Dozens more people have been killed as Israeli soldiers yet again opened fire on crowds trying to reach Gaza’s Israeli and United States-backed food distribution centres.

The Israeli military did not immediately comment on Monday’s shootings, reported to Al Jazeera by medical sources. The 38 people killed, mostly in the Rafah area in the south, made it the deadliest day since the new aid system was launched last month.

After previous shootings, which have been a near-daily occurrence since the aid centres opened three weeks ago, the military has said its soldiers had fired warning shots at what it called suspects approaching their positions, although it did not say whether those shots struck anyone.

Palestinians say they face the choice of starving or risking death as they make their way past Israeli forces to reach the distribution points, which are run by a private contractor, the Gaza Humanitarian Foundation (GHF).

More than 300 people have been killed and more than 2,000 wounded so far while trying to collect aid from GHF sites, which began operating in late May.

Palestinians are desperate to feed families suffering from hunger amid food shortages created by Israel’s blockade of the enclave. A trickle of aid has been allowed through since last month.

Israel and the US say the GHF system is intended to replace the United Nations-led humanitarian operation that had delivered aid across Gaza since the start of the war 20 months ago.

Israel contends that the new mechanism is needed to prevent Hamas from siphoning off aid.

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However, UN agencies and major aid groups deny that there is widespread theft of aid by Hamas and have rejected the new system.

They say it cannot meet the population’s needs and turns food into a weapon for Israel to carry out its military goals, including moving the more than two million Palestinians into a “sterile” enclave in southern Gaza.

Speaking at Britain’s House of Commons Foreign Affairs Committee on Monday, an official with Doctors Without Borders (or Medecins Sans Frontieres, known by its French acronym MSF) said Israel’s claims of extensive diversion by Hamas were “specious and cynical”, and were intended “to undermine a humanitarian system which was actually functioning”.

“This is neither a humanitarian enterprise nor a system. This is basically lethal chaos,” said Anna Halford, a field coordinator for the group.

Experts warn that Israel’s continuing military campaign and restrictions on aid entry put Gaza at risk of famine.

Israel’s war on Gaza has killed at least 55,432 people and wounded 128,923, according to Gaza’s Health Ministry.

An estimated 1,139 people were killed in Israel during the October 7 attacks, and more than 200 were taken captive.