Israeli strikes and gunfire killed at least 33 Palestinians in Gaza on Saturday, including people sheltering in tents or seeking scarce food, local hospitals said as a famine in Gaza’s largest city sparks new pressure on Israel over its 22-month offensive.
Israel has rejected the data-based famine declaration as "an outright lie."
Ceasefire efforts are on hold as mediators await Israel’s next steps.
Israeli strikes killed at least 17 people in southern Gaza, more than half of them women and children, according to morgue records and health officials at Nasser Hospital.
The officials said the strikes targeted tents sheltering displaced people in Khan Younis.
In northern Gaza, Israeli gunfire killed at least five aid-seekers near the Zikim crossing with Israel, where UN and other truck convoys enter the territory, health officials at Sheikh Radwan field hospital told reporters.
Eleven people were killed in attacks elsewhere, according to hospitals and the Palestinian Red Crescent.
Israel's military said it was not aware of a strike in Khan Younis at that location and was looking into the other incidents.
Mohamed Saada was among thousands seeking food from a delivery in the Zikim area on Saturday - and one of many who left empty-handed.
"I came here to bring food for my children but couldn’t get anything, due to the huge numbers of people and the difficulty of the situation between the shootings and the trucks running over people,” he said.
Some carried sacks of food like lentils and flour. Others carried the wounded, including on a wooden pallet.
They navigated fetid puddles and the rubble of war as temperatures reached above 33 degree Celsius.
Friday's report by the Integrated Food Security Phase Classification said famine in Gaza City is likely to spread if fighting and restrictions on aid continue. It said nearly half a million people - about one-fourth of Gaza's population - face catastrophic hunger.
The rare pronouncement came after Israel imposed a 2 1/2-month blockade on Gaza earlier this year, then resumed some access with a focus on a new US-backed private aid supplier, the Gaza Humanitarian Foundation.
In response to global outrage over images of emaciated children, Israel has also allowed airdrops and new deliveries by land, but the UN and others say it's still far from enough.
Journalists have seen chaos on roads leading to aid deliveries, and there have been almost daily reports of Israeli troops firing toward aid-seekers. Israel's military says it fires warning shots if people approach troops or pose a threat.
Israeli Prime Minister Benjamin Netanyahu’s office asserts it has allowed enough aid to enter during the war, while accusing Hamas of starving the hostages it holds.
With ground troops already active in strategic areas, the military operation in Gaza City could start within days in an area that has hundreds of thousands of civilians.
Aid group Doctors without Borders, or MSF, said its clinics around Gaza City see high numbers of patients as people flee.
Caroline Willemen, MSF project coordinator there, noted a marked increase in airstrikes since early August.
"Those who have not moved are wondering what they should do,” she said.
"People want to stay, they have been displaced endlessly before, but they also know that at some point it will become very dangerous to remain.”
Israel's military has said troops are operating on the outskirts of Gaza City and in its Zeitoun neighbourhood. Israel says Gaza City is still a Hamas stronghold.
Many Israelis fear the assault on Gaza City could doom the 20 hostages who are believed to have survived since 2023. Another 30 are thought to be dead.
Hundreds of thousands of Israelis protested a week ago for a deal to end the fighting and bring everyone home.
Netanyahu said on Thursday he had instructed officials to begin immediate negotiations to release hostages and end the war on Israel’s terms.
It was unclear if Israel would return to talks mediated by the United States, Egypt and Qatar after Hamas said it accepted a new proposal from Arab mediators.
Hamas has said it will release hostages in exchange for ending the war, but rejects disarming without the creation of a Palestinian state.
US President Donald Trump has expressed frustration with Hamas’ stance, suggesting the group is less interested in making deals with few hostages left alive.
"I actually think (the hostages are) safer in many ways if you went in and you really went in fast and you did it," Trump told reporters on Friday.
Gaza's Health Ministry said at least 62,622 Palestinians have been killed in the war, including missing people now confirmed dead by a special ministry judicial committee.
The number of malnutrition-related deaths rose by eight to 281, the ministry said.
A small group of Israelis protested against the far-right national security minister, Itamar Ben-Gvir, as he walked to a synagogue in Kfar Malal, north of Tel Aviv. Videos showed the minister arguing with the protesters.
"We don’t want him in our village. Our message is to bring back the hostages,” one of the protesters, Boaz Levinstein said.
Ben-Gvir is a key partner in Netanyahu’s political coalition and a staunch opponent of reaching a deal with Hamas, which hostages’ families see as the only way to secure the release of loved ones.
Associated Press