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MANAMA, Bahrain - Bahraini troops fired live ammunition and tear gas Friday at thousands of peaceful protesters in the capital's main square, causing dozens of casualties.

People carrying men, women and children - some bleeding from bullet wounds, others overcome by tear gas - crowded into Salmanya Medical Center, where the frantic, overwhelmed staff struggled to cope.

Thousands of demonstrators, who are demanding that a democratic system replace Bahrain's ruling Al Khalifa dynasty, then converged on the hospital, prompting security forces to fire tear gas around the facility.

"We are peaceful. We don't even have a rock," cried Mohammad, a 26-year-old laborer, as the throng shouted, "The victory is from Allah and it will be with us" and "Down, down, Khalifa" and "Tell the world. Tell the world. We are peaceful."

The bloodshed marked a major escalation in the crisis, which began Monday in Manama with a protest for democratic reforms. It was inspired by the popular revolts that drove out the aging despotic rulers of Egypt and Tunisia, which are fueling anti-regime movements elsewhere across the volatile region.

The violence erupted Friday after the funerals of four protesters who were killed a day earlier in a predawn onslaught by Bahraini security forces against thousands of sleeping anti-government protesters occupying Pearl Square, the capital's main traffic circle.

The funerals turned into new demonstrations against the monarchy. Thousands marched to Pearl Square, where they found soldiers, tanks and armored personnel carriers. As many knelt to pray, the troops began firing live ammunition and tear gas, igniting stampedes into nearby streets.

Many of the soldiers are recruited from other countries in the region.

"They are 100 percent Saudis," Mohammad, the laborer, said of the soldiers in the square.

Casualties streamed into the medical center even as the medical staff was staging its own protest against the monarchy.

Chaos ensued. Doctors and nurses struggled to treat the wounded, who were being rolled in on gurneys. Others held hands to form a human chain at the hospital's entrance to prevent police from entering.

"This is a massacre," said a nurse who gave her name only as Haitham.

An elderly man with blood on his hands said he'd been cradling a protester who died from a bullet wound to his head.

According to a hospital logbook, at least 16 people were admitted for wounds, and more were arriving as the evening progressed. Some people said that troops had closed off Pearl Square, barring exits to casualties still inside.

In the medical facility, staff members shouted for donations of blood, which was running short. Outside, people passed out food and water, while hospital workers held up cardboard signs showing what blood types were needed.

There also were reports of clashes in other parts of Manama.