Research says the estimated death toll in Gaza may have missed 25,000 people

They say deaths from bombs and other traumatic injuries during the first nine months of the Gaza war may have been undercounted by more than 40 percent – according to 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 to provide an unbiased third-party estimate of the toll. The United Nations relied on data from the Hamas-led Ministry of Health, which it says is largely right but Israel criticizes as inflated.

However, a modern analysis suggests that Hamas’ health ministry figures are a significant underestimate. Researchers concluded that the death toll from Israeli aerial bombardment and ground operations in the Gaza Strip from October 2023 to the end of June 2024 was approximately 64,300 instead of the 37,900 reported by the Palestinian Ministry of Health.

Estimates included in the analysis indicate that 2.9 percent of Gaza’s pre-war population died as a result of injuries, or one in 35 residents. The analysis did not take into account other war casualties, such as deaths from malnutrition, waterborne diseases or the collapse of the health care system as the conflict progressed.

The study found that 59 percent of those killed were women, children and people over 65 years of age. It has not been determined what part of the reported victims were veterans.

Mike Spagat, an expert in calculating war casualties who was not involved in the study, said the modern analysis convinced him that Gaza losses were underestimated.

“This is good evidence that the real number is higher, probably much higher than the official Ministry of Health figures, higher than I have thought for the last few months,” said Dr Spagat, a professor at Royal Holloway College, University of London.

But presenting exact numbers, such as an undercount of 41 percent, is less useful, he said, because the analysis actually shows the real total could be less or much greater. “Quantitatively, it’s a lot more uncertain than I think the paper shows,” Dr. Spagat said.

The researchers said their estimate of 64,260 trauma deaths has a “confidence interval” between 55,298 and 78,525, meaning the actual death toll is likely within that range.

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

“The issue of deaths from war injuries is critical because it raises the question of whether the campaign is proportionate and whether sufficient measures have actually been put in place to prevent civilian casualties,” said Francesco Checchi, an epidemiologist with experience in conflict and humanitarian crises and a professor at London School of Hygiene and Tropical Medicine, who authored the study. “I think commemoration is critical. There is inherent value in trying to find the right number.

The analysis used 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.

In the case of Gaza, researchers relied on three lists: The first is a register kept by the Palestinian Ministry of Health, which mainly includes those who died in hospital morgues and an estimate of the number of undiscovered people buried under the rubble. The second is deaths reported by family or community members through an online survey by a ministry created on January 1, 2024, when the pre-war death registration system broke down. It asked Palestinians in Gaza and beyond to provide the names, ages, national identification numbers and places of death of the victims. A third source was obituaries of people who died from injuries posted on social media, which may not contain all the same biographical details and which researchers compiled by hand.

Researchers analyzed these sources to look for people who appear on multiple kill lists. The high level of overlap would suggest that few deaths were uncounted; the low quantity found suggested the opposite. The researchers used models to calculate the probability of each person appearing on any of the three lists.

“The models allow us to actually estimate the number of people who were not listed at all,” Dr. Checchi said. This, combined with the figure provided, gave analysts the total amount.

Patrick Ball, director of research at the Human Rights Data Analysis Group and statistics, who has conducted similar estimates of violent conflict deaths in other regions, said the study is mighty and well-founded. However, he cautioned that the authors may have underestimated the level of uncertainty caused by the ongoing conflict.

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

“It’s really hard to take action like this in the middle of a conflict,” Dr. Ball said. “It takes time and access. “I think you could say the scope is bigger and that would be plausible.”

Although there was a tough death registration process in Gaza before the war, it now has only constrained functions after much of the health care system was destroyed. Deaths are not counted when entire families die at once and there is no one to report, or when an unknown number of people die as a result of the collapse of a enormous building; Dr. Checchi said Gazans were increasingly being buried close to their homes, without having to go through a mortuary.

The authors of the study admitted that some of the people considered dead may actually have disappeared and were most likely taken captive in Israel.

Roni Caryn Rabin AND Lauren Leatherby reporting contributed.