Israeli forces shot and killed at least 31 Palestinians as they headed to an aid distribution site near Rafah on Saturday, while separate Israeli airstrikes killed at least 28 others, including four children, according to Palestinian officials and eyewitnesses.

Hospital officials and witnesses said the 31 Palestinians were shot on their way to a distribution site operated by the US-backed Gaza Humanitarian Foundation near Rafah in the southern Gaza Strip.

The International Committee of the Red Cross (ICRC) said its field hospital received the largest number of casualties since it began operations over a year ago, with the vast majority of the more than 100 wounded having suffered gunshot wounds.

All of those reported were trying to reach food distribution sites, the ICRC said, noting the increasing frequency and scale of these alarming mass casualty incidents.

The Israeli military said it fired warning shots at people it deemed to be acting suspiciously to prevent them from approaching, adding that it was not aware of any casualties. The Gaza Humanitarian Foundation said no incident occurred near its sites, the Associated Press reported.

From inside Nasser Hospital, Abdullah �l-Haddad, who suffered a leg injury, said he was 200 metres from the distribution point when an Israeli tank began firing on crowds of Palestinians.

We were together, and they fired on us all at once, Al-Haddad said. Another witness, Mohammed Jamal al-Sahloul, said the Israeli army had ordered them to go to the distribution site, then began shooting at them.

Eyewitnesses, health officials, and UN personnel have said hundreds have been killed by Israeli fire while trying to access aid distribution points, which are located in closed military zones. The Gaza Humanitarian Foundation has denied any violence has occurred at or near its locations.

Separately, Israeli airstrikes in Deir al-Balah in the central Gaza Strip killed 13 people, including four children, officials at Al-Aqsa Martyrs Hospital said. Another 15 people were killed in Khan Younis in the south of the strip, the Associated Press reported from Nasser Hospital.

The violence comes as there appeared to be no breakthrough in ceasefire talks after two days of meetings between US President Donald Trump and Israeli Prime Minister Benjamin Netanyahu.

The war has left most of Gazas more than two million residents entirely dependent on foreign aid, with food security experts warning of an imminent famine. Israel blocked and then restricted the entry of aid after ending a ceasefire with Hamas in March.

Aid agencies have said they face difficulties distributing humanitarian assistance due to restrictions imposed by Israeli forces and a breakdown in security that has led to widespread looting.

According to a joint statement by UN aid agencies, the first fuel shipment entered Gaza this week after a 130-day interruption, amounting to 150,000 litres. The statement described the amount as minuscule compared to what it called the fundamental pillar of survival in Gaza.