Israeli troops fired on a crowd of Palestinians waiting for aid in Gaza City, witnesses have 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.

Hospital workers initially reported an Israeli strike on the crowd but witnesses later said Israeli troops opened fire as people pulled flour and canned goods off trucks.

The Israeli military declined to provide an on-the-record statement about the role of troops in the incident.

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’s October 7 attack.

The area 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 on 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 UN says a quarter of Gaza’s 2.3 million Palestinians face starvation and 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 added.

He said Israeli troops opened fire on the crowd, causing it to scatter, with some people hiding under cars.

After the shooting stopped, they 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.

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.

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 UN, 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 ceasefire.

The increasing alarm over hunger across Gaza has fuelled international calls for another ceasefire, and the US, 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.

Meanwhile, UN 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.