Study shows Gaza death toll is 70% higher than Hamas’s

Study published in Lancet estimates that 64,260 people died from injuries in Gaza during the first nine months of the conflict with Israel – from October 7, 2023 to June 30. This figure, calculated using a system referencing three separate lists, is 69.65% higher than the 37,877 deaths reported during the same period by the Gaza health authorities, whose authority falls under: Hamas control. The article suggests that based on the Gaza Ministry of Health’s report on the death toll through October – now over 46,000 – the total death toll under this methodology could be over 70,000.

The war continued October 7, 2023when the Islamist Hamas militia killed 1,200 Israelis and kidnapped 251 hostages. From that day on, the Gaza Ministry of Health published daily reports on fatalities. These numbers have sparked controversy, with some critics saying they are inflated and others saying they are underestimates. The study ultimately concluded that the official death toll had been underestimated.

Researchers used a system known as “capture-retrieval” that compares overlapping records from three sources: deaths documented in hospitals and morgues by the Ministry of Health, an online survey also managed by the ministry, and obituaries shared on various social media platforms. This technique is widely used for population estimation when it is impractical to perform complete calculations or the available data are unreliable.

The study does not cover missing persons

Epidemiologist Zeina Jamaluddine, a member of the four-person team behind the study, explains that the “capture-recapture” system was initially popularized by conservationists. “They would catch, tag and release animals or insects in a specific area, then catch them later and use species overlap to estimate population size.” The method has since been adapted to epidemiological research, including the study of disease incidence and mortality rates in various contexts, including conflict zones.

“The capture-recapture technique,” explains Jamaluddine, “has been used to estimate mortality in many conflict-affected areas, such as Kosovo, Sudan, Guatemala and Colombia. It allows researchers to estimate the total number of deaths, including those that are not recorded in any single data source, by analyzing the overlap between different lists of people killed.”

Jamaluddine claims that the Ministry of Health in Gaza had statistical systems that were among the most robust in the region before the war. “You couldn’t find something like this in Syria, even before the civil war. However, war inevitably degrades health information systems,” he explains.

The study noted that “the escalation of Israeli ground operations and attacks on health care facilities has severely disrupted” the ability of local authorities to maintain electronic death records. That’s what led researchers to undertake a three-month study that found the Ministry of Health undercounted deaths by 41% during the first nine months of the invasion.

Two of the datasets the team used came from the Ministry of Health. Asked whether this reliance suggests an over-reliance on Hamas-controlled health authorities, Jamaluddine acknowledged that this poses a challenge. “That’s true. I don’t deny that we used the ministry’s data, he says. “We relied on records with clearly identified names and carefully cleaned the data, removing duplicates and correcting errors. However, to do this properly, we would have to enter Gaza under security – and this was not possible. International agencies such as the United Nations and UNICEF operate in the Gaza Strip, but their attention is focused on providing food and medicines. They can’t call people and ask how many people have died in their homes if they want food and medicine.”

The study’s conclusions emphasize the “urgent need” for “an immediate and lasting cessation of hostilities and a lasting settlement that includes the release of Israeli hostages and thousands of Palestinian civilians held by Israel.”

“Consistent data”

This is emphasized by Eduardo Satué, president of the Spanish Society of Public Health and Health Administration (SESPAS). Lancetthe approach involves examining multiple data sources to assess their consistency. “From the data I’ve seen, I think it’s consistent,” he tells EL PAÍS by phone.

Satué explains that the “capture and recapture” method used in the study is the most reliable option given the circumstances. “This is what we have, there are no more precise alternatives at the moment,” he explains. “Ideally, such studies would be conducted in peacetime, as was done during the 2006 Iraq War, when figures were compared before and after the invasion. Even in peacetime, we have seen during the pandemic how difficult it is to fine-tune statistics, for example, distinguishing between death from Covid and death from Covid. However, under current conditions in Gaza, this method is the best way to achieve this goal.”

Satué, a pharmacist by profession, is not surprised that the death toll is higher than that reported directly by health authorities. “Traditional methods of counting casualties during conflict are based on military reports on combat casualties, data from hospitals and morgues, and direct observations. However, the latter are included in official statistics only when the identity of the deceased and the place and manner of his death are known. As a result, they tend to underestimate the number of deaths.”

This is emphasized by the president of SESPAS Lancet study focuses on direct deaths caused by the conflict, it is important to remember that the number of people “who die from the indirect effects of war is much higher than the number who die from violence.” These indirect causes include malnutrition, water pollution, lack of health care, says. “In Gaza this may have a greater impact than in other conflicts because of the high population density and because it is essentially a type of prison, which makes it much more difficult to provide adequate care.”

Lancet the study acknowledges that accurately measuring indirect mortality in ongoing war presents numerous “challenges and limitations.” Limited access and “highly unsafe conditions for humanitarian and health workers in Gaza” make such measurements unfeasible.

Satué also notes that his association recently published a publication third monograph in his series War conflicts and their impact on healthwhich examined how these conflicts affect vulnerable groups, including minorities, pregnant women and children. According to Lancet59% of deaths in Gaza for which age and gender data were available occurred among women, children and the elderly – groups that are particularly vulnerable and less likely to be involved in combat.

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