Salah Samouni banged his head in grief against a wall inside the hospital morgue where the bodies of his three nephews lay on the floor Monday. His relatives screamed at exhausted doctors, begging them to find people still buried under rubble.
After 10 days of a relentless Israeli assault, Shifa Hospital, Gaza's largest, is overwhelmed. Bodies are now crowded two to a morgue drawer, and some — like those of the Samouni children — are on the floor.
Many of the wounded are treated in hallways because rooms are full. Harried doctors and nurses run on little sleep, and the hospital is powered by emergency generators after shelling damaged power cables.
"Who ever comes with a head, we check his pulse. If there's no pulse, he's straight to the morgue. If there's no head, well, goodbye," said hospital official Raid Arini, shrugging.
The hospital scenes have only worsened since Israel began a ground offensive on Saturday. Most of the dead and wounded now arriving at Shifa are civilians, as Israel's offensive shifts from airstrikes to artillery shelling and ground fighting close to densely populated areas.
Israel says it is targeting only the Hamas militants who control Gaza in an attempt to halt seven years of rocket fire at Israeli communities. But the 550 Palestinians who have been killed include some 200 civilians, according to Dr. Moaiya Hassanein of the Gaza Health Ministry.
20 children died Monday
On Monday, 20 children between the age of two and 15 were killed, he said.
Since the military offensive began Dec. 27, three Israeli civilians and two soldiers have been killed.
Many casualties come through the shabby halls of Shifa, which echo with the sound of people screaming and the wail of ambulance sirens.
Red-eyed nurse Ahmad Abdul Salam, 34, smelled of sweat and his clothes were stained with blood. He said he couldn't sleep. "When my shift ends, I help my colleagues. These are our brothers and friends who are being harmed," he said.
The hospital's most gruesome scene is in its morgue, where blood pooled on the floor and refrigerators meant to hold 35 bodies crammed in 70 by laying them side-by-side in drawers. The three Samouni boys, Issa, 3, Mohammed, 4, and Ahmad, 5, lay on the floor on a gray mat. They appeared baby-faced and asleep, save for a large bandage wrapped around Issa's head.
The children's father was also killed in what relatives said was an Israeli strike on a house in eastern Gaza City where the family had fled to escape fighting nearby.
Relatives wept nearby, and one man screamed at a doctor to save other family members he said were still under the rubble of the house. "For God's sake, rescue them!" he pleaded.
No militants were seen at Shifa. There has been heavy fighting and Israel has said its forces have killed dozens of Palestinian gunmen, but Hamas has not listed its casualties and it is unclear where militants are being treated or where their bodies are stored.
Shifa has been powered by generators since power completely cut out in Gaza City three days ago. Israel has not replenished Gaza's power station with industrial fuel since fighting began, and air strikes have badly damaged power lines.
U.N. health official Mahmoud Daher said the generators were meant as an emergency backup but were now used all the time. He said he feared they would break down, which could be fatal to some 70 people hooked up to lifesaving devices.
Medics appeared exhausted and defiant.
Mohammed Salman, 26, a volunteer medic who was washing blood from the inside of an ambulance in the hospital garden, said he had treated people with horrific injuries, including headless children and a woman whose stomach had been torn open. The woman screamed, "Leave me and save my children," he said, and burst into tears.
Israeli aircraft have hit three ambulances in Gaza since the campaign began, killing seven medics, Gaza health officials say.
A medical building owned by a relief organization not connected to Hamas was also bombed, said Daher, the U.N. official. The building was destroyed, along with an ambulance, three mobile clinics and donated medicines, he said.
Israeli army spokespeople say they have no records of any of those strikes.
Health official Raed Arini said he has stopped filling out the space on death certificates left for "reason for death."
"The reason for death is the Israeli army," Arini said, as medics rushed in with more wounded people.