Every day the 62-year-old doctor walks past a memorial outside the Ramallah hospital he runs honouring 22 Palestinians killed by the Israeli army in 2000 at the start of the second intifada, or uprising.

But the images of death and destruction seen since the start of the war between Israel and Hamas on October 7 are something he says he "has never seen" before.

In 2000, the "bodies were piling up, the morgues were full "and we couldn't go out" to bury them.

But the latest war in Gaza "is much more violent," he said.

Israel has vowed to destroy Hamas after the Palestinian militants stormed across the border, killing some 1,200 people, mostly civilians.

It launched a major bombing campaign and ground offensive in Gaza, which the Hamas authorities say has killed 14,100 people, thousands of them children.

More than two thirds of hospitals in the besieged Palestinian territory are out of service, there is no electricity in the morgues, and bodies line the streets.

In Gaza, Beytawi's colleagues have been digging mass graves under Israeli tank fire and even in the courtyards of their hospitals.

Former soldier Wassef Erakat, 76, who fought in Lebanon during the 1975-1990 civil war, agrees this war is "the hardest and the most violent" he has ever witnessed.

Nearly half of the homes in the coastal Gaza Strip have been destroyed in relentless Israeli bombardments, UN officials say.

And some 1.5 million Gazans - more than half the 2.4 million population - have been internally displaced.

But for the former artillery officer for the Palestine Liberation Organisation (PLO) the Hamas and Islamic Jihad operations against Israel are also "unprecedented" and "meticulously planned".

- Unprecedented death tolls -

The information war has added a new dimension, igniting social networks.

Every day, the militant groups publish propaganda videos showing their fighters firing rocket launchers at tanks or stuffing explosives into Israeli armoured vehicles.

The conflict has moved way beyond the stone-throwing days of the first intifada, which exploded in 1987 and ended with the 1993 Oslo accords signed by then PLO leader Yasser Arafat, and former Israeli prime minister Yitzhak Rabin.

And with the increased violence, the death tolls have reached unprecedented levels.

The October 7 attack by Hamas militants on southern Israeli communities left 1,200 people dead - the worst death toll since the creation of Israel in 1948.

On the Palestinian side more people have died in Gaza in the current wave of Israeli strikes than during the two intifadas put together.

And in the West Bank, occupied by Israel since 1967, more than 200 Palestinians have been killed in Israeli fire - more than the total of the previous nine months.

For the first time in two decades, Israeli F-16s are again striking the West Bank from the air.

Heavily-armed Israeli troops are also again carrying out raids in Palestinian towns, manoeuvres supposedly eliminated in some areas of the West Bank by the Oslo accords.

"Israel felt it had been victorious because of its weapons and believed it had done away with the resistance," said Mohammed Zaghloul, recently released from prison after serving 20 years for attempted murder of Israeli soldiers.

But the fierce fighting in Gaza has changed the dynamic, said the former fighter with the armed wing of Palestinian president Mahmud Abbas's Fatah movement.

"We have entered a totally different phase from the earlier ones in the conflict," he said, highlighting the fears of the "regional ramifications" of the conflict.

Once the current violence has died down however, it "could bring something politically positive" for advancing the Palestinian cause, he added.