Shots were fired by soldiers around Pearl roundabout in Manama, the Bahraini capital, a day after police forcibly cleared a protest encampment from the traffic circle.
The circumstances of the shooting after nightfall on Friday were not clear. Officials at the main Salmaniya hospital said at least 66 people were injured, some with gunshot wounds to the head and chest.
Some doctors and medics on emergency medical teams were in tears as they tended to the wounded. X-rays showed bullets still lodged inside victims.
"This is a war," said Dr. Bassem Deif, an orthopedic surgeon examining people with bullet-shattered bones.
Protesters described a chaotic scene of tear gas clouds, bullets coming from many directions and people slipping in pools of blood as they sought cover.
Meanwhile, Sheikh Hamad ibn Isa Al Khalifa, the King of Bahrain, asked his crown prince Sheikh Salman bin Hamad al-Khalifa to start a national dialogue "with all parties".
Earlier on state TV the crown prince had called for calm, saying it was "time for dialogue, not fighting".
"The dialogue is always open and the reforms continue," Sheikh Hamad al-Khalifa said on Bahrain TV.
"We need to call for self-restraint from all sides, the armed forces, security men and citizens," he said. "I urge you, there should be calm. Now is time for calm."
Jalal Firooz, of the Wefaq bloc that resigned from parliament on Thursday, said demonstrators had been elsewhere in the city, marking the death of a protester killed earlier this week. The demonstrators then made for the roundabout, where army troops are deployed.
A doctor of Salmaniya hospital told Al Jazeera that the hospital is full of severely injured people after the latest shootings.
"We need help! Our staff is entirely overwhelmed. They are shooting at people's heads. Not at the legs. People are having their brains blown out," a distraught Dr Ghassan said, describing the chaos at the hospital as something close to a war zone.
He said the hospital was running short of blood and appealed for help to get more supplies.Police had no immediate comment.
An Associated Press cameraman saw army units shooting anti-aircraft weapons, fitted on top of armored personnel carriers, above the protesters in apparent warning shots and attempts to drive them back from security cordons about 200 meters from the roundabout.
Protesters claimed live ammunition was used against the demonstrators.
"People started running in all directions and bullets were flying," said Ali al-Haji, a 27-year-old bank clerk. "I saw people getting shot in the legs, chest and one man was bleeding from his head."
In the past, security forces had mostly used rubber bullets. Witnesses said about 20 police cars had driven toward the roundabout after the initial shooting.
Earlier, troops backed by tanks had locked down Manama and announced a ban on public gatherings. Tanks and armoured personnel carriers were patrolling the streets of Manama and checkpoints set up.
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