At least one person was killed and 37 injured in a stampede at a football stadium in Madagascar's capital Antananarivo, a hospital official said Sunday.
"In all, there are 41 patients that entered the hospital including one dead on the spot and two in fairly precarious states," Oliva Alison Rakoto, director of the Hrja Hospital, told AFP.
"The two critically injured patients have head and thoracic trauma." She said some of the injured have already been discharged.
The stampede occurred at the entrance to the venue just before kickoff between Madagascar and Senegal.
Witnesses said thousands of fans had been waiting outside Mahamasina Stadium since early in the morning, well ahead of the 2:30 pm (1130 GMT) kickoff.
At the hospital, 30-year-old Henintsoa Mialy Harizafy told AFP her uncle had left home around 8:00 am to attend the 2019 Cup of Nations qualifying match. "We heard he was hospitalised here after being trampled in the stampede."
She added: "I don't understand why only one entrance gate was open for such a big match."
Another fan, Rivo Raberisaona, said his group had joined the queue at 6:00 am. "We were a metre and a half (five feet) from the entrance when the stampede happened. I was trampled in the back, but my rucksack softened the blow."
Despite the crush, the match began on time with 20,000 spectators attending.
Match on TV in waiting room
Families in the waiting room of the Hjra hospital watched the game on television and could be heard bursting with joy when the Malagasy national team scored a goal and was able to equalise.
The history of African football is marked by frequent deadly crowd stampedes.
In July 2017, eight people were killed when rival supporters clashed during Senegal's League Cup final, and a stampede caused a wall to fall on escaping fans.
In February 2017, 17 people were killed and 58 injured in Angola near the northern town of Uige ahead of a season-opening match for the national championship.
The scramble came after police used tear gas to clear the area surrounding the stadium.
In 2009, 19 people died in the Ivorian economic capital Abidjan after a crush in a qualifying match for the 2010 World Cup between Ivory Coast and Malawi.
Europe has seen even deadlier stadium disasters. In 1985, a wall collapsed at Heysel Stadium in Brussels before the European Cup final between Juventus and Liverpool, killing 39 people.
Four years later a crush at Hillsborough Stadium in Sheffield, northern England, led to the deaths of 96 Liverpool supporters before an FA Cup semi-final between the club and Nottingham Forest.
Those two disasters led to widespread changes in stadium design in England and across Europe.