Iran’s Supreme Leader Ayatollah Ali Khamenei personally ordered the country’s top security body to crush nationwide protests using “any means necessary,” including lethal force, according to a report published Sunday by The New York Times citing two officials familiar with the matter.

The order, delivered to Iran’s Supreme National Security Council on Jan. 9, was followed by the deployment of security forces to the streets with “shoot to kill” instructions, directing personnel to show protesters no mercy, the report said.

“This is not merely a violent protest crackdown. It is a state-orchestrated massacre,” Raha Bahreini, a lawyer and Iran researcher at Amnesty International, told the Times.

Despite an internet shutdown that has limited independent reporting, the Times said it verified video footage from early January showing regime security forces opening fire on protesters in at least 19 cities and six neighborhoods in Tehran.

The newspaper also interviewed two dozen protesters and family members of those killed, who spoke on condition of anonymity out of fear of retaliation.

One account described the killing of Nasim Pouraghayee, 45, who was shot in the neck on Jan. 8 in Tehran’s Sadeghiyeh neighborhood, according to her cousin.

“She fell to the ground and began vomiting blood,” the cousin told the Times.

The cousin said Pouraghayee’s husband, Ali, carried her for more than an hour to reach their car before driving her to a hospital, where she was later pronounced dead.

A 50-year-old designer told the Times that her husband was shot in the lower back during an encounter with the Basij, a paramilitary force loyal to Khamenei, in central Tehran. She said a Basij member threatened to kill her but was unable to do so after running out of ammunition.

Another witness, a 40-year-old shopkeeper in Tehran Pars, told the newspaper he saw two young men shot in the back during protests in the middle-class neighborhood.

Footage verified by the Times appears to show security forces firing on protesters from the rooftop of a police station in Tehran Pars, as chants of “Death to Khamenei” can be heard in the background.

Other verified videos show tear gas canisters being thrown into crowds, demonstrators being beaten with batons, and bodies lying in the streets.

Medical workers told the Times that hospitals in Tehran and other cities were quickly overwhelmed by the volume of wounded.

A nurse at Nikan Hospital in Tehran likened conditions to a war zone, while a doctor at Shohada Tajrish Hospital said the facility was receiving approximately 70 protesters with gunshot wounds per hour between Jan. 9 and 10.

Doctors reportedly established an ad hoc triage unit outside Mashhad in northeastern Iran to treat protesters afraid to seek care in hospitals. Medical personnel told the Times that the number of injured across the country is in the hundreds.

“What I witnessed will forever haunt me,” a doctor in Isfahan said in a text message to the newspaper. “I feel guilty that I’m alive.”

The Times reported that Tehran’s main morgue, the Kahrizak Forensic Center, was quickly overwhelmed.

Families were reportedly brought into a hall where a television displayed images of the deceased, each marked with a number, and were asked to identify loved ones.

Video cited by the Times showed what appeared to be nearly 300 bodies laid out on sidewalks outside the morgue.

“It’s a line. A line of people, so they can pick up their deceased,” a person filming the video said, according to the Times.

The full number of those killed remains unclear.

The U.S.-based Human Rights Activists News Agency (HRANA) said it had confirmed 5,459 deaths as of Saturday and was investigating more than 17,000 additional cases.

On Sunday, Iran International estimated that at least 36,500 people have been killed since the protests began, citing documentation and eyewitness accounts from medical staff and families of the deceased.

The Daily Mail, citing Iranian-German professor Amir-Mobarez Parasta, reported a similar estimate of more than 33,000 deaths, along with nearly 98,000 wounded.

Both Iran International and Parasta said the regime has reportedly begun carrying out executions in multiple locations.

According to Iran International, some individuals were allegedly shot in the head after being admitted to hospitals for treatment, with medical personnel confirming that “lethal shots were fired at the injured.”

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