Five people were killed and 92 others were wounded on Monday in Iran’s latest missile strikes on Israel, according to the Magen David Adom emergency service, raising an earlier death toll of four.

The casualties were from attacks on four sites in central Israel, MDA said in a statement, adding those killed included “two women and two men around the age of 70, as well as one additional fatality.”

“So far, MDA teams have evacuated 92 injured individuals to hospitals, including a 30-year-old woman in serious condition with facial injuries, six in moderate condition, and 85 in mild condition,” it added.

Search and rescue efforts remain underway at two of the four sites targeted by Iran.

The Iranian missile barrage followed Israeli air strikes on military targets deep inside Iran. Both countries have since threatened to escalate the conflict further.

Israeli Defence Minister Israel Katz warned on Monday that Tehran’s residents would “pay the price” for Iranian strikes on Israeli civilians.

AFP images showed gutted residential buildings in Tel Aviv, with fires smouldering outside Haifa, after the Israeli army warned residents to take cover from incoming missiles. Loud explosions were also heard in Jerusalem, while Israeli air defences lit up the sky intercepting the missiles.

Israel’s surprise military assault on Iran last week has ignited the most intense direct conflict yet between the two longtime enemies, raising fears that the fighting could engulf the entire Middle East.

Israel claims that its attacks struck military and nuclear facilities, killing senior commanders and atomic scientists. However, a senior US official said on Sunday that US President Donald Trump told Israel to call off a planned assassination of Iran’s supreme leader Ayatollah Ali Khamenei.

Trump has urged both sides to “make a deal,” but admitted to reporters Sunday that “sometimes they have to fight it out” first.

The Iranian missile attack on Monday came in response to Israeli strikes targeting missile sites in central Iran. Iran’s Revolutionary Guards said they had “successfully” struck Israeli positions and warned of “effective, targeted and more devastating operations” to follow.

Iran’s latest attack brought fresh devastation to civilian areas. Israeli Prime Minister Benjamin Netanyahu accused Iran of deliberately targeting civilians.

“Iran will pay a very heavy price for the premeditated murder of civilians, women and children,” Netanyahu said while visiting a missile-hit residential building in Bat Yam near Tel Aviv.

Since Friday, Iranian missile strikes have killed more than a dozen people in Israel. On the other side, Iran’s health ministry reported at least 224 people killed and over 1,200 wounded from Israeli attacks.

Iranian state television reported that five people were killed Sunday when Israeli strikes hit a residential building in central Tehran.

Iranian Colonel Reza Sayyad issued a stern warning in a televised statement.

“Leave the occupied territories (Israel) because they will certainly no longer be habitable in the future,” he said, adding shelters will “not guarantee security.”

Addressing parliament, Iranian President Masoud Pezeshkian urged citizens to remain united. “Stand strong against this genocidal criminal aggression with unity and coherence,” he said.

Israeli Defense Minister Israel Katz repeated his warning that Iranian civilians would face consequences, saying Tehran’s residents would “pay the price” for Iran’s actions.

Despite reports of residents fleeing Tehran, some expressed determination to stay. “It is natural that war has its own stress, but I will not leave my city,” said Shokouh Razzazi, 31.

Trump maintained that the United States had no role in Israel’s military campaign but warned of severe retaliation if Iran attacked US forces. “Sometimes they have to fight it out, but we’re going to see what happens,” Trump told reporters at the White House.

A senior US official confirmed that Trump had intervened to block Israel’s reported plan to assassinate Khamenei. “We found out that the Israelis had plans to hit Iran’s supreme leader. President Trump was against it and we told the Israelis not to,” the official said.

When asked whether regime change in Iran was one of the goals of Israel’s strikes, Netanyahu told Fox News, “It certainly could be the result, because the Iran regime is very weak.”

Iran’s Foreign Minister Abbas Araghchi claimed that Tehran had “solid proof” that US forces supported Israel in its recent military operations. He told foreign diplomats, “If the aggression stops, naturally our responses will also stop.”

With the conflict raging, Iran canceled its planned nuclear talks with the United States, calling them “meaningless” amid the bombardment. Iranian authorities also announced the execution of a convicted Mossad agent, while Israel said it had arrested two people over alleged ties to Iranian intelligence.

As the fighting intensifies, fears grow that the conflict could spiral into a wider regional war.