At least 20 people were killed in a stampede at an aid distribution site in Gaza on Wednesday, according to Gaza health officials and the U.S.-backed aid group operating the site.
The incident is the latest in a series of deadly events near aid hubs run by the Gaza Humanitarian Foundation (GHF), a U.S.-based organization operating with Israeli support. GHF was designated lead distributor of aid in Gaza in late May amid international pressure over Israel’s months-long blockade, which had pushed the enclave to the edge of famine.
The death toll of Palestinians killed near GHF aid hubs has now reached nearly 700, according to United Nations figures released on Tuesday.
The GHF claimed the stampede, which took place on its distribution hub in Khan Younis, was intentionally caused by agitators in the crowd. The organization reported 19 people were trampled and one person was fatally stabbed during what it described as a “chaotic and dangerous surge.”
“We have credible reason to believe that elements within the crowd – armed and affiliated with Hamas – deliberately fomented the unrest,” GHF said, adding that it recovered at least one firearm during the incident.
Gaza’s Health Ministry disputed GHF’s version of events of what prompted the stampede, calling the statement “false and misleading.”
“This crime claimed the lives of 21 martyrs this morning, including 15 who died from suffocation and six who were shot with live ammunition, in addition to many others who were injured,” the Health Ministry statement read.
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The ministry also accused GHF of operating outside humanitarian norms, saying it “does not adhere to any professional or ethical standards of humanitarian work.”
The Health Ministry has alleged that GHF staff, which consists of armed private security personnel, and Israel Defense Forces (IDF) have fired directly upon people collecting aid.
TIME has reached out to the GHF and the IDF for comment. The Israeli military has declined to comment publicly on the incident, referring questions back to the foundation.
Witnesses said guards at the site used pepper spray after locking the gates, trapping people between the gates and the perimeter fence. Other reports from the scene allege that access to the aid center was delayed or blocked, causing panic among those gathered.
“People kept gathering and pressuring each other; when people pushed each other...those who couldn’t stand fell under the people and were crushed," Mahmoud Fojo told Reuters.
"Some people started jumping over the netted fence and got wounded. We were injured, and God saved us. We were under the people and we said the Shahada (death prayers). We thought we were dying, finished," the eyewitness continued.
In a response to the New York Times, the organization said it had used a “limited” amount of pepper spray, but “only to safeguard additional loss of life.”
GHF and its distribution sites have come under heavy criticism since operations began in May. The day after aid hubs in Gaza opened, one Palestinian was killed and another 48 injured, which appeared to be as a result of Israeli gunfire according to the U.N.
Read more: 27 Palestinians Killed After Israeli Soldiers Open Fire Near Aid Hub in Gaza
Critics have also raised concerns that the placement of GHF aid centers, mostly in southern and central Gaza, may be contributing to the long-term displacement of civilians from the north, where Israeli military operations have continued.
Despite the scale of distribution, the UN has warned that aid provided through GHF represents only a fraction of what is needed to stave off starvation for Gaza’s population of more than two million.
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