Sri Lankan civilians fled a packed hospital in the war zone after artillery shells hit it for the fourth time in two days, killing at least three people and wounding 10, the Red Cross said Tuesday.
That brings the death toll in the two days of shelling at the hospital in the northern area of Puthikudiyiruppu to 12, according to the International Committee of the Red Cross (ICRC).
Puthukudiyiruppu is inside the small wedge of jungle where Sri Lanka's surging military has surrounded the Liberation Tigers of Tamil Eelam (LTTE) separatists, reported Reuters.
The military is fighting to finish a war that started in 1983 and is now one of Asia's longest-running.
"The fourth shell struck Monday evening at 6:45 p.m. for the second day running. At least three people were killed and at least 10 people were injured," said Sarasi Wijeratne, an ICRC spokeswoman in Colombo.
The Red Cross says at least nine people were killed and 20 injured in shelling Sunday, taking the toll to at least 12 dead and 30 wounded in two days.
Sri Lankan President Mahinda Rajapaksa last week gave the Tigers 48 hours to free thousands of civilians trapped inside the 300 square km (115 sq miles) of jungle still held by the rebels, which the LTTE ignored.
The government had promised safe passage for that time, but Monday said it could not guarantee the safety of anyone still living among the rebels, unless they enter an army-demarcated no-fire zone.
"People are on the move because they are looking for a safe place. But there is no safe place," ICRC spokeswoman Carla Haddad said from Geneva.
Aid agencies say around 250,000 people are trapped in the Tiger-held area. The government says the number is closer to 120,000.
The military and the rebels again traded blame for the shelling.
"We don't fire shells on that area. It must be LTTE which are firing shells as they are desperate," military spokesman Brigadier Udaya Nanayakkara said of the attack on the hospital.
Pro-rebel www.TamilNet.com said the shells were fired by the military "throughout the whole day Monday from all directions into civilian refuges. At least 100 civilians could have been killed or maimed in the indiscriminate barrage."
It is nearly impossible to verify accounts from the war zone, off-limits for journalists except on carefully guided tours.
British Foreign Secretary David Miliband in a statement on Tuesday called again for a truce to let civilians move out.
"I very much regret the LTTE's failure to respond positively to the Sri Lankan government's offer of safe passage for civilians," he said.
"The need for a humanitarian ceasefire that is fully respected by both sides is already urgent."
Fighting raged again Tuesday, according to a government official working in a military-controlled area close to the frontlines, who spoke to Reuters on condition of anonymity.
"I can hear shelling sounds from here," the official said. "The government has ordered people to come out, but the LTTE is not allowing the people to come out. Heavy fighting is going on. The number of deaths and injured are very high."