The wounded from Israeli strikes usually arrive in waves. More than 3,000 Palestinians already have been wounded in the past two weeks of fighting, health officials say. Many, including the most serious cases, end up at Shifa.
A new wave of casualties arrives after daybreak Sunday, following a night of heavy Israeli tank fire on Gaza City's Shijaiyah neighborhood. Hospital guards shout at drivers to move to make room for the next vehicles, pushing back journalists and onlookers.
Some of the wounded get treated in a hallway near the emergency room. A medic bandages the foot of an emergency worker writhing in pain on a mattress on the floor. A little boy with shrapnel wounds arrives and the emergency worker slides off the mattress to the hard floor for the child.
Nearby, a woman cries hysterically. A man holds up a dead child, wailing. Another carries a teenage girl whose right arm is bloodied and broken.
Patients on gurneys line up outside the X-ray room. Relatives of the wounded, one in a blood-soaked white undershirt, argue over who will be examined first.
Dr. Jihad Juwaidi says his six operating rooms filled up quickly and that even the seriously wounded have to wait for surgery, including a little girl with a fractured skull.
Choosing who gets treated first is gut-wrenching, says Dr. Allam Nayef, who works in one of Shifa's intensive care units.
"Sometimes you have to select which one of them has the best chance to survive," Nayef says. "Easily in this rush, you can take a bad decision, that the one (patient) you thought will wait for you ... you won't find him when you finish your surgery."
By 2 a.m. Saturday, only two of the four beds in his ICU are occupied.
One patient is a 4-year-old boy hit by a car when Gaza residents rushed into the streets to restock during a humanitarian cease-fire last week. The other, a 22-year-old, suffered serious head injuries in an Israeli strike — a direct hit on a house that killed 18 members of his extended family. The target, Gaza's police chief, survived.
At about 3 a.m., a new patient with a serious brain injury from shrapnel is wheeled in. Neurosurgeons had patched him up downstairs, but his prognosis is bad. All that's left for Nayef is to try to stabilize him.
Nayef and his colleagues work 24-hour shifts. A storage area crammed with boxes and an old vinyl-covered sofa doubles as a lounge where the doctors rest until the next wave.