Four Palestinian demonstrators have been killed and more than 300 injured in clashes with the Israeli army on the Gaza border since Friday night, the Gaza Health Ministry says.
Three Palestinians died during the clashes, while a fourth died in hospital on Saturday from wounds he sustained the previous evening.
Violence erupted between demonstrators and Israeli soldiers stationed on the Israel-Gaza border, as tens of thousands demonstrated to mark the one-year anniversary of the Great March of Return protests.
The Israeli army, which put the number of protesters at 40,000, accused participants of throwing stones and setting tyres on fire. In addition, a number of grenades and explosive devices were hurled at the border fence, it said.
Witnesses said Israeli soldiers fired tear gas and live gunfire at the demonstrators to keep them from approaching the fence.
The Israeli army warned Gazans not to approach the fence during the protests, calling on them to keep a distance of 300 metres away.
The army said that troops had fired "in accordance with standard operating procedures".
The Gazan Health Ministry said on Saturday evening that at least 316 Palestinians had been injured. Of those, 64 sustained gunshots wounds. Others were hurt by shrapnel, exposure to tear gas or being hit by tear gas canisters.
The Great March of Return protests, which have been taking place every week since they began a year ago, call for the right of return of Palestinian refugees and their descendants to the territory of today's Israel, as well as for an end to the 12-year-long blockade imposed by Israel.
A general strike was held in the Gaza Strip and the Health Ministry and Interior Ministry declared a state of emergency.
Governmental and private sector institutions were closed, including schools, universities and stores all in the Gaza Strip, except medical institutions, clinics and hospitals.
According to the Gaza Health Ministry, 270 Palestinians have been killed and thousands injured in the protests since they started one year ago. Save the Children says "at least 50 children" were among the dead. One Israeli soldier has been shot dead.
The anniversary coincides with Land Day, which commemorates the death of six Arab Israelis who were killed by Israeli forces during protests against the expropriation of land by Israel in 1976.
Palestinian Authority President Mahmoud Abbas said in a statement: "The suffering of our people over 100 years and the enormous sacrifices made by this great people will not go to waste."
