Correspondence
Counting the dead in 35% of buildings in the Gaza Strip had requirement. The interim measures
been destroyed,5 so the number of set out by the International Court
Gaza: difficult but bodies still buried in the rubble is likely of Justice in January, 2024, require Published Online
essential substantial, with estimates of more Israel to “take effective measures to July 5, 2024
https://doi.org/10.1016/
than 10 000.7 prevent the destruction and ensure S0140-6736(24)01169-3
By June 19, 2024, 37 396 people had Armed conflicts have indirect health the preservation of evidence related
been killed in the Gaza Strip since implications beyond the direct harm to allegations of acts within the scope
the attack by Hamas and the Israeli from violence. Even if the conflict ends of … the Genocide Convention”. 11
invasion in October, 2023, according immediately, there will continue to be The Gaza Health Ministry is the
to the Gaza Health Ministry, as many indirect deaths in the coming only organisation counting the
reported by the UN Office for the months and years from causes such dead. Furthermore, these data will
Coordination of Humanitarian Affairs.1 as reproductive, communicable, and be crucial for post-war recovery,
The Ministry’s figures have been non-communicable diseases. The restoring infrastructure, and planning
contested by the Israeli authorities, total death toll is expected to be large humanitarian aid.
although they have been accepted given the intensity of this conflict; MM is a member of the editorial board of the Israel
as accurate by Israeli intelligence destroyed health-care infrastructure; Journal of Health Policy Research and of the
International Advisory Committee of the Israel
services,2 the UN, and WHO. These severe shortages of food, water, and National Institute for Health Policy Research.
data are supported by independent shelter; the population’s inability MM was co-chair of the Institute’s 2016 6th
analyses, comparing changes in the to flee to safe places; and the loss of International Jerusalem Conference on Health
Policy, but writes in a personal capacity. He also
number of deaths of UN Relief and funding to UNRWA, one of the very
collaborates with researchers in Israel, Palestine,
Works Agency (UNRWA) staff with few humanitarian organisations still and Lebanon. RK and SY declare no competing
those reported by the Ministry,3 which active in the Gaza Strip.8 interests. The authors would like to acknowledge
found claims of data fabrication In recent conflicts, such indirect study team members Shofiqul Islam and Safa
Noreen for their contribution to collecting and
implausible.4 deaths range from three to 15 times managing the data for this Correspondence.
Collecting data is becoming the number of direct deaths. Applying Editorial note: The Lancet Group takes a neutral
increasingly difficult for the Gaza a conservative estimate of four position with respect to territorial claims in
Health Ministry due to the destruction indirect deaths per one direct death9 published text and institutional affiliations.
of much of the infrastructure.5 The to the 37 396 deaths reported, it is *Rasha Khatib, Martin McKee,
Ministry has had to augment its not implausible to estimate that up to Salim Yusuf
usual reporting, based on people 186 000 or even more deaths could [email protected]
dying in its hospitals or brought in be attributable to the current conflict Advocate Aurora Research Institute, Milwaukee,
dead, with information from reliable in Gaza. Using the 2022 Gaza Strip WI 53233, USA (RK); Institute of Community and
media sources and first responders. population estimate of 2 375 259, Public Health , Birzeit University, Birzeit, Palestine
(RK); Department of Public Health and Policy,
This change has inevitably degraded this would translate to 7·9% of the London School of Hygiene & Tropical Medicine,
the detailed data recorded previously. total population in the Gaza Strip. A London, UK (MM); The Population Health Research
Consequently, the Gaza Health report from Feb 7, 2024, at the time Institute, McMaster University and Hamilton Health
Sciences, Hamilton, ON, Canada (SY)
Ministry now reports separately when the direct death toll was 28 000,
1 UN Office for the Coordination of Humanitarian
the number of unidentified bodies estimated that without a ceasefire Affairs. Reported impact snapshot. Gaza Strip.
among the total death toll. As of there would be between 58 260 deaths June 19, 2024. https://www.ochaopt.org/
May 10, 2024, 30% of the 35 091 (without an epidemic or escalation) content/reported-impact-snapshot-gaza-strip-
19-june-2024 (accessed June 21, 2024).
deaths were unidentified.1 and 85 750 deaths (if both occurred) by 2 Prothero M. Israeli Intelligence has deemed
Some officials and news agencies Aug 6, 2024.10 Hamas-run health ministry’s death toll figures
generally accurate. 2024. https://www.vice.com/
have used this development, designed An immediate and urgent ceasefire en/article/y3w4w7/israeli-intelligence-health-
to improve data quality, to undermine in the Gaza Strip is essential, ministry-death-toll (accessed May 2, 2024).
the veracity of the data. However, accompanied by measures to enable 3 Huynh BQ, Chin ET, Spiegel PB. No evidence of
inflated mortality reporting from the Gaza
the number of reported deaths is the distribution of medical supplies, Ministry of Health. Lancet 2024; 403: 23–24.
likely an underestimate. The non- food, clean water, and other resources 4 Jamaluddine Z, Checchi F, Campbell OMR.
governmental organisation Airwars for basic human needs. At the same Excess mortality in Gaza: Oct 7–26, 2023.
Lancet 2023; 402: 2189–90.
undertakes detailed assessments time, there is a need to record the 5 UNOSAT. UNOSAT Gaza Strip comprehensive
of incidents in the Gaza Strip and scale and nature of suffering in this building & housing unit damage assessment,
March 2024. 2024. https://unosat.org/
often finds that not all names of conflict. Documenting the true scale products/3804 (accessed May 2, 2024).
Submissions should be
made via our electronic
identifiable victims are included in is crucial for ensuring historical 6 Airwars. Israel and Gaza. 2024. https://airwars. submission system at
the Ministry’s list.6 Furthermore, the accountability and acknowledging org/conflict/israel-and-gaza-2023/ (accessed http://ees.elsevier.com/
May 3, 2024).
UN estimates that, by Feb 29, 2024, the full cost of the war. It is also a legal thelancet/
www.thelancet.com Published online July 5, 2024 https://doi.org/10.1016/S0140-6736(24)01169-3 1
Correspondence
7 UN Office Geneva. 10 000 people feared buried
under the rubble in Gaza. 2024. https://www.
ungeneva.org/en/news-media/news/2024/05
/93055/10000-people-feared-buried-under-
rubble-gaza (accessed May 3, 2024).
8 Reuters. More countries pause funds for UN
Palestinian agency. 2024. https://www.
reuters.com/world/britain-italy-finland-pause-
funding-un-refugee-agency-
gaza-2024–01–27/ (accessed May 2, 2024).
9 UN Office on Drugs and Crime. Global burden
of armed conflict. 2008. https://www.unodc.
org/documents/wdr/WDR_2008/WDR_2008_
eng_web.pdf (accessed April 10, 2024).
10 Jamaluddine Z, Chen Z, Abukmail H, et al.
Crisis in Gaza: scenario-based health impact
projections. 2024. https://aoav.org.uk/wp-
content/uploads/2024/02/gaza_projections_
report.pdf (accessed May 1, 2024).
11 International Court of Justice. Application of
the Convention on the Prevention and
Punishment of the Crime of Genocide in the
Gaza Strip. 2024. https://www.icj-cij.org/sites/
default/files/case-related/192/192–20240126-
ord-01–00-en.pdf (accessed May 3, 2024).
2 www.thelancet.com Published online July 5, 2024 https://doi.org/10.1016/S0140-6736(24)01169-3
