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Counting the dead in Gaza: difficult but essential
Rasha Khatib
Martin McKee
Salim Yusuf
Published:July 05, 2024
DOI:https://doi.org/10.1016/S0140-6736(24)01169-3
"By June 19, 2024, 37 396 people had been killed in the Gaza Strip since the
attack by Hamas and the Israeli invasion in October, 2023, according to the
Gaza Health Ministry, as reported by the UN Office for the Coordination of
Humanitarian Affairs.1 The Ministry's figures have been contested by the
Israeli authorities, although they have been accepted as accurate by Israeli
intelligence services,2 the UN, and WHO. These data are supported by
independent analyses, comparing changes in the number of deaths of UN
Relief and Works Agency (UNRWA) staff with those reported by the
Ministry,3 which found claims of data fabrication implausible.4
Collecting data is becoming increasingly difficult for the Gaza Health Ministry
due to the destruction of much of the infrastructure.5 The Ministry has had
to augment its usual reporting, based on people dying in its hospitals or
brought in dead, with information from reliable media sources and first
responders. This change has inevitably degraded the detailed data recorded
previously. Consequently, the Gaza Health Ministry now reports separately
the number of unidentified bodies among the total death toll. As of May 10,
2024, 30% of the 35 091 deaths were unidentified.1
Some officials and news agencies have used this development, designed to
improve data quality, to undermine the veracity of the data. However, the
number of reported deaths is likely an underestimate. The non-governmental
organisation Airwars undertakes detailed assessments of incidents in the
Gaza Strip and often finds that not all names of identifiable victims are
included in the Ministry's list.6 Furthermore, the UN estimates that, by Feb
29, 2024, 35% of buildings in the Gaza Strip had been destroyed,5 so the
number of bodies still buried in the rubble is likely substantial, with estimates
of more than 10 000.7
Armed conflicts have indirect health implications beyond the direct harm
from violence. Even if the conflict ends immediately, there will continue to be
many indirect deaths in the coming months and years from causes such as
reproductive, communicable, and non-communicable diseases. The total
death toll is expected to be large given the intensity of this conflict;
destroyed health-care infrastructure; severe shortages of food, water, and
shelter; the population's inability to flee to safe places; and the loss of
funding to UNRWA, one of the very few humanitarian organisations still
active in the Gaza Strip.8
In recent conflicts, such indirect deaths range from three to 15 times the
number of direct deaths. Applying a conservative estimate of four indirect
deaths per one direct death9 to the 37 396 deaths reported, it is not
implausible to estimate that up to 186 000 or even more deaths could be
attributable to the current conflict in Gaza. Using the 2022 Gaza Strip
population estimate of 2 375 259, this would translate to 7·9% of the total
population in the Gaza Strip. A report from Feb 7, 2024, at the time when the
direct death toll was 28 000, estimated that without a ceasefire there would
be between 58 260 deaths (without an epidemic or escalation) and 85 750
deaths (if both occurred) by Aug 6, 2024.10
An immediate and urgent ceasefire in the Gaza Strip is essential,
accompanied by measures to enable the distribution of medical supplies,
food, clean water, and other resources for basic human needs. At the same
time, there is a need to record the scale and nature of suffering in this
conflict. Documenting the true scale is crucial for ensuring historical
accountability and acknowledging the full cost of the war. It is also a legal
requirement. The interim measures set out by the International Court of
Justice in January, 2024, require Israel to “take effective measures to prevent
the destruction and ensure the preservation of evidence related to
allegations of acts within the scope of … the Genocide Convention”.11 The
Gaza Health Ministry is the only organisation counting the dead.
Furthermore, these data will be crucial for post-war recovery, restoring
infrastructure, and planning humanitarian aid.
MM is a member of the editorial board of the Israel Journal of Health Policy
Research and of the International Advisory Committee of the Israel National
Institute for Health Policy Research. MM was co-chair of the Institute's 2016
6th International Jerusalem Conference on Health Policy, but writes in a
personal capacity. He also collaborates with researchers in Israel, Palestine,
and Lebanon. RK and SY declare no competing interests. The authors would
like to acknowledge study team members Shofiqul Islam and Safa Noreen for
their contribution to collecting and managing the data for this
Correspondence.
Editorial note: The Lancet Group takes a neutral position with respect to
territorial claims in published text and institutional affiliations.
References
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