At least 21 Palestinians were killed Wednesday near an aid distribution site in Khan Younis, the Gaza Health Ministry said, blaming tear gas fired by security forces at a crowd gathered for food.

The incident occurred at a facility run by the Gaza Humanitarian Foundation (GHF), a private organization backed by the United States and Israel but condemned by the United Nations and several human rights groups.

Amnesty International has accused the foundation of using “starvation of civilians as a weapon of war” in Gaza.

Fifteen people died in a stampede after tear gas was deployed to disperse the crowd, the ministry said in a statement. Others died from suffocation. The ministry called it the first such deadly incident at an aid center in Gaza.

“The Americans fired tear gas into the crowd to disperse them, which caused a stampede, and many people died while being crushed by the crowd,” one survivor told Al Jazeera.

The foundation denied responsibility, saying Hamas militants stoked fear in the crowd, sparking the panic. The Health Ministry rejected the claim.

The GHF has operated several aid distribution sites across Gaza during the ongoing conflict.

Close to 900 Palestinians have been killed around Gaza aid centers

Since late May, at least 875 Palestinians have been killed near aid distribution centers across the Gaza Strip, most of them near sites operated by the Gaza Humanitarian Foundation, according to the U.N. human rights office (OHCHR).

The U.N. office has accused the foundation of engaging in the “weaponization of food” as malnutrition rates continue to rise in the enclave.

In June, the U.N. agency for Palestinian refugees, UNRWA, reported that more than 10% of children under age 5 in Gaza suffer from acute malnutrition. The agency also found that one in 10 children face general malnourishment.

UNRWA Commissioner-General Philippe Lazzarini has repeatedly called for the Gaza Humanitarian Foundation to be shut down.

“The humanitarian community calls for an end to the so-called ‘Gaza Humanitarian Foundation’ (GHF), since it provides nothing but starvation and gunfire to the people of Gaza,” Lazzarini wrote in a post on X, formerly Twitter, on July 1. “Under this new abomination, Gaza has gone from 400 aid distribution points to only four militarized distribution sites.”

UNRWA, which previously facilitated aid distribution across Gaza, had its operations banned by Israel in January after allegations that several of its staff were involved in the Oct. 7, 2023 Hamas attack on Israel.

Earlier this month, the Associated Press published an investigation that included testimony from GHF workers accusing their colleagues of deliberately firing on Palestinians near aid sites. 

A separate report by Israeli newspaper Haaretz, published a week earlier, cited Israeli soldiers who said they were ordered by commanders to shoot at Palestinians approaching the aid centers.