As Israeli troops pushed into Gaza overnight, intense tank fire shook parts of Khan Yunis, sending a flood of patients into the southern city's Nasser hospital.The shells smashed into buildings near the border with Israel, prompting thousands to flee their homes under the cover of darkness, only missiles lighting up the sky.
At Nasser hospital, doctors and nurses working 24-hour shifts were on alert for the wave of patients who began arriving in the early hours.
"The situation is very, very difficult," said doctor Kamel Zaqzuq.
"This is much, much more difficult than the last war," he said, referring to the previous major conflict between Israel and Hamas militants in November 2012.
"At night, it's one constant emergency."
He said the hospital was running short on some supplies, including medical sutures for stitches.
Many of those who arrived at the hospital on Thursday night and early Friday morning, after the ground operation began, were children, he said.
For some, it was too late -- doctors said 11 people ended up in the facility's morgue.
Two were still there on Friday morning, wrapped in white sheets on the steel shelves of a refrigerator, locked behind a door of rusting iron bars.
Others suffered grave injuries and were being treated in the intensive care unit, including 25-year-old Khadija Abu Hamad.
She was hurt in tank shelling in a neighbourhood known simply as Sharqiya, or eastern district.
Shrapnel ripped through most of her body, embedding itself in her brain, breaking her left arm and gouging out her left eye.
The little remaining part of her face not covered in bandages was bruised black and yellow, and metal pins were holding her broken arm together.
- 'We had to amputate' -
Next to her was 18-year-old Uday al-Astal, now paralysed on his right side after shrapnel entered his brain.
And on the other side of the room was a relative of his -- 23-year-old Yusef Astal.
"He came in with a very serious injury to his femoral artery," said doctor Moataz al-Jubur, who is supervising the intensive care ward.
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"We had to amputate his leg."
Both were wounded in an Israeli bombing on Wednesday. Four of their relatives were killed -- among them two children, aged four and six.
Across the ward, Jubur was supervising another patient hurt late on Thursday night as the ground incursion began.
Shrapnel tore into his stomach, kidneys and intestines, Jubur said.
"I keep giving him blood transfusions, but he's in very bad shape."
Downstairs, those with less serious injuries waited for treatment, or to hear news of loved ones.
Ibrahim Fayyad, 24, was sitting outside his house on Friday morning when an airstrike hit.
"It happened a few metres away and so I started to run away in fear," he said.
"Even as I was running there was another strike, a plane fired three times, there was a huge explosion, and there was shrapnel flying everywhere."
Two of his cousin's sons were killed: 26-year-old Mohammed Fayyad, and 25-year-old Mahmud Fayyad.
- 'Not the first time' -
Jubur has worked at Nasser hospital for more than five years, and was sanguine when asked about the current conflict.
"This is not the first time I've been in a situation like this," he said.
Israel and Hamas fought a bloody 22-day conflict over New Year 2009, and again in late 2012, both of which had devastating consequences for civilians in Gaza.
The current conflict has depressing echoes of those former rounds of violence.
So far, the Palestinian death toll from 11 days of violence stands at more than 270, while two Israelis have also been killed, one soldier and one civilian.
UN figures indicate that at least a third of the dead are children, and emotions in Gaza are running high.
"The whole world is watching while the Palestinians are being slaughtered," Jubur said, his voice rising.
"They are innocents, people sitting next to their homes, people sitting with their relatives," he added.
"Where should these people go?"