As dawn broke on Thursday, Haitham Abu Ammar combed through the rubble of the school that had become a refuge for him and thousands of other displaced Gazans. For hours he helped people piece together the limbs of those they loved.
“The most painful thing I ever felt was picking up those pieces of meat with my hands,” said Mr. Abu Ammar, a 27-year-old construction worker. “I never thought I would have to do something like this.”
Early Thursday morning, Israeli airstrikes hit the school compound, killing dozens of people – including at least nine militants, the Israeli army said.
Throughout the day, corpses and mutilated limbs recovered from the rubble were wrapped in blankets, piled on truck beds and taken to Al Aqsa Martyrs' Hospital, the last major medical facility still operating in central Gaza.
The Israeli military described the airstrike as carefully planned. Rear Admiral Daniel Hagari told reporters that Israeli forces had followed the militants into the school-turned-hideout for three days before opening fire.
“The Israeli army and the Shin Bet have found a solution to separate terrorists from those seeking refuge,” he said.
But reports from local and foreign doctors and a visit to the hospital by The New York Times on Thursday afternoon made clear that civilians also died.
Outside the hospital morgue, crowds gathered to cry and pray over the dead. The hospital corridors were crowded with people asking for help, or at least a little comfort.
A little girl with a bloody leg shouted: “Mom! Mom! ”, while her mother followed her sobbing through the hospital corridors.
The precise toll could not be verified, but Gaza's Health Ministry said that of the approximately 40 people killed in the attack, 14 were children and nine were women. Later in the day, the Associated Press reported different numbers, saying at least 33 people had died, including three women and nine children, citing the hospital morgue.
The Al Aqsa Martyrs' Hospital has become a symbol not only of the heavy loss of life in central Gaza, but also of the growing sense of desperation among Gazans struggling to find a place that is still safe.
In recent weeks, the region has filled with people fleeing another Israeli offensive, this time in the southern city of Rafah. Before the offensive began, Rafah was the main place of refuge for civilians, and at one point was home to more than half the population of the Gaza Strip.
Then on Wednesday, Israel announced that it had launched a new operation against Hamas militants in central Gaza, the very place where many Gazans who fled Rafah had ended up.
The attack on the school complex occurred the next day, around 2 am. It hit a building in a compound run by UNRWA, the main United Nations humanitarian agency for Palestine in Gaza.
Since Israel's offensive in Gaza began in October, in retaliation for a Hamas-led attack on Israel, such schools have been used to shelter Gazans forced to flee their homes because of the fighting. Israel says Hamas hides its forces in civilian settings such as schools or hospitals, a charge the group denies.
In the last two days of the new military campaign, Al Aqsa left 140 dead and hundreds injured, health workers said.
“It's complete chaos, because we have one mass death toll after another, but fewer and fewer medical supplies to treat them,” said Karin Huster, a nurse with the international aid group Doctors Without Borders who worked at the hospital.
During The Times' visit to Al Aqsa, doctors were seen pushing through crowds of panicked people to try to reach operating rooms, delayed by the mass of people. Amid the confusion, Ms. Huster said, doctors sometimes rushed fatally injured people into operating rooms, wasting vital time for those who still had a chance of survival.
Ms. Huster said most of the people she had treated in recent days were women and children.
Early Thursday afternoon, after burying a friend he had pulled from the rubble of the school complex, Mr. Abu Ammar once again found himself in hospital.
This time he was accompanied by his friend's brother, who he was trying to cram into a corridor near the entrance. The brother's face was cut by shrapnel and he had a deep gash in his right leg.
But he wasn't the only one desperate for help.
All around them were injured people, some lying on the floor covered in blood, others on beds crying for help. A man whose face was blackened by burns and dust from the explosion that morning begged two relatives who were with him to fan his face with a piece of cardboard they waved at him.
The scenes among the dead in the morgue were almost as chaotic as those among the living. Dead bodies lay everywhere, while relatives crowded around, crying and screaming over them. The smell of blood was unbearable.
The crowd outside the morgue came and went as bodies wrapped in blankets (shrouds were in short supply) were loaded into pickup trucks to be taken for burial. Relatives and friends lined up to pray before the dead were taken away. Passers-by on the street also stopped to join in.
“When is too much?” Mrs. Huster said. “I no longer know how I can express this in such a way as to shock people. Where did humanity go wrong?”