Washington's veto was swiftly condemned by the Palestinian Authority and Hamas, whose health ministry put the latest death toll in Gaza at 17,700, mostly women and children.
UN secretary-general Antonio Guterres triggered the rare Security Council vote by invoking a measure unused in decades. He sought the council's endorsement of a ceasefire because, he said, rapidly deteriorating conditions make it "impossible for meaningful humanitarian operations", with potentially irreversible implications for regional peace and security.
"The people of Gaza are being told to move like human pinballs - ricocheting between eversmaller slivers of the south, without any of the basics for survival," he said, referring to Israeli instructions to Gazan civilians to move to safe areas.
"The brutality perpetrated by Hamas can never justify the collective punishment of the Palestinian people," he added.
The US vetoed the Security Council resolution. US envoy Robert Wood said it was "divorced from reality" and "would leave Hamas in place able to repeat what it did on October 7". Israeli foreign minister Eli Cohen said a ceasefire "would prevent the collapse" of Hamas "which is committing war crimes and crimes against humanity, and would enable it to continue ruling the Gaza Strip".
As a permanent Security Council member, Washington can veto any resolution, while Britain, also a member, abstained on the vote, and the 13 other members voted in favour.
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