(Bloomberg) -- Scores of Palestinians were killed and injured on Thursday during an outbreak of violence in which Israeli troops opened fire near a convoy of food trucks attempting to deliver humanitarian aid in northern Gaza.

Israel denied its forces shot at the crowd, saying most of the victims were trampled or hit as the trucks sought to escape the early-morning chaos. But it said the events were under review. The Associated Press cited doctors and other witnesses who reported numerous gunshot wounds among the dead and injured.

The deadly incident threatens to further set back efforts to negotiate a cease-fire, US President Joe Biden warned. Talks led by the US, Qatar and Egypt are underway for a pause in the conflict that would allow more aid to be delivered, as well as the exchange of Hamas-held hostages for Palestinian prisoners.

The flare-up comes as Israel’s war in Gaza nears the end of its fifth month, with the military seeking to destroy the Islamist group Hamas after its militants invaded the country on Oct. 7, killing about 1,200 people and kidnapping 250 more. Israel’s counterattack has left more than 30,000 dead, according to the Hamas-run health ministry, while the bombardment has devastated parts of the territory and left hundreds of thousands with limited or no access to food and health care. Hamas is considered a terrorist organization by the US and European Union.

Senior Biden administration officials have been in touch with the Israeli government about the incident and the US will monitor the investigation and press for answers, State Department spokesman Matthew Miller told reporters Thursday.

The facts of Thursday’s deadly violence remained in dispute. 

A witness, Mohammed al-Shouli, speaking by phone, said thousands of people had gathered to wait for the trucks, which started passing an Israeli checkpoint at around 4am.

“The first truck arrived and stopped 300 meters away from the checkpoint,” he said. “People swarmed the truck and thousands proceeded further to other trucks, looking for flour.”

He said 20 trucks entered, the first seven of them carrying water and canned food, and five others with flour.

“People went further south toward the flour trucks and got closer to the tanks and the shooting started,” he said. “Trucks were invisible because thousands of people climbed over them.”

The episode — shootings, stumbling, chaos, and running away with aid — lasted for about half an hour before all trucks were emptied, he said.

‘Warning Shots’

Rear Admiral Daniel Hagari, Israel Defense Force spokesman, said tanks were deployed to secure the corridor for aid and troops fired “a few warning shots” to disperse what it called a “mob.” 

“When the hundreds became thousands and things got out of hand, the tank commander decided to retreat to avoid harm to the thousands of Gazans that were there,” Hagari said. “No IDF strike was conducted toward the aid convoy.”

An earlier army account said a handful of the casualties were caused by its soldiers, the rest a result of the chaos. One Israeli military officer said some Gazans seeking aid approached the forces in a threatening manner, and some responded with live fire.

Jadallah Shafai, the head of the nursing department at Shifa Hospital, told the Al Jazeera network that around 50 people were killed and 250 wounded. Al Jazeera ran footage showing several bodies and injured people arriving at Shifa.

Hussam Abu Safiya, the director of the Kamal Adwan Hospital, said the facility had received at least 10 bodies and 160 wounded people, according to the Associated Press.

The hospitals are barely functioning, however, after Israeli attacks since the start of the conflict, which initially focused on the north. Israel says Hamas fighters and military equipment were hidden inside and underneath the facilities, forcing it to send in its troops. 

Northern Gaza, where the events occurred, is in a particularly dire state, with hungry people searching for animal feed to turn into flour. Aid enters Gaza from the south and Israel has been insisting that those seeking help should travel in that direction.

Nonetheless, several hundred thousand Palestinians have stayed in the north and Israel has started to allow trucks to travel there. But the delivery of the aid has been fraught with looting.  

--With assistance from Jordan Fabian and Iain Marlow.

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