At least 20 Palestinians die in stampede at food distribution centre
Israeli strikes across Gaza killed at least 54 others, including 14 children, according to hospital officials.
The Gaza Humanitarian Fund (GHF) accused the Hamas militant group of fomenting unrest at the food distribution centre, leading to a 'dangerous surge', but it provided no evidence to support the claim.
Witnesses said GHF guards threw stun grenades and used pepper spray on people pressing to get into the site before it opened, causing a panic in the narrow, fenced-in entrance.
Since the group's operations began in late May, hundreds of Palestinians have been killed in shootings by Israeli soldiers while on roads heading to the sites.
GHF's four sites are all in military-controlled zones, and the Israeli military has said its troops have only fired warning shots to control crowds.
Gaza's more than two million Palestinians are living through a catastrophic humanitarian crisis, and the territory is teetering on the edge of famine, according to food security experts.
GHF said it believed that 19 of the dead died from trampling at its food distribution centre between the southern cities of Khan Younis and Rafah and one was killed by a stabbing in the crowd.
The Gaza Health Ministry said 17 people suffocated at the site and three others were shot.
It was not clear if the shootings took place during the crush or earlier on the road to the centre. The witnesses did not report shots fired at the centre but said Israeli troops fired toward the crowds as they headed to it.
Witnesses said that thousands of Palestinians arrived at the site early in the morning, and the American contractors guarding it did not open the gates. It was not clear if it was before the site's opening time or if it was not operating at all, since schedules often change.
The crowd surged forward at the turnstiles in the fenced-in entranceway, said one survivor, Ahmed Abu Amra.
'The Americans were calling out on the loudspeakers, 'go back, go back.' But no one could turn around because it was so crowded,' he said. 'Everyone was on top of each other. We tried to pull out the people who were underneath, but we couldn't. The Americans were throwing stun grenades at us.'
Other witnesses said the contractors used pepper spray as well. The Health Ministry said tear gas was used, but GHF denied that and said its contractors deployed 'limited use of pepper spray'.
'Everyone suffocated from people crushing on top of each other,' said Omar al-Najjar, a Rafah resident, as he and other men carried a wounded man on a stretcher. He said the chaos at the sites is forcing Palestinians to 'march towards death'.
GHF said it believed elements in the crowd 'armed and affiliated with Hamas' fomented the unrest. It said that its contractors identified men with firearms in the crowd and confiscated one.
Distribution at the GHF sites has often been chaotic. Boxes of food are left stacked on the ground inside the centre and, once opened, crowds charge in to grab whatever they can, according to witnesses and videos released by GHF itself.
In videos obtained recently by The Associated Press from an American contractor working with GHF, contractors are seen using tear gas and stun grenades to keep crowds back behind metal fences or to force them to disperse. Gunshots can also be heard.
The United Nations human rights office said on Tuesday that 875 Palestinians have been killed while seeking food since May. Of those, 674 were killed while en route to GHF food sites. The rest were reportedly killed while waiting for aid trucks entering Gaza.
Meanwhile, Israeli strikes killed 22 people in Gaza City, including 11 children and three women, and 19 others in Khan Younis. The Israeli military said it has struck more than 120 targets in the past 24 hours across the Gaza Strip, including Hamas military infrastructure of tunnels and weapons storage facilities.
Gaza's Health Ministry said on Wednesday that hospitals have received a total of 94 bodies over the past 24 hours, with another 252 wounded.
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But the company's product became nearly synonymous with youth vaping at a time when almost 30% of high school students used e-cigarettes. '[Mumby] is doing the same kind of viral, organic social-media marketing that he did with Juul,' Jackler said. 'We take responsible caffeine consumption and responsible marketing of our product seriously,' a Wip spokesperson said in a statement provided to NBC News. 'While there are no legal age restrictions on caffeine products, we have adopted marketing guidelines that exceed the age-related standards set by the American Beverage Association for most common energy drinks. Wip is not intended for use by anyone under the age of 18, and our guidelines ensure the product is marketed responsibly. We proactively train all external partners on our marketing guidelines so there is education and alignment at every layer of our business.' Despite their spread online, caffeine pouches do not seem to be nearly as ubiquitous in schools as Juul was at its prime, nor as either energy drinks or nicotine pouches are today. An estimated 64% and 5% of teenagers have tried energy drinks and nicotine pouches, respectively, while there is little data on youth caffeine pouch usage. Dylan Lippold, a middle school teacher in Wisconsin, said he remains more concerned about energy drink consumption among his students. 'I would walk into a class and see five or so kids drinking [an energy drink] in the morning,' he said. 'That's a little concerning that a middle schooler needs that much caffeine to get going for the day.' Health concerns Caffeine is often seen as a harmless, or even beneficial, stimulant — and within reason, it can be. Although most experts agree it's possible to become dependent on caffeine, it's not considered as addictive as nicotine. And in addition to providing energy and mental clarity, caffeine consumption can come with significant health benefits, studies conducted among adults have shown. 'In population studies, people drinking three or four cups of coffee per day have a lower risk of cardiovascular diseases, like coronary heart disease and stroke,' van Dam said. 'But going beyond that, like more than five cups of coffee per day, we do not see the same benefits.' And, he noted, it's not clear whether the caffeine in energy drinks or pouches carries the same benefits as classic coffee. At high levels of consumption, caffeine can cause side effects that range from relatively benign (anxiety, jitters, GI distress, difficulty sleeping) to more worrisome (heart palpitations, high blood pressure, increased heart rate). In rare cases, heavy caffeine consumption can cause fatal complications, including cardiac arrest, studies show. For children and teenagers, who are typically smaller and weigh less than adults, the thresholds of safe caffeine consumption are lower. The AAP recommends against pediatric caffeine usage not only because of the potential for toxicity, but also because kids who need to use a lot of caffeine probably aren't getting enough sleep, Corkins said. 'Even if you get a stimulant, it's not a substitute for sleep,' he said. Research also suggests that children who consume more than 100 mg of caffeine during a school day are more likely than those who don't to struggle with self-control and behavioral issues. For users of all ages, caffeine pouches, like nicotine pouches, may pose a threat to oral health, added Jackler, who in addition to studying tobacco marketing is an ear, nose and throat doctor. Routinely placing a foreign substance between the lips and gums may lead to gum recession and dental problems, so 'it's not necessarily an optimal way of taking in your caffeine, especially if it's something you're doing all day,' Jackler said. Consumers should also be aware that caffeine pouches may not be tightly regulated, van Dam said. While the FDA has cracked down on the sale of 'pure and highly concentrated' caffeine products — like tubs of caffeine powder that contain thousands of servings that users must measure out themselves — caffeine pouches are regulated 'as either dietary supplements or conventional foods, depending on their composition and marketing,' an FDA spokesperson said. Supplements typically do not go through FDA review and approval before being sold to consumers. Labeling is another concern, Jackler said: Some energy pouches on the market do not clearly state how much caffeine they contain. Even with accurate labels, the potency of some caffeine pouches raises eyebrows. Two-hundred milligrams of caffeine is 'really the maximum amount that's being recommended in one sitting,' van Dam said, and some brands meet or exceed that amount in a single pouch. The pouch industry isn't alone in that; energy drinks and coffee drinks can also pack in huge amounts of caffeine per serving, often also without clear labeling. But these products are both more familiar to consumers and easier to pace, in that people can stop sipping if they start to notice side effects, van Dam said. A caffeine pouch, by contrast, delivers a concentrated dose of caffeine fairly quickly, and 'once it's absorbed, it's absorbed,' he said. Research also suggests that consuming nicotine and caffeine at the same time can compound their negative effects on the heart — a concern, given that some users alternate between nicotine and caffeine pouches. Given these dangers, Jackler fears what could happen if caffeine pouches go the way of nicotine pouches, 'where kids put in four pouches in the upper lip and three pouches in the bottom lip,' he said. 'Young people, particularly, think that if a little bit helps, they're going to take even more.
