Israel pounded the outskirts of Gaza City overnight, as Benjamin Netanyahu's government vowed to press on with a planned offensive on the city.
Families streamed out of the city as explosions hit this weekend.
"I stopped counting the times I had to take my wife and three daughters and leave my home in Gaza City," said Mohammad, 40.
"No place is safe, but I can't take the risk. If they suddenly begin the invasion, they will use heavy fire."
Others said they would prefer to die and not leave.
"We are not leaving, let them bomb us at home," said Aya, 31, who has a family of eight, adding they could not afford to buy a tent or pay for the transportation.
"We are hungry, afraid and don't have money," she said.
Four people killed while seeking aid
Al-Awda Hospital and two witnesses told the Associated Press that the four people were killed when troops opened fire on a crowd heading to a site run by the Israeli-backed American contractor Gaza Humanitarian Foundation, or GHF, in the Netzarim corridor area.
It occurred hundreds of metres away from the site.
"The gunfire was indiscriminate," said Mohamed Abed, a father of two from the Bureij refugee camp.
"This incident didn't occur near our site nor as described," the GHF said in an email.
The Israeli military did not immediately respond to a request for comment.
More than 2,000 Palestinians have been killed and more than 13,500 wounded while seeking aid at distribution points or along convoy routes used by the United Nations and other aid groups, according to Gaza's Hamas-run health ministry.
Parts of city shelled
Witnesses said that overnight, they heard nonstop explosions in Zeitoun and Shejaia.
Tanks shelled houses and roads in Sabra, and buildings were blown up in Jabalia.
On Sunday, the IDF said its forces had returned to combat in Jabalia to strengthen its control of the area and dismantle militant tunnels.
This month, Israel approved a plan to seize control of Gaza City. The offensive isn't expected to start for another few weeks.
In the meantime, mediators in Egypt and Qatar are trying to resume ceasefire talks between the two sides.
On Friday, Israel's defence minister Israel Katz said that Gaza City will be razed unless Hamas releases all its remaining hostages and ends the war on Israel's terms.
Malnutrition deaths rise
Eight more people died of malnutrition and starvation in Gaza, according to the Hamas-run Gaza health ministry on Saturday.
281 people, including 114 children, have now died of malnutrition and starvation since the war started, according to the ministry.
Around half of Gaza's two million residents currently live in the city and on Friday a global hunger monitor said that Gaza City and its surrounding areas are officially suffering from famine that will likely spread.
Israel said the monitor ignores steps Israel has taken since late July to increase aid supplies into and across Gaza.
The war began on 7 October 2023, when Hamas-led gunmen killed around 1,200 people in southern Israel, mainly civilians, and took 251 hostages.
