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RAFAH, Gaza Strip — Israeli troops fired on a large crowd of Palestinians racing to pull food off an aid convoy in Gaza City on Thursday, witnesses said. More than 100 people were killed, bringing the death toll since the start of the Israel-Hamas war to more than 30,000, according to health officials.

Israeli officials acknowledged that troops opened fire, saying they did so after the crowd approached in a threatening way. The officials insisted on anonymity to give details about what happened, after the military said in a statement that “dozens were killed and injured from pushing, trampling and being run over by the trucks.”

Gaza City and the surrounding areas in the enclave’s north were the first targets of Israel’s air, sea and ground offensive, launched in response to Hamas’ Oct. 7 attack.

While many Palestinians fled the Israeli invasion in the north, a few hundred thousand are believed to remain in the area, which has suffered widespread devastation and has been largely isolated during the conflict. Trucks carrying food reached northern Gaza this week, the first major aid delivery to the area in a month, officials said Wednesday.

Aid groups say it has become nearly impossible to deliver humanitarian assistance in most of Gaza because of the difficulty of coordinating with the Israeli military, ongoing hostilities and the breakdown of public order, with crowds of desperate people overwhelming aid convoys. The U.N. says a quarter of Gaza’s 2.3 million Palestinians face starvation; around 80% have fled their homes.

Kamel Abu Nahel, who was being treated for a gunshot wound at Shifa Hospital, said he and others went to the distribution point in the middle of the night because they heard there would be a delivery of food. “We’ve been eating animal feed for two months,” he said.

He said Israeli troops opened fire on the crowd as people pulled boxes of flour and canned goods off the trucks, causing them to scatter, with some hiding under cars. After the shooting stopped, people went back to the trucks, and the soldiers opened fire again. He was shot in the leg and fell over, and then a truck ran over his leg as it sped off, he said.

Alaa Abu Daiya, another witness, said Israeli troops open fire and also that a tank fired a shell.

Medics arriving at the scene on Thursday found “dozens or hundreds” lying on the ground, according to Fares Afana, the head of the ambulance service at Kamal Adwan Hospital. He said there were not enough ambulances to collect all the dead and wounded and that some were being brought to hospitals in donkey carts.

Another man in the crowd — who gave only his first name, Ahmad, as he was being treated at a hospital for gunshot wounds to the arm and leg — said waited for two hours before someone with a horse-pulled cart had room to take him to Shifa.

Dr. Mohammed Salha, the acting director of the Al-Awda Hospital, said the facility received 161 wounded patients, most of whom appeared to have been shot. He said the hospital can only perform the most essential surgeries because it is running out of fuel to power emergency generators.

In addition to at least 104 people killed, around 760 were wounded, Health Ministry spokesman Ashraf al-Qidra said. The Health Ministry described it as a “massacre.”

Separately, the Health Ministry said the Palestinian death toll from the war has climbed to 30,035, with another 70,457 wounded. It does not differentiate between civilians and combatants in its figures but says women and children make up around two-thirds of those killed.

The ministry, which is part of the Hamas-run government in Gaza, maintains detailed records of casualties. Its counts from previous wars have largely matched those of the U.N., independent experts and even Israel’s own tallies.

The Hamas attack into southern Israel that ignited the war killed 1,200 people, mostly civilians, and the militants seized around 250 hostages. Hamas and other militants are still holding around 100 hostages and the remains of about 30 more, after releasing most of the other captives during a November cease-fire.

The increasing alarm over hunger across Gaza has fueled international calls for another cease-fire, and the U.S., Egypt and Qatar are working to secure a deal between Israel and Hamas for a pause in fighting and the release of some of the hostages.

Mediators hope to reach an agreement before the Muslim holy month of Ramadan starts around March 10. But so far, Israel and Hamas have remained far apart in public on their demands.

In a statement condemning Thursday’s attack, Hamas said it would not allow the negotiations “to be a cover for the enemy to continue its crimes.”

Meanwhile, U.N. officials have warned of further mass casualties if Israel follows through on vows to attack the southernmost city of Rafah, where more than half of Gaza’s population of 2.3 million has taken refuge. They also say a Rafah offensive could decimate what remains of aid operations.

Hundreds of thousands Palestinians are believed to remain in northern Gaza despite Israeli orders to evacuate the area in October, and many have been reduced to eating animal fodder to survive. The U.N. says one in 6 children under 2 in the north suffer from acute malnutrition and wasting.

COGAT, the Israeli military body in charge of Palestinian civilian affairs, said around 50 aid trucks entered nothern Gaza this week. It was unclear who delivered the aid. Some countries have meanwhile resorted to airdrops in recent days.

The World Food Program said earlier this month that it was pausing deliveries to the north because of the growing chaos, after desperate Palestinians emptied a convoy while it was en route.

Since launching its assault on Gaza following Hamas’ Oct. 7 attack, Israel has barred entry of food, water, medicine and other supplies except for a trickle of aid entering the south from Egypt at the Rafah crossing and Israel’s Kerem Shalom crossing. Despite international calls to allow in more aid, the number of supply trucks is far less than the 500 that came in daily before the war.

COGAT said Wednesday that Israel does not impose limits on the amount of aid entering. Israel has blamed U.N. agencies for the bottleneck, saying hundreds of trucks are waiting on the Palestinian side of Kerem Shalom for aid workers to collect them.

U.N. spokesman Stephane Dujarric on Wednesday countered by saying large trucks entering Gaza have to be unloaded and reloaded onto smaller ones, but there aren’t enough of them and there’s a lack of security to distribute aid in Gaza.

Hamas-run police in Gaza stopped protecting convoys after Israeli strikes on them near the crossing.