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Nobody knows what kind of shell it was that hit Gaza City's main vegetable market yesterday morning: the explosives were falling so thick and fast that it could have come from an Israeli naval vessel, an F16 fighter-bomber, an Apache helicopter gunship, an unmanned drone, an artillery cannon or a tank.

The results, however, were unmistakable. With Gaza's ambulance service stretched far beyond its normal capacity, the first mangled bodies arrived in private cars as locals scrambled to save the lives of the shoppers caught up in the carnage. The first to be carried in was a boy, his face masked in blood from a head wound, as medics hurried him into the overcrowded emergency rooms. The next car delivered a girl, perhaps 12 or 13 years old, her entrails blown out through a hole in her back by shrapnel.

Soon afterwards, an ambulance arrived ferrying a man whose legs had been cut to pieces by the blast. The driver left his vehicle in the forecourt as he jumped out to help to carry the critically ill patient inside — but almost immediately more ambulances started streaming in, their paths blocked by the first.

Chaos erupted outside the hospital entrance as a traffic jam of desperate ambulance and car drivers log-jammed the already restricted space. Unable to find the first ambulance driver or the keys to the vehicle, people were forced to simply push it out of the way before the macabre procession of the dead and the maimed could resume.

Medics said five people were killed in the market bombing and 40 wounded. Israel said it had no knowledge of a market being hit. At the same time, victims from other areas of the bombarded city were streaming in, including two elderly women in housecoats.

Doctors at the hospital were exhausted by the constant stream of casualties and the ever-present fear that they would run out of medical supplies or diesel fuel for their generators, which would result in life-support systems shutting down. Yet each minute they had to make life-or-death triage judgments.

“We are so tired we are probably making poor decisions about who to save and who not to,” said one drawn-looking doctor. “I think we are losing patients because of this.”

A Norwegian volunteer doctor, Eric Fosse, working at al-Shifa, the central hospital of Gaza City, said that almost 30 per cent of the casualties he had seen were children. He said two young boys had been hit by shrapnel when they were playing on the roof of their house because their parents had forbidden them from going on to Gaza's deadly streets. One was killed and the other critically wounded, with one leg amputated.

Palestinian medics said a tank shell killed five members of the same family as they were driving in their car near Gaza City, as desperate civilians fled areas of fighting. Among the dead was a 14-year-old girl, they said.

Through it all, the onslaught continued, with explosions and the menacing thud of heavy machinegun fire echoing across the strip as the day turned into yet another terrifying, sleepless night.

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