The US government says Israel may have breached humanitarian law in Gaza using American weapons.
In a delayed report, the state department says it is "reasonable to assess" that US-supplied arms have been used in ways "inconsistent" with Israel's obligations.
But it says Israel has had to confront an "extraordinary military challenge" fighting Hamas in Gaza.
The report, ordered by the White House, was submitted to Congress on Friday.
While the report was a clear rebuke of some Israeli operations in Gaza, it stopped short of definitively saying that the Israel Defense Forces (IDF) campaign had breached international law.
And it said assurances it had received from Israel about adhering to the legal use of US weapons were "credible and reliable", and so weapons shipments could continue.
The document also noted that the US government does not have "complete information" in its assessment and that, because Hamas "uses civilian infrastructure for military purposes and civilians as human shields", it was often "difficult to determine facts on the ground in an active war zone" of what are legitimate targets.
It said that given Israel's significant reliance on US-made weapons they had likely been used "in instances inconsistent with its IHL [international humanitarian law] obligations or with established best practices for mitigating civilian harm".
It concluded however that "Israel has the knowledge, experience, and tools to implement best practices for mitigating civilian harm in its military operations", but that "results on the ground, including high levels of civilian casualties, raise substantial questions as to whether the IDF is using them effectively in all cases".
The report was finally released days after US President Joe Biden publicly threatened to withhold certain bombs and artillery shells from Israel if it went ahead with an assault on Rafah, the last stronghold of Hamas in Gaza that is packed with more than a million Palestinians.
The state department also found that, despite Israel not fully co-operating with US efforts to get humanitarian aid into Gaza in the initial months after the conflict began, it does not currently assess that Israel is prohibiting or restricting the transport of aid supplies.
Israel launched a military campaign in Gaza to destroy Hamas in response to the group's attack on southern Israel on 7 October, during which about 1,200 people were killed and 252 others were taken hostage. More than 34,900 people have been killed in Gaza since then, according to the territory's Hamas-run health ministry.
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