Authorities in Gaza said 23 people were also injured while waiting for bags of flour and aid near Kuwait Roundabout.

“The Israeli occupation commits a massacre, killing 19 and injuring 23 civilians while thousands of citizens were waiting for flour and aid near Al-Kuwait roundabout,” Gaza’s media office said in a statement on Saturday.

It said that the Israeli army and tanks opened fire with machine guns “towards the hungry people who were waiting for bags of flour and aid in a place far from posing any danger to the occupation”.

Mahmud Basal, the spokesman for the Civil Defence Department in Gaza, said there had been “heavy shooting at civilians” and victims had been transported to a nearby Ahli Arab Hospital.

But with Gaza’s healthcare system at near collapse, many were treated outside in the open air.

“There were very serious injuries, some of whom were injured by shrapnel. The reality is tragic, difficult and challenging,” he said.

Alaa al-Khudary, a witness at the scene, told Al Jazeera that the Israeli forces shot at the crowd, leaving “many dead” and leaving others injured while they tried to get “a bite to eat” for their children.

Looming famine

Half of Palestinians in Gaza are experiencing “catastrophic” hunger, with famine projected to hit the north of the territory by May unless there is urgent intervention, a United Nations-backed food assessment warned on Monday.

But aid distribution has become increasingly dangerous and sometimes lethal.

Last Tuesday, 23 Palestinians were killed, and several others were injured by Israeli bombing that targeted Palestinians waiting for humanitarian aid in the northern Gaza Strip.

On February 29, Israeli forces opened fire on hundreds of Palestinians as they gathered south of Gaza City waiting to receive humanitarian aid in what is known as the “flour massacre”, leaving 118 dead and 760 wounded, according to the Health Ministry in the enclave.

UN Secretary-General Antonio Guterres said on Saturday during a visit to the Rafah crossing that the line of blocked aid trucks stuck on Egypt’s side of the border with the Gaza Strip while Palestinians face starvation on the other side is a “moral outrage”.

Al Jazeera’s Tareq Abu Azzoum, reporting from Rafah, said the latest shooting is part of a “clear, systematic policy that Israel has been using in the course of the past few months”.

He said the Israeli forces have been imposing restrictions on aid deliveries to the north of the enclave while also attacking people who attempt to reach humanitarian aid convoys.

He said that people in Gaza, despite the risks, continue to wait for the convoys as they are “hungry, dehydrated, and they want to return back to their families with something to break the fast“.

Reports of shooting ‘are incorrect’: Israel

The Israeli army denied it had fired on the crowd.

“The reports claiming that the [Israeli military] attacked dozens of Gazans at an aid convoy are incorrect,” an army statement said.

“Preliminary findings have determined that there was no aerial strike against the convoy, nor were there incidents found of [Israeli] forces firing at the people at the aid convoy.”