At least 27 Palestinians have been killed by Israeli fire as they attempted to collect aid near a distribution site in Gaza, local officials say.

Civilians were fired upon by tanks, quadcopter drones, and helicopters near the al-Alam roundabout, about 1km (0.6 miles) from the aid distribution centre, a spokesman for Gaza’s Hamas-run Civil Defence agency, Mahmoud Basal, said.

The Israel Defense Forces (IDF) said its troops fired shots after identifying suspects who moved towards them “deviating from the designated access routes”.

Israel previously denied shooting Palestinians in a similar incident on Sunday which the Hamas-run health ministry said killed 31 people and injured nearly 200.

The director of Nasser Hospital in Khan Younis, Atef Al-Hout, described 24 dead and 37 wounded arriving with gunshot injuries on Tuesday morning after Israeli forces opened fire on “crowds of civilians waiting for aid in western Rafah.”

A foreign medic working in the area told the BBC it has been “total carnage” since 03:48 local time (01:48 BST) and that they have been overwhelmed with casualties.

In a statement, the IDF said its troops were “not preventing the arrival of Gazan civilians to the humanitarian aid distribution sites.”

“The warning shots were fired approximately half a kilometer away from the humanitarian aid distribution site toward several suspects who advanced toward the troops in such a way that posed a threat to them,” it added.

Israel does not allow international news organisations, including the BBC, into Gaza, making verifying what is happening in the territory difficult.

Aid distribution in Gaza has recently been taken over by the Gaza Humanitarian Foundation (GHF), an Israel- and US-backed group which aims to replace UN agencies and other organisations in delivering aid.

The GHF system requires civilians to go to distribution centres situated in areas of Israeli military control, and staffed by armed American contractors. The previous system delivered aid directly to communities.

The GHF has been heavily criticised by UN bodies and the wider international community for “weaponising” aid and going against humanitarian principles.

Responding to Tuesday’s incident, the group said: “While the aid distribution was conducted safely and without incident at our site today, we understand that IDF is investigating whether a number of civilians were injured after moving beyond the designated safe corridor and into a closed military zone. This was an area well beyond our secure distribution site and operations area.”

During Sunday’s incident, the International Committee of the Red Cross (ICRC) said its hospital in Rafah received “a mass casualty influx” with 21 “declared dead upon arrival”.

The IDF said its findings from an initial inquiry showed its forces had not fired at people while they were near or within the aid centre.

The GHF also denied the claims of injuries and casualties at its site and said they had been spread by Hamas.

These denials were in direct contradiction to what dozens of civilian witnesses, NGO’s, and health officials said.

Responding to Sunday’s incident, UN Secretary General António Guterres said in a statement: “I am appalled by the reports of Palestinians killed and injured while seeking aid in Gaza yesterday

“I call for an immediate and independent investigation into these events and for perpetrators to be held accountable.”

Later on Monday, UN human rights chief Volker Türk told the BBC the way humanitarian aid is now being delivered is “unacceptable” and “dehumanising”.

“I think what it shows is utter disregard for civilians. Can you imagine people that have been absolutely desperate for food, for medicine, for almost three months and then they have to run for it or try to get it in the most desperate circumstances?” he told the BBC World Service’s Newshour programme.

“It does show a huge dehumanisation of the people who are desperately in need.”

Israel launched a military campaign in Gaza in response to Hamas’ cross-border attack on 7 October 2023, in which about 1,200 people were killed and 251 others were taken hostage.

At least 54,470 people have been killed in Gaza since then, including 4,201 since Israel resumed its offensive, according to the territory’s health ministry.