Of course, when sanding by hand, you do not necessarily have to use a sanding block. But it does have some obvious advantages over purely manual sanding. This may make the surface a little more even, or it may be easier to get into a corner.
The same applies analogously to the size and hardness of the sanding block as to the machines:
Fig: Hand sanding with suction
As far as dust is concerned, recently there are also sanding blocks with suction.