At least 51 people were killed and more than 200 others injured by Israeli fire as they waited for aid trucks to arrive in Khan Younis in southern Gaza early Tuesday morning, the Palestinian Ministry of Health said.

At least 45 Palestinians were killed in the Gaza Strip while waiting for U.N. and commercial trucks to enter the territory with desperately needed food, according to Gaza’s Health Ministry and a local hospital.

It is potentially the deadliest of the almost daily shootings that have been taking place recently near aid distribution sites.