A stampede at a food distribution site run by an Israeli-backed American organization in the Gaza Strip killed 20 Palestinians on Wednesday, the group said, in the first acknowledgment of deadly violence at its operations.

DEIR AL-BALAH, Gaza Strip (AP) — Malnutrition rates among children in the Gaza Strip have doubled since Israel imposed sharp restrictions on the entry of food in March, the U.N. said Tuesday. New Israeli strikes killed more than 90 Palestinians, including dozens of women and children, according to health officials.

The Israeli military says it targets only militants and tries to avoid harming civilians and blames civilian deaths on Hamas because the militants operate in densely populated areas.