Researchers say the death toll in Gaza is likely 40 percent higher than reported

Deaths from bombs and other traumatic injuries during the first nine months of the war in Gaza may have been underestimated by more than 40 percent, according to estimates. A new analysis published in The Lancet.

The peer-reviewed statistical analysis, led by epidemiologists at the London School of Hygiene and Tropical Medicine, used modeling in an attempt to provide an objective, third-party estimate of casualties. The United Nations has relied on figures from the Hamas-led Health Ministry, which it says are largely accurate, but which Israel criticizes as exaggerated.

But the new analysis indicates that the tally of the Hamas Ministry of Health is much lower than the real number. The researchers concluded that the death toll from the Israeli aerial bombardment and military ground operation in Gaza between October 2023 and the end of June 2024 was about 64,300, instead of the 37,900 reported by the Palestinian Ministry of Health.

The estimate in the analysis corresponds to 2.9 percent of Gaza’s pre-war population killed by traumatic injuries, or one in every 35 people. The analysis did not take into account other war-related losses such as deaths from malnutrition, waterborne diseases, or the collapse of the health system as the conflict progressed.

The study found that 59% of the dead were women, children and people over 65 years old. The proportion of fighters among the reported deaths was not specified.

Mike Spagat, an expert in war casualty calculations who was not involved in this research, said the new analysis convinced him that Gaza’s casualties were underestimated.

“This is good evidence that the real number is higher, perhaps much higher, than the official Department of Health numbers, and higher than I have been thinking for the past few months,” said Dr. Spagat, a professor at Harvard Medical School. Royal Holloway College, University of London.

But he said showing precise numbers, such as the 41 percent proportion of deaths that go unreported, is less useful, because the analysis actually shows the true total could be less than that, or much more. “Quantitatively, it’s a lot more uncertain than I think it says in the paper,” Dr. Spagat said.

The researchers said their estimate of 64,260 deaths due to traumatic injuries has a “confidence interval” between 55,298 and 78,525, meaning the actual number of victims is likely in that range.

If the estimated level of underreporting of deaths through June 2024 is extrapolated to October 2024, the total number of casualties in Gaza in the first year of the war would exceed 70,000.

“The war casualty deaths are important, because they raise the question of whether the campaign is proportionate, and whether in fact sufficient measures are being taken to avoid civilian casualties,” said Francesco Cecchi, an epidemiologist. He has experience in conflict and humanitarian crises and is a professor at the London School of Hygiene and Tropical Medicine who was one of the authors of the study. “I think commemoration is important. There’s inherent value in just trying to come up with the right number.

The analysis uses a statistical method called capture-recapture analysis, which has been used to estimate casualties in other conflicts, including the civil wars in Colombia and Sudan.

For Gaza, the researchers relied on three lists: The first is a register maintained by the Palestinian Ministry of Health, which mainly includes the dead in hospital morgues and estimates of the number of people who have not been recovered and are buried under rubble. The second is deaths reported by family or community members through an online survey form created by the ministry on January 1, 2024, when the pre-war death registration system collapsed. It asked Palestinians inside and outside Gaza to provide the names, ages, national ID number, and place of death of the victims. The third source was obituaries of people who died from injuries posted on social media, which may not include all the same biographical details that the researchers collected manually.

The researchers analyzed these sources to search for individuals who appear on multiple lists of the dead. A high level of overlap would have indicated that a small number of deaths were not counted; The low amount they found suggests otherwise. The researchers used models to calculate the probability that each individual would appear on any of the three lists.

“The models enable us to estimate how many people might not have been included at all,” Dr. Chichi said. This, combined with the number mentioned, gave the analysts their total number.

Patrick Bull, research director at the Human Rights Data Analysis Group and a statistician who has conducted similar estimates of violent deaths in conflicts in other regions, said the study was robust and well justified. But he cautioned that the authors may have underestimated the amount of uncertainty caused by the ongoing conflict.

The authors used various forms of mathematical modeling in their calculations, but Dr Ball said that rather than presenting a single number – 64,260 deaths – as an estimate, it might have been more appropriate to present the number of deaths in a range of 47,457 to 47,457 88,332 deaths, a range that includes all estimates. Resulting from modeling the overlap between the three lists.

“It’s really difficult to do this kind of thing in the middle of conflict,” Dr. Paul said. “It takes time, it takes getting there. I guess you could say the scale is bigger, and that would be reasonable.”

While Gaza had a robust death registration process before the war, its function is now limited after much of the health system was destroyed. Deaths are not counted when entire families are killed at once, with no one left to report, or when an unknown number of people die in a large building collapse; Dr. Al-Shishi said that Gazans are increasingly being buried near their homes without passing through the morgue.

The study’s authors acknowledged that some of those presumed dead may actually be missing, and were most likely being held as prisoners in Israel.

Ronnie Karen Rabin and Lauren Letherby Contributed to reports.