The Hamas-run government in Gaza said Israeli fire killed 19 people as they were waiting at an aid distribution point on Saturday, a charge Israel denied.
The deaths if confirmed would be the latest in a series of cases of Gazan civilians being killed while seeking desperately needed relief supplies.
The Hamas government media office said 19 people were killed and 23 wounded. The health ministry said "they were waiting for aid trucks at the Kuwait roundabout" when they were hit by "Israeli occupation army tank fire and shells".
The Israeli army denied it had fired on the crowd.
"The reports claiming that the (Israeli military) attacked dozens of Gazans at an aid convoy are incorrect," an army statement said.
"Preliminary findings have determined that there was no aerial strike against the convoy, nor were there incidents found of (Israeli) forces firing at the people at the aid convoy."
AFPTV footage showed bloodied Gazans arriving at the crowded compound of Al-Ahli hospital, at least one of them transported by donkey cart.
Gaza City resident Wael al-Mamlouk appealed to Arab governments to intervene to prevent what he described as Israeli abuses.
"Where are the Arabs? Where is the Arab nation? Enough with this injustice," he said.
Latest aid distribution tragedy
Mahmud Basal, spokesman for the civil defence department in Gaza, said there had been "heavy shooting at civilians" and victims had been transported to a nearby hospital.
"There were very serious injuries, some of whom were injured by shrapnel. The reality is tragic, difficult and challenging," he said.
Half of Gazans are experiencing "catastrophic" hunger, with famine projected to hit the north of the territory by May unless there is urgent intervention, a United Nations-backed food assessment warned Monday.
With aid agencies reporting huge difficulties gaining access to Gaza, particularly the north, the UN has warned for weeks that a famine is looming.
But aid distribution has become increasingly dangerous and sometimes lethal.
On March 15, Gaza's health ministry said Israeli fire killed 20 people and wounded 155 waiting to receive aid, also at Kuwait roundabout, an account that Israel rejected as "erroneous".
The Israeli military said "armed Palestinians" had opened fire as Gazans awaited the arrival of aid trucks, then "continued to shoot as the crowd of Gazans began looting the trucks".
On February 29, also in north Gaza, the health ministry said more than 100 Gazans were killed when Israeli troops opened fire on people scrambling for food from a convoy.
The Israeli army said its initial investigation found troops "fired precisely" at suspects who approached them and posed a threat.
Just over a month earlier, in late January, the health ministry said Israeli forces killed 20 people waiting for humanitarian aid to be distributed, again at the Kuwait roundabout.
The Israeli military said at the time it was looking into the reported deaths.
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