At least three Palestinians were killed and dozens wounded on Tuesday as chaos unfolded during the first day of a controversial US- and Israeli-backed aid distribution initiative in Gaza.

The deadly incident occurred at a distribution point operated by the Gaza Humanitarian Foundation (GHF) in the southern city of Rafah, according to local authorities.

The Gaza Ministry of Health reported that 46 people were injured and seven remain missing after the Israeli military opened fire on crowds rushing to receive humanitarian aid amid weeks of severe hunger caused by an ongoing blockade.

The Israeli military, however, denied responsibility for the deaths, stating its forces fired warning shots outside the aid site to regain control after a momentary loss of order. Meanwhile, the GHF denied reports of fatalities linked to the aid distribution.

The incident sparked widespread condemnation from the United Nations and Palestinian officials, who accused Israel of using excessive force against starving civilians.

A spokesperson for UN Secretary-General António Guterres described the scenes at the aid distribution points as "heartbreaking, to say the least," urging for more principled and operationally sound humanitarian efforts. Stephane Dujarric, the UN spokesperson, reaffirmed the UN’s commitment to delivering aid despite the challenges.

The US State Department defended the initiative, downplaying the violence as isolated and dismissing criticisms as mere "complaints about style."

Tammy Bruce, spokesperson for the department, pointed to Hamas’ opposition to the aid programme, stating that militant efforts to obstruct aid had failed and that aid was reaching those in need.

In contrast, the Government Media Office in Gaza condemned the Israeli military’s actions as a "deliberate massacre" and a "full-fledged war crime" committed against civilians weakened by more than 90 days of siege-induced starvation. The statement accused Israel of total failure in managing the humanitarian crisis it has helped create.

Israeli Prime Minister Benjamin Netanyahu acknowledged the disruption at the distribution site but insisted the situation was quickly brought under control. He defended the initiative as a controlled and coordinated effort with American partners and controversially denied signs of malnutrition among Gaza’s population since the conflict began.

The aid distribution initiative by the Gaza Humanitarian Foundation has drawn scrutiny for its ties to the US and Israel, raising concerns about impartiality and effectiveness in delivering critical assistance to Gaza’s vulnerable population.