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At least 20 Palestinians were killed at a food distribution centre run by an Israeli-backed American organisation in the Gaza Strip, mostly from being trampled, the group said.

The Gaza Humanitarian Foundation (GHF) accused the Hamas militant group of fomenting unrest at the food distribution centre, causing the stampede on Wednesday, Gaza time.

They were the first deaths reported at one of the group’s sites, though hundreds have been killed by Israeli forces on the roads leading to them, according to witnesses and health officials.

For the first time since its operations began in May, “a large number” of people in the crowd were armed with pistols, GHF spokesperson Chapin Fay told reporters. He said an American medic was stabbed and wounded.

GHF said the Israeli military had warned that Hamas had infiltrated the crowd, but did not provide evidence for any Hamas presence, aside from a photo of a pistol that it said one of its contractors had confiscated.

Witnesses said GHF guards threw stun grenades and used pepper spray on people pressing to get into the site before it opened, causing a panic in the narrow, fenced-in entrance.

AP