Before American jets began their bombing on Monday morning, American troops in front of the hospital took intense fire from small arms and rocket-propelled grenades from insurgents across the river. American Bradleys and tanks began returning fire.
In Washington, Pentagon officials said Secretary of Defense Donald H. Rumsfeld and Gen. Richard B. Myers, the chairman of the Joint Chiefs of Staff, were monitoring the preparations and updated combat reports.
Most civilians in Falluja, a city of about 250,000 people 35 miles west of Baghdad, were believed to have left by the time the invasion began.
It was the second time in six months that a battle had raged in Falluja. In April, American troops were closing in on the city center when popular uprisings broke out in cities across Iraq. The outrage, fed by mostly unconfirmed reports of large civilian casualties, forced the Americans to withdraw.
American commanders regarded the reports as inflated, but it was impossible to determine independently how many civilians had been killed. The hospital was selected as an early target because the American military believed that it was the source of rumors about heavy casualties.
"It's a center of propaganda," a senior American officer said Sunday.
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