The U.S. abstention on the resolution, which also called for the “immediate and unconditional release of all hostages,” appeared to mark a significant policy change for the Biden administration. The United States has frequently provided diplomatic cover for Netanyahu’s government as its campaign to defeat Hamas has led to the killings of more than 32,000 people in Gaza, according to local health authorities.

White House National Security Council spokesman John Kirby told reporters immediately after the vote that the abstention did not represent a “change in policy” by the administration.

“There is no reason for this to be seen as some sort of escalation,” he said. “Nothing has changed about our policy. We still want to see a cease-fire. We still want to get all hostages out. And we still want to see more humanitarian assistance get in to the people of Gaza.”

Kirby confirmed the cancellation of the visit by top advisers to Netanyahu. “We’re very disappointed that they won’t be coming to Washington, D.C., to allow us to have a fulsome conversation with them about viable alternatives going in on the ground in Rafah,” he said.

Coming hours after Israeli Defense Minister Yoav Gallant arrived in Washington for talks on weapons and U.S. support, the abstention looked set to further strain Washington’s relationship with Israel as frustrations grow within the Biden administration over Netanyahu’s open defiance of its calls for restraint in Gaza.

In a March 18 call, Biden had asked Netanyahu to send a senior interagency team that could listen to U.S. concerns about Israel’s planned military operation in Rafah, a city in southern Gaza where nearly 1.5 million displaced Palestinians are sheltering.

The United States has sent more than 100 weapons deliveries to Israel since the war began Oct. 7 with a Hamas attack on Israel that killed at least 1,200 people and resulted in the taking of 253 hostages. The ensuing military operation has sparked a humanitarian crisis so catastrophic that senior aid officials describe its intensity and breadth as unparalleled in decades.

The United States has vetoed three previous cease-fire resolutions and failed to secure passage of its own resolution Friday that tied a stop to the fighting to the release of hostages. Monday’s measure, supported by Russia and China, separated the two provisions as independent demands. An amendment proposed by Russia which would have inserted the word “permanent” before the cease-fire demand failed to pass.

The resolution says the cease-fire should begin immediately and last throughout Ramadan, Islam’s holy month of fasting, which began earlier this month, and lay the groundwork for a sustainable end to the war.

In explaining the abstention, U.S. Ambassador to the United Nations Linda Thomas-Greenfield said that “certain key edits were ignored” by the sponsors and that the United States “did not agree with everything in the resolution.” While “we fully support some of the objectives,” she said, “we believe it was important to speak out and make clear that any cease-fire must come with the release of all hostages.”

The drama unfolded as Gallant was set to meet with Defense Secretary Lloyd Austin, Secretary of State Antony Blinken, national security adviser Jake Sullivan and CIA Director William J. Burns. In a statement Sunday night, Gallant had said the visit would focus on “preserving Israel’s qualitative military edge,” including “our ability to obtain platforms and munitions.” He said that he also planned to speak with U.S. officials about “ways to achieve our common goals: victory over Hamas and returning the hostages home.”

But while the Israeli side emphasized goals shared with Washington, U.S. officials said the visit will also focus on an issue on which Israeli and U.S. policies diverge — most notably, on the situation in Rafah.

On Sunday, Vice President Harris told ABC News’s “This Week” that any military operation in Rafah “would be a huge mistake.” Asked whether there would be “consequences” from the United States for an Israeli operation in Rafah, she said, “I am ruling out nothing.”

Netanyahu, addressing the nation late Sunday on the Jewish holiday of Purim, said that “it is impossible to defeat the sheer evil [of Hamas] by leaving it intact in Rafah. … We will enter Rafah and achieve total victory.”

Analysts say that Netanyahu’s bellicose rhetoric regarding a potential Rafah operation is aimed in large part at his domestic constituency, overstating its imminence for political gain.

Aid groups have warned that such an operation could deepen Gaza’s humanitarian disaster. Half of the enclave’s 2.2 million population is already facing catastrophic levels of hunger, a U.N.-backed report concluded last week. Famine may already have reached some communities.

In the north, where Gaza’s hunger crisis is most acute, fighting raged for a seventh day Monday as the Israel Defense Forces said that it was continuing operations in the area of al-Shifa Hospital.

The IDF has cast that mission as advancing its goal of destroying Hamas, reporting that more than 150 people the IDF said were terrorists have been killed and that hundreds of suspects have been detained since the operation began. In a statement Monday, the IDF said that fighting was taking place within the hospital buildings and that “many weapons” had been discovered inside the maternity ward. The claims could not immediately be verified.

But global health officials have voiced horror at the conditions faced by medics and patients trapped inside the facility. Citing an unnamed doctor, Tedros Adhanom Ghebreyesus, the director general of the World Health Organization, said Friday that 50 health-care workers and 143 patients were trapped in one building, with extremely limited food and water and a single nonfunctional toilet. He reported that many of the patients were in critical condition and lying on the floor.

Hossam, a 28-year-old man trapped with dozens of relatives inside an apartment building near the hospital, said that the sounds of fighting were constant. He asked that his surname be withheld out of concerns for his safety.

“What scares us most now is that the soldiers find out about us,” he said. “From time to time we see troop carriers carrying a large number of detainees.” He said that the men of the family had given the women and children pieces of paper carrying the contact information of relatives and acquaintances in southern Gaza, in case they were separated.

From their building high above the hospital, Hossam reported seeing tanks in the courtyard of the medical complex, “while the bulldozers carry out continuous sweeping operations of the streets and neighboring houses.”

While Israel has proposed moving displaced families in the southern city of Rafah to “humanitarian islands” in other parts of the enclave, it is unclear how that would work in practice. Fighting between the Israeli army and Hamas militants has continued to rage in areas that were once designated as safe zones. Civilians, most of them displaced multiple times, say there is no place left in Gaza that is truly safe.

But despite the harsher rhetoric from U.S. leaders, they appear unwilling to use the most direct leverage they have, which would involve imposing conditions on the supply of U.S. military equipment to Israel. During a visit Friday to Tel Aviv, Blinken was asked repeatedly whether the United States might halt or slow aid to Israel if it invades Rafah or if the conflict continues, and each time he said he would not speculate about hypotheticals.

Global opinion, meanwhile, has been coming together in opposition to a Rafah campaign. On Monday in Amman, Jordan, U.N. Secretary General António Guterres described a growing consensus “to tell the Israelis that the cease-fire is needed.”

“I heard it in the U.S., I heard it from the European Union, not to mention of course the Muslim world, a growing consensus to tell clearly to Israelis that any ground invasion of Rafah could mean a catastrophic humanitarian disaster,” he said.

Hajar Harb in London, Lior Soroka in Tel Aviv, Rachel Pannett in Sydney, Annabelle Timsit in London and Sarah Dadouch in Beirut contributed to this report.