At least 20 Palestinians were killed Wednesday in a deadly stampede at a food distribution hub in Gaza, as desperation over scarce supplies turned into chaos.

The site, run by the Israeli-backed American group Gaza Humanitarian Fund (GHF), confirmed it was the first-time fatalities had occurred during its operations, though aid-seekers and health officials say deaths at or near the hubs have become all too common.

The incident unfolded in the southern city of Khan Younis, where crowds surged and people became trapped in turnstiles, suffocated, and trampled. One victim was stabbed in the melee.

Gaza’s Health Ministry and several witnesses accused GHF workers of using tear gas and pepper spray, which reportedly caused panic and left many gasping for air. GHF denied responsibility, blaming Hamas for inciting fear and spreading misinformation — though it offered no evidence to support the claim.

Witnesses described scenes of terror as people pressed forward, some believing aid had been delayed or canceled, while others scrambled through the bottlenecked entrance.

“When they saw people killing each other, they opened the gate and people stepped over each other and suffocated,” said one man at a nearby hospital, standing among the injured. Another resident, Omar Al-Najjar of Rafah, called the chaotic aid lines a march “towards death.”

Videos from earlier distributions showed similar scenes, with hundreds sprinting toward gates and cramming into fenced enclosures. Footage obtained by the Associated Press from an American contractor showed private security contractors deploying tear gas and stun grenades inside fenced corridors as people struggled to reach food.

GHF began operations in February to deliver humanitarian aid to Palestinians amid the ongoing war. Its hubs are located inside Israeli-controlled military zones, guarded by private U.S. contractors and surrounded by Israeli soldiers. The Israeli army says its troops stay at a distance and only use live fire when crowds pose a threat.

But Gaza’s Health Ministry and the U.N. human rights office say the toll of seeking food has been staggering: 875 Palestinians killed since May, 674 of them near GHF-run aid sites. The majority, they say, were shot by Israeli forces.

Elsewhere in Gaza on Wednesday, Israeli airstrikes killed at least 41 people, including 11 children and three women, according to hospital officials. Strikes on Gaza City and Khan Younis targeted what Israel called Hamas tunnels and weapons storage. The military said it hit more than 120 targets over 24 hours, and again blamed Hamas for civilian deaths, saying the group operates from residential neighborhoods.

For many in Gaza, the twin realities of bombings and hunger have left residents trapped between fear of airstrikes and fear of being crushed in line for a meal. As one witness put it: “We came for food. We left carrying bodies.”