Shells hit a hospital in northern Sri Lanka on Sunday, killing two people and wounding five more, the International Committee of the Red Cross says.
The Puthukkudiriruppu hospital in Mullaittivu district took two direct hits, the ICRC said, as government troops and Tamil Tiger rebels were locked in combat in the troubled region.
There were more than 500 in-patients at the hospital, one of the few still operating in a region where government forces say they are conducting the final phase of operations to finish off the Tamil Tiger rebels.
The ICRC did not say who was responsible for the latest attack, but that people injured by the ongoing fighting continued to arrive at the hospital.
"The staff are under acute stress, surrounded as they are by the sound of the ongoing fighting and the influx of new patients," said Morven Murchison-Lochrie, an ICRC medical coordinator at the hospital.
"Ambulances are constantly arriving, but people are also being brought in by wagon, pick-up truck, tractor and even motor scooter."
The ICRC urged both parties to respect their obligation to spare medical facilities and activities, as required by international humanitarian law.
The organisation had earlier said "hundreds" of civilians were killed and "scores" wounded last month in Mullaittivu, where up to a quarter of a million people had been trapped by the fighting.
The Red Cross and other rights groups have asked the Tamil Tigers to allow civilians to leave the area, but the rebels have said the civilians are "voluntarily" staying back.