Hospital officials in Gaza reported that at least 33 Palestinians seeking food were killed by Israeli fire on Sunday, as increasingly desperate crowds travelled through military-controlled areas toward aid distribution points. The deaths came amid warnings that the territory was approaching a worst-case famine scenario after months of restrictions on humanitarian supplies.

Two hospitals in southern and central Gaza said they received bodies from roads leading to sites run by the Israeli-backed Gaza Humanitarian Foundation. Eleven of those killed had been trying to reach a distribution point through the Teina area of Khan Younis, according to the hospital accounts. Three Palestinian witnesses told The Associated Press they saw soldiers fire along routes inside military zones. One witness said bullets prevented him from stopping to help people he saw bleeding.

The Israeli military said it was unaware of casualties caused by its gunfire near the aid sites. The foundation said there had been no shooting at or close to its facilities. It has maintained that its armed contractors use pepper spray or warning shots only to control dangerous crowding. The United Nations, however, said 859 people had been killed near foundation sites between May 27 and July 31, with hundreds more killed along routes used by UN food convoys.

The day’s violence extended beyond the food routes. The Palestinian Red Crescent Society said an Israeli strike hit its headquarters in Khan Younis, killing one staff member and injuring three. Israel’s military said it was reviewing that claim.

Aid access had already been sharply constrained. No assistance entered Gaza from March 2 until May 19, and deliveries remained limited after they resumed. Aid workers and doctors described malnutrition among children, with especially severe effects on those with disabilities or wounds. Gaza’s population of more than two million was confronting shortages while distribution remained dangerous and contested.

The crisis unfolded as Israeli National Security Minister Itamar Ben-Gvir visited and prayed at the Jerusalem compound known to Jews as the Temple Mount and to Muslims as the Noble Sanctuary, home to Al-Aqsa Mosque. Open Jewish prayer there conflicts with a longstanding arrangement governing the site. Prime Minister Benjamin Netanyahu’s office said the rules had not changed. Palestinian leaders, Jordan, Saudi Arabia and Turkey condemned the visit, adding another source of tension while mediators sought to halt the war and secure the release of hostages held in Gaza. The deaths occurred as famine warnings, unsafe access routes and competing accounts from the military and aid operator made it difficult for civilians to obtain food without risking exposure to violence.