Israeli soldiers have killed at least four Palestinians, three of them minors, as violence flared along the border between Gaza and Israel during rallies to mark the anniversary of year-long protests against a crippling blockade on the Strip.

Gaza’s health ministry said Mohammed Saad, 20, died from shrapnel wounds after coming under fire from Israeli forces early in the morning. Three 17-year-olds, named locally as Adham Emara, Tamer Abu-Kheir and Bilal Najjar, were later killed by Israeli fire during the rallies.

Save the Children said that the deaths of the three teens raised the total death toll of children to over 50 since the marches erupted in March 2018.

Over 300 people were also injured on Saturday, including 86 children, 29 women and six journalists.

The Israeli army said 40,000 “rioters and demonstrators” had gathered at several locations along the fence on Saturday hurling stones and setting fire to tyres. The army added that some had thrown grenades and explosive devices at the security border.

Gunfire crackled as groups of youth wielding flags dashed towards the heavily fortified fence, while some threw stones with slingshots. Tear gas canisters rained down into the crowds, while some were dropped overhead by drones. Later in the afternoon, small groups set fire to tyres, sending plumes of black smoke into melee.

Paramedics on the front line at Malaka, east Gaza, told The Independent that they had begun receiving several people injured with live bullet wounds to their legs from the early afternoon.

Dr Diaa Abu Hussein, head of the emergency medical services in the area, said that at least one journalist and one medic had been hit.

“Two of our ambulances were targeted directly with tear gas directly,” he said. “We have received several live bullet wounds to the lower limbs.”

Protestors gather near the Gaza Strip’s border with Israel (AP)

Many had feared Saturday’s rallies would be the crescendo to a year of violence that has seen over 260 Palestinians killed by Israeli fire, and tens of thousands wounded in the weekly protests.

According to Medecins Sans Frontieres, the injuries have sparked a “slow motion” medical crisis in the besieged enclave which has struggled to treat the influx of gunshot wounds.

Save the Children urged the Israeli army to revise its rules of engagement related to the use of live fire against minors, saying that over 50 children had been killed, 6,000 injured and 21 had their limbs amputated over the last 12 months.

Since March 2018, hundreds of thousands of Palestinians have marched towards Israel each week, protesting against a 12-year Israeli blockade and demanding the right to return to their lands they were forced from during the conflict which surrounded the creation of Israel in the 1940s.

Over half of Gaza’s 2.2 million population live under the poverty line, while youth unemployment has soared past 65 per cent and is one of the highest in the world. The United Nations has warned the 25-mile besieged enclave will be “uninhabitable” by 2020.

The UN has also accused Israel’s army of committing possible war crimes for targeting children, medics and journalists with sniper fire. The military has defended its use of force saying the protesters have launched incendiary kites and explosives over the border threatening Israeli civilians who live nearby.

At the marches, protesters, injured in previous rallies or wars, headed towards the gunfire, chanting as they held their crutches aloft. Families with small children had also gathered, in spite of the dangers.

“I lost my leg, my home and my entire family in the 2008 war and have been unable to find work since then which is why I’m here,” said Mahmoud Moussa, 30, from Gaza City who was a tiler before his right leg was amputated.

“Living here is worse than being buried underground. Gaza is a like a big prison. I swear the protests would stop if they lifted the blockade and we could find some work,” he added.

Great March of Return: Injured Gazans still receiving rehabilitation treatment one year on from protest

To his right a family from Shujaiyya in northeast Gaza were clambering down sandbanks in the rain. The youngest, just five years old, was crying from the tear gas.

“I have six children, I have no job, I rely on donations and aid. My eldest daughter is 11 and has lived through three wars already. That can’t be normal,” said Salem Salam, 40, the father.

“We are dying a slow and miserable death. It is better to demand our rights and get it over and done with.”

The conflict has piled pressure on the two warring sides at a fraught time. Over the last week tensions reached breaking point, after a long-range rocket fired from Gaza destroyed a family home in central Israel on Monday, injuring seven people including a baby.

Gaza protests: Wounded patients being treated at MSF clinic Show all 9 1 /9 Gaza protests: Wounded patients being treated at MSF clinic Gaza protests: Wounded patients being treated at MSF clinic Palestinian patients wounded during Gaza-Israel border protests at a clinic run by medical charity Doctors Without Borders (MSF) in Gaza City Bel Trew Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic 'I was a fisherman before, but I now can’t do anything, I have no work. I can’t walk. I’m struggling,' says Rami Hessi Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic According to Gaza’s ministry of health, more than 5,800 Palestinians have been injured by live fire shot by Israeli soldiers during regular rallies held at the border fences since March 2018 Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic Sabreen al-Najjar, left, the mother of Razan, a 20-year-old medic who was shot dead on the Gaza border last year Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic Palestinian patients wounded during Gaza-Israel border protests at a clinic run by medical charity Doctors Without Borders (MSF) in Gaza City Bel Trew Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic Palestinian patients wounded during Gaza-Israel border protests at a clinic run by medical charity Doctors Without Borders (MSF) in Gaza City Bel Trew Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic Palestinian patients wounded during Gaza-Israel border protests at a clinic run by medical charity Doctors Without Borders (MSF) in Gaza City Bel Trew Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic Palestinian patients wounded during Gaza-Israel border protests at a clinic run by medical charity Doctors Without Borders (MSF) in Gaza City Bel Trew Bel Trew/The Independent Gaza protests: Wounded patients being treated at MSF clinic Palestinian patients wounded during Gaza-Israel border protests at a clinic run by medical charity Doctors Without Borders (MSF) in Gaza City Bel Trew Bel Trew/The Independent

Israel, who blamed Hamas the militant group that controls the Strip, launched retaliatory airstrikes. Armed factions within Gaza, fired back with rockets.

An Egyptian security delegation furiously shuttled between the two sides to nail down a ceasefire in time for the mass rallies over the weekend, fearing a bloody day at the border might spill into another war.

No formal agreement was reached before the protests began. However, Hamas spokesman Fawzi Barhoum, who attended the Malaka rally, told The Independent a message had been sent via the Egyptians that protesters would be peaceful as long as Israel held their fire.

He called Saturday’s rallies a “test” that would determine Hamas’s response to Israel in the coming weeks.

A Palestinian protester waves the national flag near the border with Israel east of Gaza City (AFP/Getty)

“Based on today’s reaction we will decide what to do in the coming days. We don’t want a war, we are defending ourselves ... the one who has the control to end this is Israel,” he added.

Hamas had sent out text messages to people on local mobile networks warning the youth on the border not to approach the fences “to avoid enemy traps”. At the marches, men on loud speakers repeated the warning to those heading to the front.

Abdel-Salem Haniyeh, the son of Hamas leader Ismail Haniyeh, was also at the protests and said they would remain peaceful “depending on Israel’s response”.

“We don’t want a war but it depends on the Israelis,” he told The Independent.