GAZA, Occupied East Jerusalem/TUNIS, Tunisia - It has been six days since the Israeli army fired into a crowd of the hungry and the starving at al-Rashid Street in Gaza City, an incident that has been dubbed the Flour Massacre.

However, for the families of the 118 civilians killed by Israel during the early hours of Thursday morning, it is the moment their lives would forever be divided into before and after.

Thursday's massacre has been followed by two subsequent killings by Israeli forces of hungry Palestinians scrambling for aid, on Saturday and Monday night, adding to the mounting death toll among the uncounted and malnourished thousands battling the first signs of starvation.

When word went around that a convoy would be coming to Gaza City, thousands headed out to camp on the street and wait for it along its expected route.

After weeks of blockade, Gaza’s hunger was - and remains - so extreme that the convoy had to stop as thousands of people gathered, clambering up the sides of the truck to try to grab any amount of flour to take home to their starving families.

According to the Israeli army, the convoy contained 30 trucks - witnesses put the number at about 18 - overlooked by several Israeli military vehicles, including tanks.

In the early hours of Thursday morning, as thousands of malnourished Palestinians tried to claw their way to some food, the soldiers opened fire.

According to Al Jazeera’s Ismail al-Ghoul, who was at the scene, the firing took place in two bursts, the first as people seized the goods and the second when the crowd returned to the trucks.

“After opening fire, Israeli tanks advanced and ran over many of the dead and injured bodies,” he said.

By the time the shooting died down, dozens of people had been killed and hundreds injured.

Accounts of what led the Israeli forces to fire vary and Israel claims that many Palestinians died in the stampede for food, not because they were shot.

Accounts from the thousands of Palestinians who were there are clearer: Israeli forces fired indiscriminately into the crowd which killed dozens of people and led to a stampede in which more people died.

“The blood was everywhere”

Thirty-four-year-old Mohammed al-Simry, a father of four, had been undecided whether to go and wait for the aid convoy.

On the one hand, he felt the large crowd offered too tempting a target to Israeli snipers, on the other, he and his family were dying anyway.

He had nothing to lose, he felt, so along with his cousin, Amer, he left to sleep at the Nabulsi Roundabout in advance of the convoy's arrival.

Nothing prepared him for the carnage that followed. According to witnesses, the Israeli forces fired into the crowd of hungry civilians clamoring for food for one and a half hours.

"The blood was everywhere," he recalled.

Mohammed continued, describing how thousands tried to flee the scene, their faces and clothing covered in blood, many carrying the dead bodies of their friends. In the confusion, Mohammed stumbled across Amer’s body - they had gotten separated in the tumult.

"We’d talked about what we needed, how we would bring it to our starving children and eat until we finally beat the hunger," he said. "Sadly, that never happened. Not only did I leave the convoy hungry, I left without a loved family member who had only wanted a bite of bread," he said.

He paused, unable to understand why Israel would delay aid shipments to the point where people were so hungry that it "tears their bodies apart”.

Hossam Abu Shaar, a 29-year-old resident of Gaza City, was injured in the attack.

“I’m never returning to wait for aid again there," Abu Shaar said, recalling the live fire from the Israeli forces that the crowd endured.

Like Mohammed, he was aware of the risks of gathering in such large numbers. Like Mohammed, his hunger and that of his family left him with no choice.

Like Mohammed, nothing could ever have prepared him for the ferocity and scale of the massacre.

"It was so huge that nearly everyone was either killed, shot, injured," he said. "I was among the very few lucky ones, he said, recalling how he had felt the wind of the bullets pass him by.

"I was hit in the leg by shrapnel from an artillery shell that landed nearby."

"I saw bodies being scattered all across the road. It was horrific," he recalled. "We’ve faced similar situations before, when Israeli tanks fired at us, killing and injuring many. But this time the world paid attention, maybe because we were killed on camera," he said.

"I don’t know if we are lucky or damned," he said. "This bag of flour turned out to cost the life of its bearer, it's the most expensive food ever made.

“This is happening right now. Right here. In Gaza.”

On Friday, the United Nations described the likelihood of famine within the Gaza Strip as “almost inevitable” as aid into the small strip of land is choked off under Israel's siege.

Israel is ranked by the IMF as having the 13th-highest per capita income in the world and is a significant recipient of military and economic aid from the United States and Europe.

Aid into Gaza, an area reliant upon external relief, dropped from 500 to 600 trucks a day to just 98 daily in February. Malnutrition, particularly among children, pregnant women and the elderly has become the norm, a UN report warned in January, and conditions have deteriorated since then.

Last week, Al Jazeera’s Mohammed Mhawish, who contributed to this report, was told that he and his family, including his two-year-old son, had been diagnosed with malnutrition, the condition that precedes starvation.

On October 9, Israeli Defence Minister Yoav Gallant labelled Palestinians in Gaza “human animals” and declared a complete siege of the enclave. Since then, aid into the south has been extremely limited, with the bulk of deliveries to the north blocked since December, the UN said.

Coordinating aid and services for Palestinian refugees for 75 years, the UN agency for Palestinian refugees (UNRWA) is barely able to function in Gaza given the danger its staff faces from Israeli attacks, restrictions on movement within Gaza, and a catastrophic funding shortfall.

UNRWA is missing more than $450m in funding stopped by major donors, including the US, after Israel accused some agency staff of taking part in an attack on Israel, resulting in the summary dismissal of nine, by Hamas’s Qassam Brigades and other Palestinian fighting groups on October 7, in which 1,139 people were killed and about 250 taken captives.

However, diplomats who saw last week’s preliminary report from the UN Office of Internal Oversight Services, which had been tasked with investigating the allegations, said Israel had produced no evidence to support its initial allegations.

With UNRWA at “breaking point”, the effects are being felt throughout Gaza.

However, "once a famine is declared, it is too late for too many people", Jens Laerke, a spokesperson for the UN humanitarian agency OCHA, warned.

According to Israeli media, and many Israelis, most Palestinians died after trampling one another in a stampede.

A visit by UN observers to Gaza City’s al-Shifa Hospital, where many of the wounded were treated, confirmed that many of the injured still there were being treated for bullet wounds.

The Times of Israel reported that Israeli soldiers did “not fire on the crowd” trying to reach the aid convoy, but shot at “several Gazans who endangered” them.

The Israeli army has not provided evidence for its claim nor did it claim that any of the Palestinians the Israeli soldiers shot at were armed, saying instead that some Palestinians had “moved towards them”.

For Palestinians in occupied East Jerusalem, the implications of the massacre were more immediate.

"The Israelis are fully responsible [regardless of what happened]," said Mohamad*, who watched news of the incident on television.

"They keep all food and aid out of Gaza. It's intentional ... they have committed so many massacres in Gaza,” Mohamad added.

"All the talk of there ‘red lines’ in this war [from the global community] is nonsense. Did you see the children running into the water to get food?" he said, referring to airdrops of aid that starving Palestinians run into the sea to retrieve.

Ahmad*, for his part, does not believe reports that most of the victims died any other way: "They died from Israeli shelling or gunfire. How else could they have died? There are more than 100 people dead."

The Palestinians in Israel who spoke to Al Jazeera asked that their names be withheld, out of fear.

"All Palestinians are silent here. Nobody talks about Gaza for fear of being accused of supporting Hamas and going to prison," said Moussa*.

"We’re not ‘citizens of Israel’. We just have residence permits. We can be punished by Israel, any time," he added, referring to Israel's crackdown on Palestinian citizens of Israel for expressing sympathy or support for civilians in Gaza after October 7.

International indignation, much of it from countries that have supported and armed Israel throughout the war, was quick.

The US, Israel's principal international ally, said it was urgently seeking further information on the incident, while simultaneously being the only UN Security Council member to block Algeria's call to condemn the Israeli action.

The United Kingdom, another steadfast ally of Israel, was also unsparing in its characterisation of the incident, with Foreign Secretary David Cameron calling for an urgent investigation while linking the incident directly to inadequate aid provision.

Within the European Union, France and firm Israel supporter Germany have also called for urgent investigation into the massacre, with German Foreign Minister Annalena Baerbock expressing her shock.

“People wanted relief supplies for themselves and their families and ended up dead. The reports from Gaza shock me. The Israeli army must fully explain how the mass panic and shooting could have happened,” she wrote on social media.

The UN Secretary-General Antonio Guterres was at pains to condemn the attack without naming the perpetrator, writing on X, formerly Twitter, “I condemn Thursday’s incident in Gaza in which more than 100 people were reportedly killed or injured while seeking life-saving aid.

The desperate civilians in Gaza need urgent help, including those in the north where the UN has not been able to deliver aid in more than a week.”

At the time of writing, Israel maintained that “tens” of Palestinians died in the incident, a small number to Israeli fire, while the bulk of deaths took place in the stampede resulting from crowding around for food.

Commenting shortly after the killings, Israel’s characteristically bellicose national security minister, Itamar Ben-Gvir, praised the soldiers who had fired into the “mob” and claimed that the massacre justified his calls for halting all aid into the strip.