The Israeli army killed 46 Palestinians and wounded 200 Saturday in a large-scale ground operation in the northern Gaza Strip, Palestinian medical sources said, DPA reported. The sources said Israeli warplanes and tanks fired missiles and shells at houses and individuals in the area. At least 20 of the victims were civilians, including four women and six children. Mo'aweya Hassanein, chief of emergency and ambulance services at the Palestinian health ministry, told reporters: "It is the highest ever figure of death casualties in the Gaza Strip. "I have never witnessed such a high death toll since I started my career 20 years ago." The Israeli incursion has left around 80 Palestinians dead since Wednesday, Palestinian sources said. The highest number of death casualties in a single day was in November last year, when the Israeli army killed 21 Palestinians. Saturday was the bloodiest and the most violent since 1967. Hassanein warned of a humanitarian disaster if Israeli airstrikes were allowed to go on, referring to the lack of medical support and fuel for ambulances after miore than eight months of israeli closure on the Gaza Strip.