At least 51 people were killed Tuesday morning and more than 200 injured while waiting for aid in the Khan Younis area, Gaza’s Health Ministry said in a statement. The Israel Defense Forces said that it was aware of reports of “a number of injured individuals from IDF fire following the crowd’s approach” and that the incident was under review.

Twenty of the cases involved serious injuries, and the dead and injured were taken to the Nasser Medical Complex, the Health Ministry said.

The IDF said in a statement that a “gathering was identified” next to an aid distribution truck that got stuck in the Khan Younis area “in proximity to IDF troops.”

“The IDF regrets any harm to uninvolved individuals and operates to minimize harm as much as possible to them while maintaining the safety of our troops,” it said.

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Zaher Al-Wahidi, head of the Health Ministry’s statistics team, described “many cases” requiring amputations. He and Munir al-Bursh, the ministry’s director, both said the injuries at the Al-Tahlia roundabout appeared to be from shelling. The Washington Post could not immediately verify their assessments.

Asked about the “mass casualty event” at a news briefing, World Health Organization officials said the agency received reports of people being killed and injured while waiting for food supplies Tuesday but did not provide further details, citing a “breakdown of communication.”

“This is again the result of another food distribution initiative by a non U.N. actor,” Thanos Gargavanis, WHO trauma surgeon and emergency officer, said in the briefing.

Health authorities inside Gaza say Israeli troops have repeatedly shot and killed civilians approaching recently established aid sites run by the Gaza Humanitarian Foundation, a nonprofit backed by the United States and Israel that uses armed contractors for security at designated distribution hubs. The IDF has said it is investigating some of those shootings. The GHF, which began distributing food aid last month in the southern and central Gaza Strip, said in a statement that there had been no incidents at its four sites Tuesday.