At least 48 Palestinians were killed and many others wounded on Wednesday while waiting for food at the Zikim Crossing in Gaza, according to a hospital treating the injured. The deadly incident came amid ongoing tensions over humanitarian aid distribution, as the U.S. special envoy for the Middle East prepares to visit Israel for talks.

The ongoing Israeli military campaign and blockade have created what experts are calling a "worst-case scenario of famine" in Gaza, home to around 2 million people. Aid convoys have been repeatedly overwhelmed by large, desperate crowds as law and order continues to break down.

U.S. envoy Steve Witkoff, who has been working to bring an end to the nearly two-year conflict and secure the release of hostages taken during Hamas’ October 7 attack on Israel, is scheduled to arrive in Israel on Thursday.

At the Zikim Crossing—one of the main entry points for humanitarian supplies in northern Gaza—Shifa Hospital reported receiving dozens of casualties. It remains unclear who was responsible for the gunfire, and the Israeli military has yet to issue a statement.

Video from the scene shows people being transported in wooden carts, while others carried away bags of flour. Al-Saraya Field Hospital reported treating over 100 dead and wounded individuals, while additional bodies were sent to other hospitals, suggesting the death toll could rise.

Overnight and into Wednesday, Israeli strikes and gunfire reportedly killed at least 46 Palestinians, most of whom were also trying to obtain food. The Gaza Health Ministry added that seven more people, including a child, died from causes related to malnutrition.

Although Israel says it targets only militants and holds Hamas responsible for civilian deaths due to their presence in populated areas, it did not immediately comment on the latest casualties.

Limited Aid, Rising Hunger

Despite recent steps to allow more humanitarian aid into Gaza, aid workers say the efforts fall far short of what’s needed. The Integrated Food Security Phase Classification (IPC) stopped short of officially declaring a famine but warned on Tuesday that Gaza is facing "widespread death" unless urgent action is taken.

According to COGAT, the Israeli agency overseeing aid, over 220 trucks entered Gaza on Tuesday—still well below the 500-600 trucks per day that entered during a brief ceasefire earlier this year and the minimum the U.N. says is needed.

Challenges persist in distributing the aid that does enter, with Israeli-controlled areas often crowded and chaotic. An alternative aid effort led by the Israeli-supported Gaza Humanitarian Foundation (GHF) has also seen violent incidents.

Since May, more than 1,000 Palestinians have reportedly been killed while trying to access aid, mostly near GHF-operated areas. The Israeli military maintains it has only fired warning shots, while GHF claims its contractors have only used non-lethal measures to manage crowds.

Air-dropped aid deliveries have resumed, but many packages have landed in restricted zones or in the sea, forcing people to risk their lives retrieving them.

Growing Death Toll from Malnutrition

Gaza’s Health Ministry reports that 89 children and 65 adults have died from malnutrition since the start of the war, with adult deaths being recorded since late June. Israel, however, denies that starvation exists in Gaza and has criticized the emphasis on hunger as undermining negotiations for a ceasefire.

The war began on October 7, 2023, when Hamas militants attacked southern Israel, killing around 1,200 people and taking 251 hostages. Roughly 50 hostages remain, including about 20 believed to be alive.

Israel’s military response has since killed over 60,000 Palestinians, according to Gaza’s Health Ministry. While the figures don’t distinguish between civilians and combatants, international bodies regard the ministry’s data as the most credible available.