Around 9,000 Palestinians participated Friday in the violent weekly border protest.
At least 40 Palestinians were shot by Israeli fire in the protests, Gaza's health ministry said, with volunteer medic Abdullah al-Qatati killed after being hit in the chest east of Rafah in southern Gaza. It said over 300 people were hurt, of whom dozens were shot by Israeli troops.
Rockets fired by Hamas have not killed any Israelis.
A journalist was also said to have been wounded by Israeli fire.
A source familiar with ceasefire negotiations said Egypt and the United Nations had negotiated a return to calm starting shortly before midnight Thursday, seemingly bringing an end to the upturn in violence.
The implication was that Israel had ceased its reprisal attacks in the Strip because Hamas had halted rocket attacks on Israeli communities, but did not see itself obligated to a truce.
Israeli soldiers also opened fire at some 50 Palestinian fishing boats that sailed off Gaza's northern coast on Saturday to protest Israel's sea and land blockade of the enclave, the fishermen's union said.
The strike came as Hadashot TV news reported an Israeli denial of a ceasefire with Hamas ending intense Gaza rocket fire into Israel, which had prompted IDF response attacks Wednesday and Thursday.
It would be the third such truce in a month.
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Israel and Hamas have come close to serious conflict in recent weeks after four months of violence along Gaza's border.
Reserve General Doron Almog, former head of Israel's southern command which deals with Gaza, told army radio on Friday morning that the next 24 hours would be crucial.
"He was the only one who demanded to launch a large-scale operation in the Gaza Strip".
Hugh Lovatt, Israel-Palestine fellow with the European Council on Foreign Relations, said the "increasingly frequent cycles of escalation and de-escalation" were similar to events before the previous wars.
Per usual, the riots featured Palestinians launching fiery kites into Israel, according to the Times of Israel (TOI).
Now the protests occur mostly on Fridays, though pro-Palestinian activists have sought to find new ways to draw attention to Israeli oppression and abuses, such as flotillas of activists attempting to break the naval blockade.
Qattati's killing followed that of another medic in June, Razan al-Najjar, when she was shot dead while treating Palestinians wounded by Israeli forces using live fire, rubber-coated bullets and tear gas.
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