At least 45 Palestinians were killed in the Gaza Strip while waiting for U.N. and commercial trucks to enter the territory with desperately needed food, according to Gaza’s Health Ministry and a local hospital.

Medics said residents said Israeli tanks fired shells against crowds of desperate Palestinians awaiting aid trucks along the main eastern road in Khan Younis, expecting the number of fatalities to rise as many of the wounded were in critical condition.

Palestinians say Israeli forces opened fire on people trying to access a U.S.-backed group's aid distribution hub in Gaza, in the deadliest of such incidents reported to date.