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Gaza’s civil defence agency said 16 people were killed by Israeli fire Monday in the Palestinian territory devastated by more than 21 months of war.

Agency spokesman Mahmud Bassal said the dead included five people killed in an overnight strike on a residential building in the southern Gaza district of Al-Mawasi.

A pregnant woman was among those killed, the Palestinian Red Crescent said, adding its teams saved the woman’s foetus by performing a Caesarean section in a field hospital.

Israel designated Al-Mawasi, a coastal area west of the southern city of Khan Yunis, as a humanitarian zone in the early months of the war.

Despite that designation, it has continued to be hit by air strikes and now shelters a large share of Gaza’s displaced people.

All of Gaza’s 2.4 million residents have been displaced at least once since the start of the war, and the United Nations says 88 per cent of the territory is now either under evacuation orders or within Israeli military zones.

The civil defence spokesman said five people were killed in another air strike in Khan Yunis’ Japanese neighbourhood.

The Israeli military said it was looking into the Al-Mawasi and Khan Yunis strikes.

Bassal said six more people were killed in two separate strikes in Gaza City and central Gaza.

Central Gaza’s Al-Awda hospital in Nuseirat camp said in a statement that one person was killed and nine wounded when Israeli forces opened fire on Palestinians waiting for aid in central Gaza.

The health ministry of Gaza’s Hamas-run government said Monday five people had died of malnutrition in Gaza in the previous 24 hours, bringing the total death toll from malnutrition to 147 since the start of the war.

Meanwhile, truckloads of food reached hungry Gazans on Monday after Israel promised to open secure aid routes, but humanitarian agencies warned vast amounts more were needed to stave off starvation.

With Gaza’s population of more than two million facing famine and malnutrition, Israel bowed to international pressure at the weekend and announced a daily ‘tactical pause’ in fighting in some areas.

‘For the first time, I received about five kilos of flour, which I shared with my neighbour,’ said 37-year-old Jamil Safadi, who shelters with his wife, six children and a sick father in a tent near the Al-Quds hospital in Tel al-Hawa.

Safadi, who has been up before dawn for two weeks searching for food, said Monday was his first success. Other Gazans were less fortunate; some complained aid trucks had been stolen or that guards had fired at them near US-backed aid centres.

‘I saw injured and dead people. People have no choice but to try daily to get flour. What entered from Egypt was very limited,’ said 33-year-old Amir al-Rash, still without food and living in a tent.

Israel imposed a blockade on Gaza on March 2 after talks to extend a six-week ceasefire broke down. Nothing was allowed into the territory until late May, when a trickle of aid resumed.

Now, the Israeli defence ministry’s civil affairs agency says the UN and aid agencies had been able to pick up 120 truckloads of aid on Sunday and distribute it inside Gaza, with more on the way Monday.

Jordan and the United Arab Emirates have begun air-dropping aid packages by parachute over Gaza, while Egypt has sent trucks through its Rafah border crossing to an Israeli post just inside Gaza.

The UN agency for Palestinian refugees, UNRWA, cautiously welcomed Israel’s ‘humanitarian pauses’ but warned Gaza needed at least 500 to 600 trucks of basic food, medicine and hygiene supplies daily.

‘We hope that UNRWA will finally be allowed to bring in thousands of trucks loaded with food, medicine and hygiene supplies. They are currently in Jordan and Egypt waiting for the green light,’ the agency said.

‘Opening all the crossings and flooding Gaza with assistance is the only way to avert further deepening of starvation among the people of Gaza.’

Over the weekend aid trucks began arriving from Egypt and Jordan and dropping their loads at distribution platforms just inside Gaza, ready to be picked up by agencies working inside the war-shattered territory.

But their number still falls far short of what is needed, aid agencies warn, calling for a permanent ceasefire, the reopening of more border crossings and a long-term large-scale humanitarian operation.

Truce talks between Israel and Hamas — mediated by Egypt, Qatar and the United States — have stumbled, and Netanyahu remains determined to push on with the campaign to destroy Hamas and recover Israeli hostages held in Gaza.