As the International Court of Justice (ICJ) debates whether Israel is committing genocide in Gaza, one of the world’s most-respected medical journals has estimated that at least 186,000 Palestinians have been killed in Gaza since October 2023.
The widely cited official death toll has been approximately 37,000 with more than 10,000 missing, according to the Gaza Health Ministry and the UN Office for the Coordination of Humanitarian Affairs.
While Israel has continued to contest these figures, they are accepted as accurate by Israeli intelligence services, the UN, and the World Health Organisation (WHO).
The Lancet, one of the world’s oldest and highest impact peer-reviewed medical journals, published a letter by three health scientists this week that arrived at its “harrowing” yet “conservative” figure based on scholarly death toll counting in recent conflicts.
Armed conflicts, The Lancet authors argued, 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 the conflict, the destroyed healthcare infrastructure, severe shortages of food, water, and shelter, the population’s inability to flee to safe places, and the loss of funding to the UN Palestinian refugees agency UNRWA, one of the few humanitarian organisations still active in the Gaza Strip.
“In recent conflicts, such indirect deaths range from three to 15 times” the number of direct deaths, the report “Counting the Dead in Gaza: Difficult but Essential,” said.
Applying a conservative estimate of four indirect deaths per one direct death 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,” its authors stated.
Using a 2022 Gaza Strip population estimate of 2,375,259, this would translate to 7.9 per cent of the total population in the Gaza Strip. A report from 7 February 2024 at a time when the direct death toll was 28,000 estimated that without a ceasefire there would be between 58,260 (without an epidemic or escalation) and 85,750 deaths (if both occurred) by 6 August 2024.
Citing The Lancet’s figures, British Labour MP Zarah Sultana called on the UK government “to immediately end all arms sales to Israel.”
The letter, a collective effort by international health scientists Rasha Khatib, Martin McKee, and Salim Yusuf, supports previous estimates by war and health experts who have warned that Israel’s disproportionate use of 2,000-pound bombs on tiny Gaza over the past nine months has exceeded all bombing campaigns in previous wars in intensity, speed, frequency, targets and staggering death toll.
The report acknowledged that collecting data is becoming increasingly difficult for the Gaza Health Ministry due to the destruction of much of its infrastructure. 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 10 May 2024, 30 per cent of the 35,091 deaths were unidentified.
The report cited the NGO Airwars, which undertakes detailed assessments of incidents in the Gaza Strip but often “finds that not all names of identifiable victims are included in the ministry’s list.”
The UN estimates that by 29 February 2024, 35 per cent of the buildings in the Gaza Strip had been destroyed, so the number of bodies still buried in the rubble is likely to be substantial, with estimates of more than 10,000.
The report says that 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 the suffering in the conflict, the authors concluded.
“Documenting the true scale is crucial for ensuring historical accountability and acknowledging the full cost of the war. It is also a legal requirement,” they said.
The report cites the interim measures set out by the ICJ in January 2024, which 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.”
This has not been heeded by the Israeli Occupation Forces.
As Israel pursues its massive war, now in its ninth month, starving Gaza’s population while destroying life-saving facilities and services, the conservative international media coverage of Palestinian suffering might be waning, observers say.
The findings and staggering estimate of the actual death toll of the Palestinians in The Lancet’s 650-word letter put the genocidal scale of Israel’s war in a new perspective. They also open avenues for a more pressing conversation about the repercussions of the war and its historical consequences.
* A version of this article appears in print in the 11 July, 2024 edition of Al-Ahram Weekly
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