US drone strikes in Pakistan last year killed a woman who was farming with her grandchildren and 18 other civilians, Amnesty International has said.
The human rights group called on the US to investigate the killings, which it documented in a report, and provide the victims with "full reparation".
"We cannot find any justification for these killings," said Mustafa Qadri, the Amnesty researcher who wrote the report.
Washington considers its drone programme to be a key weapon against insurgents who go across the border into Afghanistan.
Islamabad opposes drone attacks, saying they kill too many civilians in addition to their intended targets.
The drone campaign is a source of tension between the two countries and complicates their ability to co-ordinate efforts against militants based in Pakistan, including al Qaeda operatives.
Amnesty said it conducted a detailed investigation into two incidents in North Waziristan, an area in Pakistan near the border with Afghanistan that is subjected to an intensive drone campaign.
According to the report, a drone strike in October 2012 killed Mamana Bibi, a 68-year-old grandmother and the wife of a retired head teacher, as she was gathering vegetables.
The drone campaign has drawn protests in Pakistan and elsewhereThree of the woman's grandchildren were wounded in the strike, as were several others who were nearby.
Amnesty said 18 men were killed in a second drone attack in July 2012.
Residents described the dead as a woodcutter, a vegetable seller and miners who had gathered in the shade at dusk to talk after a day's work. The youngest was 14.
"Everyone in the hut was cut to pieces," Amnesty quoted one witness as saying.
"We started to panic and each person was trying to run in a different direction."
The report was based on more than 60 interviews conducted by teams of researchers working independently of each other.
"There are genuine threats to the USA and its allies in the region, and drone strikes may be lawful in some circumstances," said Mr Qadri.
"But it is hard to believe that a group of labourers, or an elderly woman surrounded by her grandchildren, were endangering anyone at all, let alone posing an imminent threat to the United States."
Amnesty said Pakistan had an "ambiguous attitude" towards the drone programme, and also noted the government's limited control on tribal areas.
It said victims have either received no compensation or inadequate assistance from Islamabad.
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