A new independent study published in the Lancet medical journal estimates that Gaza’s death toll in Israel’s ongoing military offensive has been severely underreported — a finding that aligns with the very real challenges local officials continue to face in counting the Palestinian territory’s dead without the proper health care infrastructure.
The Gaza Ministry of Health (MOH) reports that 37,877 Palestinians were killed by violence in the first nine months of the military offensive, which began in October 2023 after Hamas’ deadly attack in Israel.
But according to researchers with the London School of Hygiene & Tropical Medicine (LSHTM), the number of Palestinians killed by violence in the same period is estimated to be closer to 64,260 – a whopping 41% higher than the ministry’s count. That number amounts to 1 in 35 inhabitants of Gaza’s estimated pre-war population.
“The high mortality rates shown by our study, combined with previous evidence, underscore the severe crisis in the Gaza Strip,” said the peer-reviewed LSHTM study published Thursday in The Lancet. “Our findings validate concerns raised by Palestinian and international organizations, including reputable human rights and humanitarian organizations and UN special rapporteurs, about the scale of civilian casualties.”
Based on that underreporting rate, the study estimates that the number of Palestinians killed by violence exceeds 70,000 as of October – not 41,909, as the MOH reported.
“Our study supports the view that the MOH figures are more likely to underestimate than overestimate mortality,” the researchers said. “This evidence confirms the need for urgent international interventions to prevent further loss of life and address the long-term health consequences of the Israeli military assault in Gaza.”
The study reflects the reality that Gaza has been operating with a health care system destroyed by Israel. Once considered a credible statistics source in the eyes of the international community, the MOH has been unable to keep up with the bodies piling from increased Israeli strikes, ground operations and hospital raids.
Morgues have run out of room, and those with no transportation have buried their loved ones where they can. Some victims are anonymous because strikes have either burned them beyond identification or blown their bodies up into multiple pieces. The study’s estimate would be even higher if researchers also included missing persons, many of whom are presumed dead under rubble.
LSHTM said researchers conducted the study using “capture-recapture analysis,” which “overlaps data from multiple sources to arrive at estimates of deaths when not all data are recorded.” The sources relied on for the study included the MOH’s hospital morgue records, an online survey and social media obituaries.
Researchers said that 59% of deaths in the study that had age and sex data available were women, children and older people — “groups considered particularly vulnerable in conflict-affected settings and less likely to be combatants.”
“Both the scale and age-sex patterns of traumatic injury deaths raise grave concerns about the conduct of the military operation in Gaza despite Israel stating that it is acting to minimize civilian casualties,” the study said.
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Even with the study’s increased death estimate, researchers predict the toll to be much higher, given that they didn’t include deaths that aren’t traumatic injuries but still a result of Israel’s military operations. Those deaths can stem from weather exposure, starvation, thirst, disease, stress, pregnancy complications, a lack of hospital access and Israel’s ongoing blockade of life-saving humanitarian aid.
“Patients on dialysis will not get dialysis. Children who will need proper care will not get proper care. Pregnant women will not get prenatal care,” MedGlobal president Dr. Zaher Sahloul said last week. “And that will create untold morbidities and suffering and death that are not counted as victims of war. These are deaths related to the war, but it’s related to removing these health care centers and anchors to the community.”
The study stressed that while it is currently unsafe and not feasible to accurately measure indirect deaths from the ground, rebuilding Gaza’s health information system must be a priority once Israel ends its offensive. This would allow public health officials to count the dead, detect disease outbreaks early, allocate resources and memorialize the impact on the territory.