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At least 112 people were killed when Israeli forces opened fire at Palestinians waiting for aid lorries in Gaza city on Thursday, the enclave's health ministry said.
Israel claimed the deaths were caused by a crush of civilians trying to reach the convoy.
Gazan Health Ministry spokesman Ashraf Al Qudra said 760 people were injured in the shooting that took place at Al Nabulsi roundabout on Al Rashid Street, a major coastal road to the west of Gaza city in the north of the enclave.
Hundreds of injured people were taken to hospitals nearby, including Al Shifa Hospital, which is already overloaded with patients and barely functioning.
Israel disputed the account provided by health officials in Hamas-run Gaza, where almost five months of war have killed more than 30,000 people and cut off access to basic goods for most of the enclave's 2.3 million people.
Israeli military spokesman Avichai Adraee posted footage filmed from the sky on social media which it said showed crowds of Palestinians rushing to seize aid from the convoy.
The crowds "surrounded the trucks and as a result, dozens were killed and injured from pushing, trampling and being run over by the trucks," said Mr Adraee in a post on X, formerly Twitter.
An Israeli military official later said it was "continuing to review the circumstances".
The official said two separate incidents had occurred as the convoy passed into northern Gaza from the south along the main coastal road.
In the first incident, he said aid lorries were surrounded by hundreds of people and in the confusion, dozens were injured or killed in a crush. As the lorries left, he said, a second incident occurred in which some of the people who rushed the convoy approached Israeli forces including a tank, which then opened fire.
"The soldiers fired warning shots in the air and then fired towards those who posed a threat and did not move away," he said.
The Palestinian presidency condemned what it described as a “heinous massacre” of "innocent civilians," who "put their lives at risk to get food".
It called for Israel to brought to justice in the international courts.
The US also said it was looking into what it described as a “serious incident”.
President Joe Biden said Washington was examining the incident amid "two competing versions of what happened".
"We think that this latest event needs to be thoroughly investigated," said deputy White House spokeswoman Olivia Dalton.
"We've been in touch with the government of Israel this morning about the need to gather information, to request that they investigate and provide more information about the circumstances that led to this tragedy."
Aid groups say it has become nearly impossible to deliver humanitarian assistance in most of Gaza because of the difficulty of co-ordinating with the Israeli military, continuing hostilities and the breakdown of public order, with crowds of desperate people overwhelming convoys.
Palestinians seeking treatment at Al Shifa Hospital reported they were shot at by Israeli troops while waiting for aid.
Kamel Abu Nahel, who was being treated for a gunshot wound at Al 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 said.
He said Israeli troops opened fire on the crowd, causing it to scatter, with some people hiding under cars. After the bullets stopped, many went back to the convoy and the soldiers started shooting again.
He was shot in the leg and fell to the ground, then a lorry 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 the dead and wounded and some were being brought to hospitals in carts pulled by donkeys.
Gaza city and the surrounding area in the enclave's north were the first targets of Israel’s air, sea and ground offensive, launched in response to Hamas’s attack on October 7.
The area has suffered widespread devastation and has been largely isolated during the conflict. Lorries carrying food reached northern Gaza this week, the first major aid delivery to the area in a month, officials said on Wednesday.
Despite the dire humanitarian conditions, far-right Israeli minister Itamar Ben-Gvir said Israel should be preventing aid from reaching Gaza.
“Today it was proven that the transfer of humanitarian aid to Gaza is not only madness while our hostages are held in the strip … but also endangers soldiers,” Mr Ben-Gvir said.
The incident is “another clear reason why we must stop transferring this aid”, he wrote on X.
The UN says a quarter of Gaza’s 2.3 million Palestinians face starvation. About 80 per cent have fled their homes.
UN aid chief Martin Griffiths said he was “appalled” at reports of the latest incident.
“Even after close to five months of brutal hostilities, Gaza has still the ability to shock us,” Mr Griffiths wrote on X.
“Life is draining out of Gaza at terrifying speed,” he said.
