At least 12 people have died following clashes in Juliaca in southern Peru, a regional health ministry says, after a resumption of protests demanding early elections and the release of jailed former president Pedro Castillo.
The latest casualties take the death toll from anti-government clashes with security forces to 34 since the protests began in early December following the removal and arrest of Castillo shortly after he tried to illegally dissolve Congress.
Castillo is serving 18 months of pre-trial detention on charges of rebellion, which he denies.
At least 38 people had been injured and hospitalised in Juliaca, the ministry said in a statement published on Facebook.
In Juliaca, near the banks of Lake Titicaca in Peru's southern Puno region, a Reuters witness recorded footage of gunshots and smoke on the streets as protesters took cover behind large metal plates and road signs and threw rocks at police using improvised sling-shots.
Other footage showed people administering CPR to a man lying motionless on the ground in a blood-stained sweater, and people with severe injuries in a crowded hospital waiting room.
"We ask the forces of law and order to make a legal, necessary and proportional use of force and we urge the state prosecutor's office to carry out a prompt investigation to clarify the facts," the ombudsman's office wrote on Twitter.
Protests resumed last week after a holiday lull. Apart from early elections and the release of Castillo, the protestors are calling for the resignation of new President Dina Boluarte, closure of Congress and changes to the constitution.
Speaking at a "national agreement" meeting earlier on Monday with representatives from the country's regions and various political institutions, Boluarte said she could not grant some of the protesters' key demands. She called for citizens to "reflect".
"The only thing that was in my hands was moving forwards the elections, which we have already proposed," she said. "What you are asking for is a pretext to continue generating chaos in the cities."