White House National Security Council spokesperson John Kirby stressed on Tuesday there are currently no "active efforts" to evacuate Americans from the region beyond charter flights the US government began operating earlier this month out of Israel.

"It would be imprudent and irresponsible if we didn't have folks thinking through a broad range of contingencies and possibilities," Kirby said. "And certainly evacuations are one of those things."

The White House addressed the contingency plans amid growing concerns that the 18-day-old Israeli war on Gaza could further escalate.

The US has advised Israel that postponing a possible ground invasion of Gaza could be helpful as the US and other partners in the region try to secure the release of more than 200 hostages who were captured in the October 7 attack.

The contingency planning was first reported by The Washington Post.

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US says 'it's going to be messy'

Gaza's 2.3 million people have been running out of food, water, fuel and medicine.

The humanitarian aid convoys allowed into Gaza so far have carried a fraction of what's needed.

The ongoing war is the deadliest of five Gaza wars for both sides. Gaza authorities said at least 5,791 Palestinians have been killed and 16,297 wounded.

In the occupied West Bank, 96 Palestinians have been killed and 1,650 wounded in violence. At least 1,400 Israelis have also been killed in the conflict.

Meanwhile, Kirby said while Washington opposed a full ceasefire, stoppages in the fighting to facilitate the delivery of aid was "something that ought to be considered."

"We want to see all measure of protection for civilians and pauses in an operation is a tool and a tactic that can do that for temporary periods of time," he said. "It's not the same as saying a ceasefire."

Kirby meanwhile warned that while the United States had urged Israel to minimise civilian casualties, some were "inevitable".

"This is war. It is combat. It is bloody. It is ugly, and it's going to be messy, and innocent civilians are going to be hurt going forward," he said.

"I wish I could tell you something different and wish that that wasn't going to happen, but it is going to happen. And that doesn't make it right. It doesn't make it dismissible."