The United Nations says 52 civilians were killed by shelling in Sri Lankan's northern war zone where the army has surrounded Tamil Tiger rebels.
UN spokesman Gordon Weiss said on Wednesday 80 others were wounded in the Suthanthirapuramin area.
Sri Lanka's military has encircled the separatist Liberation Tigers of Tamil Eelam and is confident it will soon win a war that is one of Asia's longest-running conflicts. Some 70,000 people have been killed in the fighting since 1983.
The United States and Britain urged a a ceasefire so casualties can be evacuated and relief supplies allowed into the war zone.
The Tamil Tigers are holding out in a 300 sq km slice of jungle in Sri Lanka's northeast. Aid agencies say 250,000 people are trapped in Tiger-held areas, but the government says the number is about half that.
A crowded hospital, the only one in the war zone, was evacuated after being hit for a fifth time in three days, said the International Committee of the Red Cross. At least 12 people have been killed in the hospital in Puthukudiyiruppu.