COLOMBO, Sri Lanka – Shells hit the only hospital in Sri Lanka’s northern war zone Wednesday, killing at least 50 people in the second such attack in two days, a doctor said. Medics at the makeshift facility said they were using brief lulls between explosions to tend to patients but had little to offer beyond gauze and bandages.

It was the third attack this month on the hospital and comes on the heels of shelling this past weekend that killed as many as 1,000 civilians. On Tuesday, shells struck the admissions ward, killing 49. But trapped in the tiny coastal strip as the government presses ahead with its offensive against the rebels, the wounded had little alternative but to converge by the hundreds to seek treatment.

Scores of people crowded beneath tarps outside the hospital building waiting for care as a person wailed in grief in the background, according to a video footage.

The military has denied firing any heavy weapons in recent weeks, but Human Rights Watch says both sides are using the estimated 50,000 civilians packed into the last rebel-held territory as “cannon fodder.” The Red Cross said one of its workers was killed in shelling Wednesday.

The Tamil Tigers are cornered in a two square-mile (five square-kilometer) pocket of land. The military said it pressed ahead with its offensive into that strip Wednesday, capturing one of the rebels’ heavy guns and fending off a suicide attack launched by the group’s naval wing.

On Wednesday afternoon, the area around the hospital came under heavy shell attack, Dr. V. Shanmugarajah told The Associated Press by telephone — the third time it has come under fire this month and just one day after the last attack. One shell landed in an administrative office of the hospital, while another hit a ward filled with patients already wounded by previous shelling, he said.

Dr. Thurairaja Varatharajah, the top health official in the war zone, said the attack killed at least 50 people, including patients, relatives and a health aide, and wounded about 60 others.

He said heavy shelling continued throughout the day.

“We are unable to treat the people properly because a lot of aides have fled the hospital. We go into bunkers when there is shelling and try to treat them as much as we can when there is a lull,” he said by telephone.

More than 1,000 civilians — many with amputations or chest wounds — were waiting for treatment at the hospital when it was struck, and every 10 minutes or so another one or two died, according to a third hospital official, who spoke only on condition of anonymity because he was not authorized by the government to speak to the media.

Overwhelmed doctors have been reduced to handing out gauze and bandages to the seriously wounded, the official said. More than 100 dead bodies have been left inside the compound because no one will risk burying them amid the constant shelling, he said.

Rebel spokesman Seevaratnam Puleedevan said shells also hit a home for mentally handicapped women, killing 38 and wounding more than 40. The health officials said they were not able to confirm that attack.

Shelling also killed Red Cross worker Mayuran Sivagurunathan and his mother and prevented a Red Cross ferry off the coast from delivering food aid and evacuating the wounded, according to the International Committee of the Red Cross.

The aid group said it was not sure if its employee was killed in the hospital attack.

“There are many shells falling. I don’t know if it was the same attack,” Red Cross spokesman Marcel Izard said.

Reports of the fighting are difficult to verify because the government has barred journalists and aid workers from the war zone.

The government has come under heavy international criticism for the large civilian toll of its offensive against the Tamil Tiger rebels. British Foreign Secretary David Miliband called the conflict zone “as close to hell as you can get,” and Secretary of State Hillary Rodham Clinton joined him in expressing alarm at the civilian casualties.

Human Rights Watch said witness testimony and satellite images of the area taken Sunday and analyzed by experts “contradict Sri Lankan government claims that its armed forces are no longer using heavy weapons” in the war zone.

The group also accused the rebels of using the civilians as human shields and shooting those who try to escape.

“Neither the Sri Lankan army nor the Tamil Tigers appear to have any reluctance in using civilians as cannon fodder,” said Brad Adams, Asia director at Human Rights Watch.

The American Association for the Advancement of Science analyzed satellite photos of the area taken Sunday morning — after a night of heavy shelling was reported in the area — and compared it to an image taken four days before. The report was done at the request of Human Rights Watch and Amnesty International.

“By comparing before-and-after satellite images, we were able to see a significant movement of the region’s human population, suggesting widespread displacement. We also saw destroyed structures and circular, crater-like features consistent with widespread shelling,” said Lars Bromley, director of the association’s Geospatial Technologies and Human Rights project.

One area, which had been densely packed with tents and other structures in the earlier photo was nearly empty Sunday morning. Another photo provided by Amnesty showed two white circles near a cluster of trees that were identified as impact craters.

While Bromley said the images did not show who was behind the destruction, Human Rights Watch said a health official in the area had told them the artillery was being fired from an area under government control.

Military spokesman Brig. Udaya Nanayakkara denied troops were responsible for any shelling, saying the war zone had grown too small for the use of such weapons. He said exploding booby traps set by the rebels could account for the craters and the reports of shelling.

Indian forces personnel prepare to fire towards the Taj Hotel in Mumbai, India, on Friday. After hours of intermittent gunfire and explosions at the elegant Taj Mahal hotel Friday, the fight heated up at dusk when Indian forces began launching grenades at the hotel, where at least one militant was believed to be holed up inside a ballroom, officials said.

WASHINGTON – The government ordered FBI agents Friday to fly to India to investigate the bloody Mumbai attacks that killed two American travelers and a former New York couple. U.S. citizens still in the city were warned their lives remain at risk.

Intelligence officials looked urgently for clues about the identity of the attackers, a crucial unknown as Indian officials charged, without giving details, that “elements in Pakistan” were involved. A tentative rapprochement between the two nuclear-armed rivals could hang in the balance, and a U.S. counterintelligence official cautioned against rushing to judgment on the origins of the militants.

President George W. Bush pledged cooperation with Indian authorities and mourned the deaths of more than 150 people at the hands of gunmen who attacked targets across India’s financial capital starting Wednesday night.

“My administration has been working with the Indian government and the international community as Indian authorities work to ensure the safety of those still under threat,” he said in a statement from the Camp David presidential retreat in Maryland. “We will continue to cooperate against these extremists who offer nothing but violence and hopelessness. ”

A U.S. counterterrorism official said it was premature to reach conclusions on who may be responsible for the attacks. The official, who spoke on condition of anonymity because of the sensitivity of the investigation, said some “signatures of the attack” were consistent with the work of militants who have fought against India in the disputed Kashmir region.

Officials were working out the final details with Indian diplomats Friday for the departure of an FBI team, said U.S. authorities, who also spoke on condition of anonymity because of the delicate nature of the operation. A second group of investigators was on alert to join the first team if necessary.

The investigators aim to learn more about the militants who carried out the lethal strikes on luxury hotels, a train station and an Orthodox Jewish center where a rabbi and his wife, who had moved to Mumbai from New York, were among five hostages slain. An American and his teenage daughter traveling with a Virginia-based spiritual group were also among those killed during the coordinated attacks.

“Americans are still at risk on the ground” in Mumbai on Friday, the State Department said Friday, warning citizens not to travel to the stricken city at least through the weekend.

U.S. officials were checking with Indian authorities and hospitals to learn more about the extent of casualties.

In New York, the Chabad-Lubavitch movement confirmed Friday that Rabbi Gavriel Noach Holtzberg and his wife, Rivka, were among those killed in the terrorist assault on the ultraconservative group’s Mumbai headquarters.

A spokeswoman for a meditation group in Virginia said two Americans traveling with the organization in Mumbai also were killed. Bobbie Garvey, speaking for the Synchronicity Foundation, based in Faber, Va., identified the two slain members as Alan Scherr, 58, and his 13-year-old daughter, Naomi.

State Department spokesman Robert McInturff said U.S. officials have activated a phone tree to contact American citizens who registered with the U.S. consulate in Mumbai.

Pakistan’s ambassador to the U.S., Husain Haqqani, said in a statement that his country is “confronting the menace of terrorism with great vigor.” Haqqani insisted “it is unfair to blame Pakistan or Pakistanis for these acts of terrorism even before an investigation is undertaken.”

Democratic Sen. Russ Feingold of Wisconsin said that “as we continue to learn the details about the attacks and those responsible for them, we must not allow them to undermine the progress that has been made to foster better relations between India and its neighbor Pakistan, two critical partners in our global fight against terrorism.”

President-elect Barack Obama has spoken by telephone with Secretary of State Condoleezza Rice about the attacks and received several intelligence briefings, State Department officials said. They said Rice spoke again Friday with Indian Foreign Minister Pranab Mukherjee.

The State Department set up a call center for Americans concerned about family members who may be in Mumbai. The number is 1-888-407-4747.

A resident walks past a mound of rubble which used to be a high rise apartment building in the southern suburbs of Beirut, Lebanon, Monday. After over two weeks of sustained Israeli air strikes on the previously densely-populated Hezbollah-controlled area of the capital, few civilians remain.

JERUSALEM – Israel’s prime minister declared Monday there would be no cease-fire with Hezbollah guerrillas, saying “we will not give up on our goal to live a life free of terror.” His Security Cabinet approved widening the ground offensive.

Although Israel suspended most airstrikes on south Lebanon for 48 hours, its warplanes struck deep inside the country early Tuesday. They hit an area that is a stronghold of Hezbollah guerrillas, witnesses said. Warplanes also hit Hezbollah fighters battling with soldiers near the border as the guerrillas fired mortars into Israel.

The cutback in Israeli airstrikes and a pause by the guerrillas in rocket attacks on northern Israel brought both countries their quietest day since the conflict began three weeks ago.

Lebanese fled north in overflowing trucks and cars. About 200 people – mostly elderly – escaped the border town of Bint Jbail, where Israeli troops and Hezbollah guerrillas fought their bloodiest clashes. Two residents dropped dead on the road out, one of malnutrition, the other of heart failure.

Some survivors described living on a piece of candy a day and dirty water as the fighting raged.

“All the time I thought of death,” said Rimah Bazzi, an American visiting from Dearborn, Mich., who spent weeks hiding with her three children and mother in the house of a local doctor.

The lull was felt across northern Israel, too: In the town of Nahariya, residents who had been hiding in shelters for the better part of three weeks began emerging. Supermarkets were fuller than before and more people were in the streets, walking along the beach and shopping.

But diplomatic efforts to end the crisis faltered, despite increased world pressure for a cease-fire after the devastating strike in Qana.

Israel’s Security Cabinet early Tuesday approved widening the ground offensive, a participant said, and rejected a cease-fire until an international force is in place in southern Lebanon.

The participant, speaking on condition of anonymity because he was not authorized to talk to reporters, said Israel’s airstrikes would resume “in full force” after a 48-hour suspension expires in another day.

Thousands of army reserves have been called up in recent days in advance of the decision, which is expected to lead to sending more troops into the border area. Israeli leaders have said they want to carve out a zone about 1 mile wide that would be free of Hezbollah.

Israel called the 48-hour suspension after the Qana attack to give time for an investigation – though it said its warplanes would still hit urgent Hezbollah targets, and at least three strikes took place Monday.

Jet fighters struck Hermel, 75 miles north of the Israeli border in the Bekaa Valley in eastern Lebanon. Warplanes fired at least five air-to-surface missiles on the town, the witnesses said. It was not clear what was hit and whether there were any casualties.

Another strike targeted an area near the Syrian border, about 6 miles north of Hermel.

Many of those living in the northeast are Shiite Muslims, the country’s largest sect from which Hezbollah draws its support.

Israeli Prime Minister Ehud Olmert apologized for the civilian deaths in Saturday’s strike, in which 56 people, mostly women and children, were killed.

“I am sorry from the bottom of my heart for all deaths of children or women in Qana,” he said. “We did not search them out. … They were not our enemies and we did not look for them.”

But he insisted Israel, which began its offensive after Hezbollah snatched two soldiers and killed three others in a cross-border raid July 12, had no choice but to fight.

“There is no cease-fire, there will be no cease-fire,” he said. “We are determined to succeed in this struggle. We will not give up on our goal to live a life free of terror.”

President Bush resisted calls for an immediate halt to fighting, underlining that any peace deal must ensure that Hezbollah is crippled. He said Iran and Syria must stop backing the Shiite militant group with money and weapons.

“As we work with friends and allies, it’s important to remember this crisis began with Hezbollah’s unprovoked attacks against Israel. Israel is exercising its right to defend itself,” Bush said.

Secretary of State Condoleezza Rice earlier in the day said she expected a U.N. resolution for a cease-fire within a week. But as she headed to Washington after a visit to Jerusalem derailed by the Qana strike, she struck a more pessimistic tone.

“There’s a lot of work to do,” she told reporters. “You have to get all the work done, you have to get it done urgently.”

The central focus for a peace deal has been the deployment of a U.N.-mandated international force in southern Lebanon to ensure guerrillas do not attack Israel. But details of the force still must be worked out. With talks continuing, the U.N. postponed a Monday gathering meant to sound out contributions to a force.

Hezbollah’s allies Syria and Iran quietly entered the diplomacy. Egypt was pressing Syria not to try to stop an international force in the south, diplomats in Cairo said. Iran’s foreign minister pulled into Beirut for talks with his French and Lebanese counterparts.

Syrian President Bashar Assad called on his army Monday to increase readiness to cope with “regional challenges.” Travelers from Syria have reported that some reservists have been called up for military duty – a sign that Syria is concerned the fighting in Lebanon could spill over.

Thousands of Lebanese took advantage of the lull in airstrikes to make a dash for safety farther north after weeks trapped in homes in the war zone, afraid to move because of intense missile strikes on roads.

Across the south, cars and trucks packed with women and children, mattresses strapped to the roofs and white flags streaming from the windows, made their way to the coast, then turned north. They passed flattened houses, shattered trees and burned-out cars strewn on the roadside.

At one point north of Tyre, vehicles gingerly made their way around a gigantic crater half filled with water into which a car had toppled when a missile struck.

In Qana, grocer Hassan Faraj – who had sworn a day earlier never to leave – jumped at the chance to escape. He shuttered his shop and loaded his wife and child into a van to go north into the mountains.

“My mother is very unwell, I must go and see her,” he said, explaining his change of mind and insisting he was just dropping off his family to return.

Aid groups were caught off guard by the sudden break and struggled to rush aid to the south.

Outside the Lebanese border town of Marjayoun a battle raged between Hezbollah guerrillas and Israeli soldiers. Grass fires set by shelling blazed into the night sky from the hills.

Nearby, a U.N. peacekeepers’ convoy nearby carrying food found the bridges across the Litani River destroyed. So the trucks drove across the knee-deep waters. Indian peacekeepers assembled a ramp out of stones to get them up the steep opposite bank as artillery pounded only a few hills away.

Warplanes struck around the village of Taibeh to give ground cover after Hezbollah fighters hit a tank with an anti-tank missile. The guerrillas also fired mortars into the nearby Israeli town of Kiryat Shemona, causing no casualties.

Hezbollah announced that five of its fighters were killed in the clashes, bringing the group’s acknowledged death toll to 42. Israel says dozens more fighters have died.

Israel carried out two other airstrikes. One killed a Lebanese soldier in his car outside Tyre, prompting Israel to express its regrets, saying it had believed the vehicle was carrying a senior Hezbollah official. The other strike hit the main Lebanon-Syria border crossing for the third day in a row.

The guerrilla group did not shoot a single rocket into Israel as of early evening, a remarkable turnaround for an area that had been hit by dozens of missiles each day during the offensive.

At least 524 people have been killed in Lebanon since the fighting began, according to the Health Ministry. Fifty-one Israelis have died, including 33 soldiers and 18 civilians who died in rocket attacks.

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Hendawi reported from Marjayoun, Lebanon. AP writers Tom Wagner in Jerusalem, Mark Lavie in Tel Aviv, Lee Keath in Beirut, Kathy Gannon in Bint Jbail and Katherine Shrader traveling with Rice contributed to this story.

By Hamza Hendawi, Ravi Nessman