The US has intensified its attacks on Iran, hitting targets near Tehran and striking a ship it accused of trying to break its blockade, while Iran retaliated by firing missiles and drones at US allies in the region

Six consecutive days of back-and-forth attacks threaten to pull the region back into a total war and cast serious doubt about an interim deal reached last month meant to achieve a permanent peace.

US attacks had killed more than 35 people and wounded more than 300 others in recent days, Iranian authorities said.

Tehran accused the US of carrying out a “barbaric attack” after a cancer hospital in south-west Iran was evacuated because of strikes nearby.

“This barbaric attack, reminiscent of Israel’s atrocities against healthcare facilities, caused severe suffering and anxiety upon the hospitalised children,” Iran’s foreign ministry spokesperson said on X. Esmaeil Baghaei added that “211 patients undergoing chemotherapy” were evacuated.

Iran responded on Thursday with missiles and drones targeting Bahrain, Jordan and Kuwait, which host US bases. Iraq’s prime minister, Ali al-Zaidi, also said there was an overnight drone attack on the city of Erbil in Iraqi Kurdistan. The attack, which was intercepted, came as al-Zaidi pledged to disarm non-state armed groups during a trip to the US.

Iraqi authorities also suspended crude oil loading at all Iraqi terminals on Thursday after a drone crashed into an oil tanker in Basra without causing damage, Reuters reported.

Zolfaghari added that the only way to reopen the strait was for the US to follow the 14-point Memorandum of Understanding (MoU) signed last month, as well to abide by “Iranian regulations” for transiting ships.

Much of the latest fighting has focused on the strait, as Iran and the US fight for the future of the critical waterway.

The MoU signed last month said the strait should remain open for the 60-day period of the interim deal. However, the two sides interpret the MoU differently, with both sides insisting that ships transit the strait via their own separately designated lanes.

The strait was all but closed by Iran after the start of the war, sending global energy prices and inflation soaring. Trump is keen to have the strait reopened because higher energy prices could harm Republican candidates in autumn’s midterm elections.

Fewer vessels went through the strait on Wednesday after the US blockade was reimposed and fighting continued, shipping data showed. Nine ships, mostly on the Iranian-provided route, not the US one, navigated the strait as opposed to 13 on Tuesday.

India, one of the largest contributors of sailors to merchant vessels worldwide, told shipowners and recruitment companies not to send Indian sailors on ships heading for the strait.

“There should be no deployment of Indian seafarers on vessels undertaking voyages involving passage through the strait of Hormuz until further orders,” India’s directorate general of maritime administration said in a statement on Wednesday.

The price of oil has increased to about $85 a barrel – the highest price in a month, but still below the peak of $120 during the war. Analysts said that continued disruptions to shipping in the strait could see oil prices increase further, reaching as high as $100 a barrel.

The US has threatened that it could open the strait by force, but experts have said that such an operation would need thousands of ground troops.

Trump has continued to insist that Iran was ready to make a peace deal, though Iranian officials have said they will not bow to military pressure.

“They don’t like what we’re doing, and they do want to settle. We’ll find out whether or not we settle with them, or we just finish it off,” Trump said on Wednesday during a speech at the US army’s war college.

Trump’s statements conflicted with those of Iranian officials, with Iran’s top negotiator and speaker of parliament, Mohammad Bagher Ghalibaf, saying in a statement that “we are in an essential and existential war with America”.