The only sound in a room of the intensive care unit at al-Shifa Hospital in Gaza City was the heartbeat of 8-month-old Haneen Tafish, amplified through a cardiac monitor. Her 50-year-old grandfather Ahmad Tafish watched her with teary eyes as he shook.
Haneen was hit in the head with shrapnel late Thursday afternoon when Israeli jets bombed her home in eastern Gaza.
"What was she doing? Was she carrying a missile? A rocket? Firing on Israel?" the grandfather asked. "She is just a little girl."
Haneen died Thursday evening. She was the 16th Palestinian death since Israel began an operation Wednesday against Gaza-based militants.
As the Israeli military assault ramped up and militants retaliated with rockets, civilians on both sides faced painful but all-too-familiar scenes.
Staff members at al-Shifa Hospital, where many of the wounded were brought Thursday, reflected on the similarities to Operation Cast Lead, a three-week Israeli military offensive in the Gaza Strip that kicked off in December 2008 and left more than 1,000 Palestinians dead.
The situation at al-Shifa Hospital was not as bad as it was four years ago, staff members noted, but some were still shocked by what they saw.
"I've never seen such things. I'm wondering now is it a war against terrorism infrastructure or is it a war against children and civilians?" said Ayman Tahabani, head of the emergency room. "Most of the wounded are civilians, women, children."
About 18 miles north of Gaza in Kiryat Malakhi, a modest, working-class Israeli town, two men and one woman were killed and a baby was left in critical condition after an 8 a.m. rocket attack Thursday.
The blast blew out at least two walls and two windows in a pastel-pink four-story apartment building. One of the apartments had been reduced to smoky rubble, with burned plastic chairs and beds. In an apartment across the hall, blood spots were visible on a child's mattress.
Israel's minister for civil defense, Avi Dichter, told reporters that the three would not have died had they followed instructions and stayed in a shelter or in the rear of their apartment.
"These people could still be here," Dichter said, as jets roared overhead.
One woman who heard his comments berated him and accused him of using the violence for political gain. Other residents directed their anger at the Palestinians.
"The Gaza people chose Hamas. They are not innocent, anybody there. We are the innocents," said Gadi Mamo, a 37-year-old teacher who lives in a building next to the site of the rocket attack and knew the people killed. "They are strong [enough] to hit a baby. They are strong enough to hit the soldiers."
As the military assault continued Thursday, many ordinary Gazans had not yet started stocking up on food and fuel, partly because the Rafah border crossing to Egypt is open and goods can still be brought in.
Some Gazans praised the Egyptian government's decision to withdraw its ambassador from Israel and held out hope that international pressure could bring a quick end to the fighting.
But a Hamas spokesman indicated that the conflict is likely to escalate.
"It's an open war," Fawzi Barhoum said. "We will use all our cards."
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Brulliard reported from Kiryat Malakhi. Babak Dehghanpisheh in Beirut contributed to this report.