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More than 100 Palestinians are reported to have been killed while waiting for aid to be delivered in northern Gaza.
The Hamas-run health ministry blamed Israeli forces, and Palestinian media cited medical sources saying Israeli troops fired at the crowd.
An Israeli military source said troops opened fire as they believed soldiers were “endangered”.
An Israel Defense Forces (IDF) statement also said dozens were killed being trampled and run over by trucks.
A journalist in Gaza City told the BBC that Israeli tanks fired on a crowd who had come to get supplies. The Israeli military says it has no knowledge of shelling in the area and that the incident is under review.
Graphic videos posted on social media show the dead in Gaza City loaded onto emptied aid lorries and a donkey cart.
It happened hours before Gaza’s health ministry announced that more than 30,000 people, including 21,000 children and women, had been confirmed killed since the start of the war between Israel and Hamas.
Some 7,000 others have been reported as missing and 70,450 have been treated for injuries over the past four months, according to the ministry.
The UN is also warning of a looming famine in the north of the territory, where an estimated 300,000 people are living with little food or clean water.
The Israeli military launched a large-scale air and ground campaign to destroy Hamas – which is proscribed as a terrorist organisation by Israel, the UK and others – after its gunmen killed about 1,200 people in southern Israel on 7 October and took 253 other people hostage.
Health ministry spokesman Ashraf al-Qudra said 104 people were killed and 760 others wounded at the Nabulsi roundabout on Rashid Street early on Thursday morning, and blamed Israeli forces for what he described as a “massacre”.
He warned that dozens of casualties in a critical or severe condition had been brought to the nearby al-Shifa Hospital, in Gaza City, and that medics there were unable to cope with the volume and severity of cases.
The director of the Kamal Adwan hospital in the northern town of Beit Lahia, Hussam Abu Safieyah, told Reuters that it had received the bodies of 10 people and dozens of wounded from western Gaza City. “We don’t know how many there are in other hospitals,” he added.
Paramedic Fares Afana also told the Associated Press that ambulance crews had found “dozens or hundreds” lying on the ground at the scene. He said some of the dead and wounded were being transported to hospitals on donkey carts because there were not enough ambulances.
The official Palestinian news agency, Wafa, cited medical sources as saying that Israeli forces fired towards thousands of people from Gaza City and other northern areas as they waited at Nabulsi roundabout for the arrival of lorries loaded with humanitarian aid.
The north of Gaza suffered widespread devastation after being the focus of the first phase of the Israeli ground offensive.
It has been largely cut off from humanitarian assistance for several months despite some relief efforts by UN aid agencies.
Last week, the World Food Programme said it had been forced to suspend aid deliveries to northern Gaza after its first convoy in three weeks was surrounded by crowds of hungry people close to the Israeli military’s Wadi Gaza checkpoint, and then faced gunfire in Gaza City.
Another convoy faced what it called “complete chaos and violence due to the collapse of civil order”. Several lorries looted in central Gaza and a driver was beaten, while the remaining flour was “spontaneously distributed” upon entering Gaza City.
On Tuesday, a senior UN aid official warned that at least 576,000 people across the Gaza Strip – one quarter of the population – faced catastrophic levels of food insecurity and were at risk of famine.
He also warned that one in six children under the age of two in the north were suffering from acute malnutrition and wasting.
On Wednesday, Gaza’s health ministry said six children had died from dehydration and malnutrition at hospitals in northern Gaza. Two of the death were at al-Shifa and four at the Kamal Adwan, it added.