Monday was the tenth day of Israeli attacks on the Gaza Strip, and the second full day of a ground offensive aimed at Hamas.

Heavy gun battles took place on Monday night in eastern and northern Gaza City and there are signs the conflict is taking a heavy toll on civilians.

Some of Monday's heaviest fighting was over strategic high-ground to the east of Gaza City.

From the air, jet fighters attacks continued while on the ground, Israeli tanks and troops advanced behind heavy artillery fire.

Northern Gaza has seen some of the fiercest fighting since the ground offensive began. People there were seen running for shelter as explosions rang out and children caught up in the conflict were clearly in distress.

Palestinian residents from the northern Gaza Strip fled their homes and tried to seek shelter in Gaza City.

The overall death toll in the Gaza Strip has continued to rise. The United Nations and Gaza health officials reported more than 550 Palestinians dead, including at least 200 civilians. At least 20 Palestinian children were killed throughou Monday.

Gaza Refugee, said, "The Israeli army has no mercy. It is targeting everyone who moves. Anything that moves is a target. They are bombing our lands, our homes, they are firing missiles on our houses, on the homes of the residents. They are saying that they are not targeting civilians, but they are lying."

After ten days of relentless Israeli military strikes, Gaza's largest hospital is being overwhelmed by an influx of dead and wounded.

The hospital is now relying on generators for power after shelling damaged power cables in the area.

Haitham Dababish, Shifa Hospital, said, "In this hospital, we are set up to receive dozens of injuries, not hundreds. We are not prepared for receiving large numbers of hundreds non-stop. We the medical team are doing everything we can, we are working day and night."

Five Israelis have been killed since the offensive began, including a soldier who died in the ground operation.

Gaza militants have continued to pummel southern Israel with rockets launching more than 30 on Monday.

Hamas has vowed to to wait for Israeli soldiers "in every street and every alleyway," as the ground offensive continues.

Israel has three main demands: an end to Palestinian attacks, international supervision of any truce and a halt to Hamas rearming.

Hamas is demanding a cessation of Israeli attacks and the opening of vital Gaza-Israel cargo crossings, Gaza's main lifeline.

(CCTV January 6, 2009)