Two months of relative calm in Gaza has come to an end.
Residents in the war-torn region were again fleeing for their lives after Israel resumed heavy bombardment of Gaza, launching a new air and ground campaign against Hamas.
The death toll has now surpassed 50,000, according to the Palestinian health ministry.
The toll counts all those confirmed killed since Israel's invasion in response to the Hamas-led October 7 attacks in southern Israel, in which nearly 1,200 people were killed and 251 taken hostage.
Warning: This story contains details some readers may find disturbing.
Perth doctor Mohammed Mustafa, volunteering in Gaza City, said hospitals have been dealing with multiple "mass casualty events" since attacks resumed on March 18.
"We've been dealing with children with missing limbs," he told the ABC.
"Adults with missing limbs. We've been dealing with gunshot wounds. We've been dealing with crush injuries from people being pulled under rubble."
Israel's government and military have said the death toll is inflated, claiming the health ministry is compromised because it operates under Gaza's Hamas-run government.
International experts and agencies have said the ministry's methodology is sound.
European Union foreign policy chief Kaja Kallas called on Israel to respect civilian lives.
"Israel's military offensive has caused an appalling loss of life," she said.
"As long as this war continues, both sides lose."
More than half of the victims in Gaza are women, children and the elderly
At the beginning of the war, death tolls were calculated entirely by counting bodies that arrived in hospitals.
Data included the names and identity numbers for most of those killed.
But as the conflict escalated and fewer hospitals and morgues continued to operate, the authorities adopted other methods.
From early May 2024, the Gaza health ministry updated its breakdown of deaths to include unidentified bodies which accounted for nearly a third of the overall toll.
Since then, health authorities have been working to identify them and that portion has shrunk to less than three per cent.
Health authorities in Gaza have attributed the progress in identifying bodies to restoring a central database from Shifa Hospital and a new system allowing families to provide input on victims, which is then verified by medics and police.
Of the identified dead, about 55 per cent were estimated to be women, children or elderly, according to a Reuters calculation based on Palestinian data released in January.
The UN Human Rights Office has also said the deaths it has verified so far show that the majority of victims were women and children.
Health officials have said the numbers do not necessarily reflect all victims as it estimates there are at least 10,000 bodies unaccounted-for under the rubble.
In January, the Lancet journal released a study that found the death toll during the first nine months of the war was likely under counted by about 40 per cent due to Gaza's healthcare infrastructure collapsing.
Israeli officials have said about 20,000 Hamas fighters have been killed, which they say is a ratio of about one civilian killed for every fighter.
Gaza health authorities have said men of fighting age represent only a fraction of all identified victims.
Israel's most recent attack on Sunday has been described by Mustafa Gaber, a journalist who fled with his family, as "displacement under fire".
"The shells are falling among us and the bullets are [flying] above us," said Amal Nassar, also displaced.
"The elderly have been thrown into the streets. An old woman was telling her son, 'Go and leave me to die.' Where will we go?"
Israel Defence Minister Israel Katz said on March 19 the renewed assault would be worse than the extensive death and damage already suffered in Gaza.
If hostages weren't released and Hamas was not "eliminated", he said, the alternative was "complete destruction and devastation".
A third of those killed in Gaza are children
At least one-third of victims in the war in Gaza have been children, according to the United Nations.
In January, the UN Office for the Coordination of Humanitarian Affairs reported that about 13,319 of those who have been killed since the beginning of the war were children.
It also estimates that about 25,000 children have been injured.
Ahmad Alhendawi, Save the Children's Regional Director, said the most recent attacks from Israel have plunged the children of Gaza back into a familiar world they cannot escape.
"These air strikes come as hundreds of thousands of Palestinians remain displaced, their homes destroyed and uninhabitable, with tents all that stand between them and explosive weapons designed for wide reach," Mr Alhendawi said.
"Children are the most vulnerable to explosive weapons.
"Their lighter bodies are thrown further by the blasts and their bones are softer and bend more easily, with higher risk of secondary injuries and long-term deformities and disabilities.
"Their small bodies have less blood to lose — a death sentence when emergency services can't safely operate and reach them."
'No distinction' for hundreds of families entirely wiped out
More than 1,200 families have been completely wiped out since the October 7 attack, according to Reuters analysis of health ministry data.
An Associated Press (AP) investigation in June last year found at least 60 different Palestinian families who had lost at least 25 members.
Between October and December of 2023, some families lost four generations from the same blood line.
No family has been spared, Omar Shabaan, an independent researcher and economist from Gaza, told AP.
"Everyone is targeted," he said.
"Families from all classes, poor, Bedouins, farmers, businessmen, wealthy people who are nationalist but unaffiliated with political action. There is no distinction.
"It is becoming clear that this is a targeting of the social structure."
To date, 1,238 Palestinian families have been wiped out, with no survivors, according to the ministry figures.
The data defines families as married couples and their children.
Seventy per cent of these families were made up of between two to four people.
Among larger families, there were three families of 11 people.
After Israel bombed Suhail al-Majdalawi's apartment building two months into the war, rescue workers helped unearth the bodies of 11 of his relatives.
But they could not find six more, including three small children. He is waiting for authorities to bring heavy equipment to dig out their bodies.
"I've lost all my family and I am very tired and don't know what to do," he said.
Palestinian health authorities have said there could be 10,000 dead still lying, uncounted, under the rubble.
The number of Gaza residents killed in the current conflict surpassed the death toll for any Arab conflict with Israel in more than 40 years.
According to the Palestinian Central Bureau of Statistics, an estimated 15,000 Palestinians were killed in the war following Israel's creation in 1948.
That war lasted nine months.
ABC/Reuters/AP
