GAZA CITY, Gaza Strip — They come in waves, usually not long after a blast rattles the building or a black cloud of smoke rises up over the apartment buildings.
First come the ambulances, careening through Shifa Hospital's crowded courtyard as frenzied medics rush bloody patients through mobs of Palestinians who've come in previous waves to find out if their relatives are alive or dead.
Then come beat-up cars packed with Palestinians injured by Israeli shrapnel: brothers carrying bloodied younger sisters, fathers carrying lifeless sons, uncles carrying wailing nephews.
Shifa Hospital has long been crisis central for the Gaza Strip. In a seemingly endless series of conflicts, the wounded always come here.
Even doctors seasoned in Gaza's many emergencies, however, are reeling from the scale and intensity of the latest Israeli assault, which has killed more than 550 Palestinians and injured 2,500 others in 10 days of fighting.
As Israel's campaign against the militant Islamist group Hamas shifts from targeted air strikes to intense artillery barrages and street battles, the number of civilians caught in the crossfire is growing. Now the military strikes are also taking a toll on the harried medical crews sent into the urban battlefields to rescue wounded survivors.
At least six medics have been killed by Israeli strikes and three ambulances have been destroyed by Israeli fire, according to United Nations officials.
"There are no safe areas, and Gazans who want to flee the fighting have been prevented from leaving the Strip," said John Prideaux-Brune, the head of Oxfam-Great Britain's Palestinian office.
Prideaux-Brune lost one Palestinian colleague on Sunday when an Israeli shell hit the ambulance he was in as it tried to spirit a wounded patient away from advancing Israeli forces in the northern Gaza City town of Beit Lahiya.
The increasing risk to medics means that some emergency calls are going unanswered because ambulances can't safely navigate the battlefield.
"Some wounded people simply die while waiting for an ambulance," said Antoine Grand, the head of the Red Cross office in the Gaza Strip. "This is of course absolutely appalling."
The Israeli military says that it's doing all it can to avoid civilian casualties and blames Gaza militants for putting innocent Palestinians in the line of fire by using homes, apartments and mosques as hideouts and launching pads for counterattacks.
With artillery fire raining down and firefights breaking out in densely populated neighborhoods, civilian deaths are rising. Of the 550 Palestinians killed during the past 10 days, at least 111 of them have been children, according to Moaiya Hassanain, an official with the Health Ministry in the Hamas-controlled Gaza Strip.
Among those killed on Monday, medical officials said, were four young siblings who died when an Israeli missile struck a house in Gaza City and three children who were killed when the Israeli navy shelled the refugee camp that's home to Hamas political leader Ismail Haniyeh.
Israel has barred foreign reporters from entering Gaza, and there was no way to confirm the Health Ministry figures; Israel said it had no information on civilian casualties.
However, the chaotic scene at Shifa Hospital, which is running on generators because it's been without normal power for three days, lends credibility to the numbers.
Doctors treat the crush of patients on the dirty reception room floor. Throngs of family members push past Hamas security to reach fallen relatives inside, and at the hospital's small morgue, families quietly console one another.
In one corner of the reception area, medics worked to stabilize Asmaa Bahtatete, a 10-year-old in furry pink pajama bottoms who'd been hit by shrapnel from an Israeli strike.
Nearby, Mohammed Sahwail and Ali Abu Jazar waited for news about Ali's brother, who they said was among a group of Palestinians hit by an Israeli strike while the men were gathering in a mourning tent to honor another Gaza resident who died during the ongoing fighting.
Jabel Abdel Dayam stood watch over his 21-year-old son, Slem, and angrily cursed everyone from Egyptian President Hosni Mubarak to Israeli Defense Minister Ehud Barak.
"Hosni Mubarak opened the Suez Canal for American warships to liberate Kuwait from Iraq," he said of the Egyptian president. "Let's then imagine that Kuwait is Palestine and Iraq is Israel. Why can't they liberate us the way they did with Kuwait?"
Dayam said he'd lost three nephews, one of whom was a medic who was killed while he was trying to rescue people trapped by the Israeli campaign.
"Barak is a dog," the anguished father said later while standing over his son's bed.
On Monday, Israel gave the International Committee of the Red Cross permission to send in new international medical teams to help treat the wounded.
"The system is completely exhausted and overstretched," said Red Cross official Anne-Sophie Bonefeld.
(Hamda, a McClatchy special correspondent, reported from Gaza City. Nissenbaum reported from Jerusalem.)
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