LOS ANGELES - Madonna has defended a graphic music video depicting a nightclub massacre, saying people need to understand “this is what happens when people shoot”.

The pop superstar’s song God Control calls for people to “wake up” about the reality of gun violence in the US.

The scenes in the music video recall the 2016 Pulse nightclub shooting in Orlando, Florida, where 49 people were killed.

Pulse survivor Patience Carter said she was “truly disturbed” by the video.

The eight-minute video shows actors playing revellers being shot and lying lifeless and covered in blood in a fictional nightclub called The Globe.

“I couldn’t even watch after the first 45 secs @Madonna,” Carter wrote on Twitter.

“There are so many creative avenues that could’ve been taken to bring awareness to gun control. The victims of these mass shootings should always be taken into consideration. I applaud the attempt, but I am truly disturbed.”