The shells smashed into buildings near the border with Israel, prompting thousands to flee their homes under the cover of darkness, only missiles lighting up the sky.
At Nasser hospital, doctors and nurses working 24-hour shifts were on alert for the wave of patients who began arriving in the early hours.
"The situation is very, very difficult," said doctor Kamel Zaqzuq.
"This is much, much more difficult than the last war," he said, referring to the previous major conflict between Zionist regime and Hamas resistance group in November 2012.
"At night, it's one constant emergency."
He said the hospital was running short on some supplies, including medical sutures for stitches.
Many of those who arrived at the hospital on Thursday night and early Friday morning, after the ground operation began, were children, he said.
For some, it was too late -- doctors said 11 people ended up in the facility's morgue.
Two were still there on Friday morning, wrapped in white sheets on the steel shelves of a refrigerator, locked behind a door of rusting iron bars.
Others suffered grave injuries and were being treated in the intensive care unit, including 25-year-old Khadija Abu Hamad.
She was hurt in tank shelling in a neighborhood known simply as Sharqiya, or eastern district.
Shrapnel ripped through most of her body, embedding itself in her brain, breaking her left arm and gouging out her left eye.
The little remaining part of her face not covered in bandages was bruised black and yellow, and metal pins were holding her broken arm together.
Next to her was 18-year-old Uday al-Astal, now paralyzed on his right side after shrapnel entered his brain.
And on the other side of the room was a relative of his -- 23-year-old Yusef Astal.
Israel and Hamas fought a bloody 22-day conflict over New Year 2009, and again in late 2012, both of which had devastating consequences for civilians in Gaza.
The current conflict has depressing echoes of those former rounds of violence.
UN figures indicate that at least a third of the dead are children, and emotions in Gaza are running high.
NJF/NJF