A new analysis suggests Gazas real death toll, including those from deprivation, could be more than ten times higher than official figures, write DrRichard Hiland DrGideon Polya.

COUNTING THE DEAD and injured in war scenarios is always a fraught exercise, especially when that scenario is Gaza. The level of destruction in this tiny enclave of 360 square kilometres and one of the most densely populated places on Earth is such that gaining access to those impacted by bombs and bullets is indescribably difficult.

The Strip has been decimated, with the Israel Defence Forces (IDF) by June of this year having dropped100,000 tonsof explosives. Anywhere between 20,000 and 120,000 bodies remain buried beneath40 million tonsof rubble. Additionally, getting the injured to hospitals or the dead into mortuaries is equally difficult, given the incessant attacks on medical centres and Gazasone functioning hospital.

Apart from such logistical challenges, there is the question of politics and the various ways in which opposing factions manipulate body counts for their own strategic purposes. Anyone who has watched the supposed debates onPiers Morgan Uncensoredis aware of what this means in practice: high-pitched claims and counterclaims, with the truth of secondary concern.

Standing up for human rights in the 2020s is something that moves at a glacial pace.

The official count and its detractors

The Palestinian Ministry of Health has long been regarded as among the most accurate of death count monitoring organisations in the region. The IDF and Israeli Government spokespeople, however, consistently argue that the Ministry is a Hamas-run propaganda outlet, even though Israels ownintelligence serviceshave deemed the Ministrys data to be generally accurate.

Moreover, as Associated Press journalistIsabel Debre points out:

Debre quotesMichael Ryan, of the World Health OrganisationsHealth Emergencies Program, as saying the Ministrys figures largely reflect the level of death and injury.

Ryan asserts that the Ministrys data have been positively assessed by the UN independent investigators and have been aligned with Israels own estimates. Interestingly, as Debre notes, in past Gazan conflicts, the UN humanitarian office has conducted its own research into civilian deaths, which have matched figures provided by the Ministry. Israeli officials and organisations, however, continue to question their veracity.

The Ministrys numbers have also been queried by an international team of epidemiological researchers who put the Gazan death toll at 64,260. Writing in the respected medical journal,The Lancet, the researchers argue that this figure was arrived at by drawing on multiple data sources to estimate deaths due to traumatic injury in the Gaza Strip between October 7, 2023, and June 30, 2024.

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The researchers conclude:

Importantly, they argue that the actual death toll was likely much higher given the exclusion of non-trauma deaths resulting from the destruction of health care facilities, food insecurity and lack of water and sanitation.

Imposed deprivation spikes death toll numbers

Based on The Lancetstudys findings of the first nine months of the Israeli-imposed Gaza massacre, the projected death total by 25 April 2025 is calculated at 136,000 violent deaths after 15.5 months of killing.

In 2024,The Lancetreported aconservative estimate of four indirect deaths per one direct death. Assuming that deaths from deprivation were four times the violent deaths an estimate at the lower end of projections then the 136,000 violent deaths after 15.5 months of killing (25 April 2025) would imply 544,000 Gaza deaths from imposed deprivation. This would mean the total Gazan death toll would be 136,000 violent deaths plus 544,000 from imposed deprivation, leading to a staggering total of 680,000 deaths by 25 April 2025.

Most of these victims, as indicated in earlier counts by the Ministry of Health, are women and children.

Shocking in its enormity, the figure of 680,000 is derived from calculations based on other conflicts around the world. The UNHCRRefworld Global Law and Policy Databaserecords that the ratio of indirect deaths (non-violent deaths from imposed deprivation) to direct deaths (violent deaths) ranges from about two to 16 in a variety of wars in recent decades. The estimate of 680,000 Gazan deaths is thus about 11 times greater than the latest death toll figure of about 60,000 presently reported by Western mainstream media.

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Infants are the most at risk.Exhaustive analysisof avoidable deaths from deprivation in all countries from 1950 onwards reveals that under-five-year-old infant deaths make up about 70 per cent of avoidable deaths in impoverished countries. In early May 2024, ajoint studyby theUN Development Programmeand the Economic and Social Commission for Western Asia (ESCWA) reported that the poverty rate in Gaza, already chronic, surged to 58.4 per cent since 7 October 2023.

Since then, conditions have deteriorated. Infants are highly vulnerable. Thus, for example, breast feeding would be highly problematic for highly traumatized Gaza mothers substantially denied water, food, shelter, hygiene, baby bottles, baby formula, electricity, sanitation, medicines, medical care and other life-sustaining requisitesdemanded of the occupying powerby Articles 55 and 56 of theFourth Geneva Convention (IV)relative to the Protection of Civilian Persons in Time of War.

In conclusion, the full scale of death in Gaza since 7 October 2024 cannot be attributed simply to violent deaths caused by the actions of the IDF. Deaths from imposed deprivation must be factored into the analysis. In so doing, the actual death toll of 680,000 deaths from violence and imposed deprivation by 25 April 2025 posits an extraordinary picture of unremitting carnage in which children and women are most impacted.

The figures provided by the Gazan Health Ministry are merely the tip of a huge iceberg that reflects unimaginable human suffering experienced by the Palestinian people. This, of course, is only part of a much larger and harrowing story of physical and psychological hardship almost beyond comprehension.

DrRichard Hilis adjunct professor in the School of Health Sciences and Social Work at Griffith University, Gold Coast; adjunct professor in the Faculty of Law, Business and Arts at Southern Cross University.

DrGideon Polyais a Melbourne-based biochemist, writer, humanitarian activist and artist.

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