The Israeli military has killed at least 67 people waiting for UN aid lorries in northern Gaza, the territory’s Hamas-run health ministry says.

The UN World Food Programme said its 25-truck convoy “encountered massive crowds of hungry civilians which came under gunfire”, soon after it crossed from Israel and cleared checkpoints.

The Israel Defense Forces (IDF) said that it had “fired warning shots” to remove “an immediate threat”. It disputed the number of reported deaths.

On Saturday the ministry warned that extreme hunger was increasing in Gaza and growing numbers of people were arriving at its facilities “in a state of extreme exhaustion and fatigue”.

“We warn that hundreds of people whose bodies have wasted away are at risk of imminent death due to hunger,” it said. The UN has also said civilians in Gaza are starving and called for an urgent influx of essential goods.

On Sunday the ministry said it had recorded 18 deaths “due to famine” over the past 24 hours.

Many of the casualties from northern Gaza were taken to Shifa hospital in Gaza City. The medical director there, Dr Hassan al-Shaer, told BBC Arabic on Sunday the facility had been “overwhelmed”.

Outside the hospital one woman told BBC Arabic that “the whole population is dying”.

“Children are dying of hunger because they have nothing to eat. People are surviving on water and salt… just water and salt,” she said.

In an updated death toll, Gaza’s civil defence agency said Israeli fire had killed a total of 93 people and wounded dozens more across Gaza on Sunday. Eighty people were killed in northern Gaza, it said, while nine people were shot dead near an aid point in Rafah and four more near an aid point in Khan Younis, both in southern Gaza.

In Gaza City, Qasem Abu Khater told AFP he had attempted to get a bag of flour but instead found a desperate crowd and “deadly overcrowding and pushing”.

“The tanks were firing shells randomly at us and Israeli sniper soldiers were shooting as if they were hunting animals in a forest,” he said.

“Dozens of people were martyred right before my eyes and no one could save anyone.”

The UN’s World Food Programme (WFP) condemned violence against civilians seeking aid as “completely unacceptable”.

In a statement posted on X, the WFP said “malnutrition is surging with 90,000 women and children in urgent need of treatment”. “Nearly one person in three is not eating for days,” it said.

There have been almost daily reports of Palestinians being killed while seeking food since late May. On Saturday at least 32 people were killed by Israeli gunfire near two aid distribution points in southern Gaza, according to the ministry.

Many of the incidents have taken place near sites run by the controversial US and Israel-backed Gaza Humanitarian Foundation (GHF), which uses private security contractors to distribute aid from sites in Israeli military zones, but some have taken place near aid brought in by the UN.

Meanwhile the Israeli military has issued evacuation orders for a crowded part of central Gaza where it has not launched a ground offensive during its 21 months of war against Hamas.

The IDF said on Sunday that residents and displaced Palestinians sheltering in the city of Deir al-Balah should evacuate immediately and move towards al-Mawasi on the Mediterranean coast.

The evacuation demand, which could signal an imminent attack, has caused widespread panic among tens of thousands of Palestinians, as well as the families of Israeli hostages who fear their relatives are being held in the city.

The IDF has conducted air strikes in the area, but it has not yet deployed ground troops.

On Sunday, the Israeli military dropped leaflets from the sky ordering people in several districts in southwest Deir al-Balah to leave their homes and head further south.

“The (Israeli) Defense Forces continues to operate with great force to destroy the enemy’s capabilities and terrorist infrastructure in the area,” the military said, adding that it had not yet entered these districts during the war.

The affected neighbourhoods of Deir al-Balah are crowded with displaced people living in tents.

Israeli sources told Reuters news agency that the reason the army has stayed out of these districts so far is because they suspect Hamas might be holding hostages there.

At least 20 of the remaining 50 hostages in captivity in Gaza are believed to still be alive.

Most of the Strip’s population of more than two million people have been displaced at least once during Israel’s war with Hamas, with repeated Israeli evacuation calls covering large parts of the territory.

On Sunday, Pope Leo XIV called for an “immediate end to the barbarity of the war” and urged against “indiscriminate use of force”.

His comments came days after a deadly Israeli strike hit Gaza’s only Catholic Church, which Israeli Prime Minister Benjamin Netanyahu said his country deeply regretted.

Israel launched its war in Gaza in retaliation for the Hamas-led attacks on 7 October 2023, which killed about 1,200 people and led to 251 others being taken hostage.

Israeli attacks have since killed more than 58,895 people in Gaza, according to the Hamas-run health ministry. The ministry’s figures are quoted by the UN and others as the most reliable source of statistics available on casualties.