Plight of Americans stuck in Gaza grows more dire as fighting rages

Despite the latest heavy fighting in southern Gaza, the State Department has yet to secure safe passage for at least 350 American citizens stuck inside the besieged enclave since Israel's war with Hamas began two months ago -- just some of the tens of thousands of civilians caught in the crossfire.

Even given the severity of the situation, some family members of the Americans there say the Biden administration has not done enough -- and there's little public evidence of an intensified diplomatic push in recent weeks to expedite their departure.

"It continues to be something that we are focused on," department spokesperson Matthew Miller said Wednesday. "We continue to work with the government of Israel, with the government of Egypt to try and get more Americans out."

In addition to the hundreds of U.S. citizens, roughly 600 legal permanent residents and immediate family members of Americans eligible to depart Gaza were also still stuck, Miller said.

Although it took weeks of complex deliberations involving the U.S., Egypt, Israel, Hamas and other parties to hash out a deal that would allow foreigners to exit through the Rafah Crossing into the Sinai Peninsula in Egypt, implementing that diplomatic agreement has proven just as tedious -- and the slow-moving exodus of foreigners has failed to keep pace with the expansion of Israel's offensive.

Since the beginning of November, the State Department has helped approximately 1,100 Americans and their relatives exit Gaza, but both Egypt and Israel have limited the flow of individuals and sporadically closed the portal with little warning or explanation --leaving U.S. officials struggling to communicate why the crossing was closed or when it might be opened again.

Hamas -- which controls Gaza's side of the border and the list of individuals eligible to depart on any particular day -- is even more opaque in its operations, often giving Americans and other foreigners attempting to navigate the war-torn streets of Gaza little guidance regarding when they should arrive at the gate.

"We have a number of Americans who are on the list -- who are clear to leave and who have not yet left. We'll continue to try and get them out," Miller said.

The State Department maintains that while U.S. officials can't offer help with transportation inside Gaza, they are in steady contact with Americans inside the enclave.

But some family members, like Chicago resident Yasmeen Elagha, have criticized the administration for what they say is a lack of transparency.

Elagha told ABC News that two of her cousins who live in Gaza are American citizens, and although they filled out crisis-intake forms on the State Department's website, they have not received any response.

"You don't receive a confirmation email. You don't receive any point of contact. You don't receive any guidance for next steps. So it just becomes a waiting game," Elagha told ABC News.

That waiting game seems poised to become even more dangerous as the death toll inside the enclave continues to rise.

On Thursday, the Hamas-run Gaza Ministry of Health reported that 350 people had been killed over the previous 24 hours alone, but so far U.S. officials have not confirmed that any American civilians inside the enclave have died as a result of the conflict.

At least one lawsuit alleging that the State Department has not done enough to help Americans in Gaza has been filed in federal court. Administration officials say their hands are tied and outside of land crossings like the Rafah gate, there's no way to safely evacuate civilians amid the ongoing conflict.

Miller explained that while the Biden administration was tracking roughly 1,000 individuals connected to the U.S. that wanted to leave Gaza in the early days of the conflict, the estimate has ballooned over time as more people have tuned to the State Department for help.

"This remains a fluid and quickly evolving situation," he said.

To alleviate at least some of the suffering that Americans and others unable to leave the enclave are experiencing, Miller said the U.S. has been working to ramp up the amount of humanitarian aid that can enter Gaza—including by working with Israeli authorities towards opening the Kerem Shalom crossing, just a few miles south of the Rafah gate.

"We continue to think that Kerem Shalom would be a good facility to use for increased inspections of trucks. I've said in the past that Israel has had security concerns about that. We've been trying to work through those security concerns with Israel," he said.

American officials say that while they see opening Kerem Shalom to goods as an attainable goal in the near-term, allowing individuals to cross remains a non-starter for Israel.

A high-level official at the United Nations said on Thursday there were "promising signs" the border crossing could be opened soon.

"If we get that, well it would be the first miracle we've seen for some weeks," said U.N. Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Martin Griffiths.

ABC News' Ayesha Ali and Ella Ward contributed to this report.