DEIR AL-BALAH, Gaza Strip (AP) — At least 48 Palestinians were killed and dozens were wounded Wednesday while waiting for food at a crossing in the Gaza Strip, according to a hospital that received the casualties. The latest violence around aid distribution came as the U.S. Mideast envoy was heading to Israel for talks.

Israel’s military offensive and blockade have led to the “worst-case scenario of famine” in the coastal territory of some 2 million Palestinians, according to the leading international authority on hunger crises. A breakdown of law and order has seen aid convoys overwhelmed by desperate crowds.

U.S. envoy Steve Witkoff, who has led the Trump administration’s efforts to wind down the nearly 22-month war and release hostages taken in Hamas’ Oct. 7 attack that sparked the fighting, will arrive in Israel on Thursday for talks on the situation in Gaza.

Wooden carts ferry the wounded as survivors carry flour

Shifa Hospital in Gaza City said the dead and wounded were among crowds massed at the Zikim Crossing, the main entry point for humanitarian aid to northern Gaza. It was not immediately clear who opened fire and there was no immediate comment from the Israeli military, which controls the crossing.

Associated Press footage showed wounded people being ferried away from the scene of the shooting in wooden carts, as well as crowds of people carrying bags of flour.

Al-Saraya Field Hospital, where critical cases are stabilized before transfer to main hospitals, said it received more than 100 dead and wounded. Fares Awad, head of the Gaza Health Ministry’s emergency service, said some bodies were taken to other hospitals, indicating the toll could rise.

Israeli strikes and gunfire had earlier killed at least 46 Palestinians overnight and into Wednesday, most of them among crowds seeking food, health officials said. Another seven Palestinians, including a child, died of malnutrition-related causes, according to the Gaza Health Ministry.

The Israeli military did not immediately comment on any of the strikes. It says it only targets militants and blames civilian deaths on Hamas, because the group’s militants operate in densely populated areas.

Israel has eased its blockade but obstacles remain

Under heavy international pressure, Israel announced a series of measures over the weekend to facilitate the entry of more international aid to Gaza, but aid workers say much more is needed.

The Integrated Food Security Phase Classification, or IPC, the leading world authority on hunger crises, has stopped short of declaring famine in Gaza but said Tuesday that the situation has dramatically worsened and warned of “widespread death” without immediate action.

COGAT, the Israeli military body that facilitates the entry of aid, said over 220 trucks entered Gaza on Tuesday. That’s far below the 500-600 trucks a day that U.N. agencies say are needed, and which entered during a six-week ceasefire earlier this year.

The United Nations is still struggling to deliver the aid that does enter the strip, with most trucks unloaded by crowds in zones controlled by the Israeli military. An alternative aid system run by the Israeli-backed Gaza Humanitarian Foundation, or GHF, has also been marred by violence.

More than 1,000 Palestinians have been killed by Israeli fire while seeking aid since May, most near sites run by GHF, according to witnesses, local health officials and the U.N. human rights office. The Israeli military says it has only fired warning shots at people who approach its forces, and GHF says its armed contractors have only used pepper spray or fired warning shots to prevent deadly crowding.

International airdrops of aid have also resumed, but many of the parcels have landed in areas that Palestinians have been told to evacuate while others have plunged into the Mediterranean Sea, forcing people to swim out to retrieve drenched bags of flour.

Deaths from malnutrition

A total of 89 children have died of malnutrition since the war began in Gaza. The ministry said that 65 Palestinian adults have also died of malnutrition-related causes across Gaza since late June, when it started counting deaths among adults.

Israel denies there is any starvation in Gaza, rejecting accounts to the contrary from witnesses, U.N. agencies and aid groups, and says the focus on hunger undermines ceasefire efforts.

Hamas started the war with its attack on southern Israel on Oct. 7, 2023, in which militants killed around 1,200 people and abducted 251 others. They still hold 50 hostages, including around 20 believed to be alive. Most of the rest of the hostages were released in ceasefires or other deals.

Israel’s retaliatory offensive has killed more than 60,000 Palestinians, according to Gaza’s Health Ministry. Its count doesn’t distinguish between militants and civilians. The ministry operates under the Hamas government. The U.N. and other international organizations see it as the most reliable source of data on casualties.

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Magdy reported from Cairo and Abou Aljoud from Beirut. Associated Press writer Matthew Lee in Washington contributed to this report.

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