GAZA CITY, Gaza Strip – Wailing in grief, Salah Samouni banged his head against a wall inside the hospital morgue where the bodies of his three young nephews lay on the floor Monday.
After 10 days of a relentless Israeli assault, Shifa Hospital, Gaza's largest, is overwhelmed. Bodies were crowded two to a morgue drawer, and some — like 3-year-old Issa, 4-year-old Mohammed and 5-year-old Ahmad — were on the floor.
Shifa's shabby halls echoed Monday with the sounds of people screaming and the wail of ambulance sirens. Many of the wounded were being treated in hallways by harried doctors and nurses running on little sleep. The hospital was powered by emergency generators after shelling damaged power lines.
Since Israel began a ground offensive Saturday, most of the dead and wounded arriving at Shifa are civilians, as Israel's offensive shifts from airstrikes to artillery shelling and 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 at least 200 civilians, according to Dr. Moaiya Hassanein of the Gaza Health Ministry.
On Monday, 20 children between the ages of 2 and 15 were killed, he said. Since the military offensive began Dec. 27, three Israeli civilians and two soldiers have been killed.
Nurse Ahmad Abdul Salam, 34, red-eyed and smelling of sweat, his clothes stained with blood, 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 was in its morgue, where blood pooled on the floor and refrigerators meant to hold 35 bodies were crammed with 70, laid side-by-side in drawers.
Lying on a gray mat on the floor, the three Samouni brothers appeared baby-faced and almost as though they were asleep, except 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 Monday and one man screamed for help for other family members he said were buried under the rubble of the house. "For God's sake, rescue them!" he pleaded.
No militants were seen at Shifa. Israel says 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 were taken.
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 airstrikes have badly damaged power lines.
U.N. health official Mahmoud Daher said the generators were meant only as an emergency backup and he feared they would break down with the constant use, imperiling some 70 people hooked up to lifesaving equipment.
Throughout the day, exhausted medics rushed in with the wounded and the bodies of the dead.
Mohammed Salman, 26, a volunteer medic washing blood from the inside of an ambulance, 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, according to Gaza health officials.
A medical building owned by a relief organization not connected to Hamas was also bombed, said Daher. He said the building was destroyed, along with an ambulance, three mobile clinics and donated medicines.
The Israeli army says it has no records of any of those strikes.
Raed Arini, a Shifa hospital official, said he has stopped filling out the space on death certificates that says "reason for death."
"The reason for death is the Israeli army," he said, as medics rushed in with more wounded people.