A study in the scientific journal indicates that the people who have died in Gaza from traumatic injuries in the first nine months of the war against Israel – between October 7, 2023 and June 30 – amount to 64,260. This calculation, based on a system that compares three different lists, exceeds by 69.65% the figure of 37,877 deaths in the same period, provided by the authorities of Gaza, a territory controlled by Hamas. The article of The Lancet suggests that, taking into account the number of deaths recorded until October by the Strip’s Ministry of Health – which today already exceeds 46,000 – the total number of deaths using its methodology would amount to more than 70,000.
On October 7, 2023, the war began, with. Since then, the Gaza Ministry of Health has provided a record of the fatalities every day. These figures have been the subject of controversy both by those who consider them too high and by those who consider them too low. Finally, the work ensures that the number of deaths has been underestimated.
The researchers used a work system known as “capture-recapture,” based on the superposition of three lists: one with deaths recorded in hospitals and morgues of the Ministry of Health, a survey on line prepared by the ministry itself and the obituaries spread on various social networks. This method is often used to estimate populations when complete counts are not practical or reliable.
The missing, excluded from the study
The epidemiologist, a member of the team of four researchers responsible for the study, explains that the “capture-recapture” system was popularized by environmentalists. “They captured, marked and released animals or insects in a specific area, then captured them again and, based on the overlaps, estimated the size of the populations.” The method has also been adapted in epidemiology to study disease prevalence and mortality rates in various contexts, including conflict zones. “The capture-recapture technique,” continues the researcher, “has been applied to estimate mortality in several conflict-affected areas, such as Kosovo, Sudan, Guatemala and Colombia. It allows researchers to estimate the total number of deaths, including those not recorded in any single data source, by analyzing the overlap between different lists of people killed.
Jamaluddine assures that the statistical data managed by the Ministry of Health before the war was among the best in the region. “You cannot find anything like this in Syria, not even before the civil war. But war also degrades health information systems,” he continues. The study clarifies that “the escalation of Israeli ground military operations and attacks on health facilities seriously disrupted the ability” of the authorities to electronically register deaths. That’s what prompted scientists to undertake a study that lasted three months. And the result they found was that the Ministry of Health had underestimated the number of deaths by 41% during the first nine months of the invasion.
Two of the lists that the team has worked with The Lancet They come from the Ministry of Health. When the researcher is asked if this does not imply too great a dependence on the Hamas health authorities, she responds: “It is. “I don’t mean to say that we haven’t used the ministry’s data,” he assumes. “We relied on those with a clearly identified name and cleaned the data by removing duplicates and correcting errors. But to do it properly we would have needed to enter Gaza with protection. And that has not been possible. There are international agencies that work in the Strip, such as the UN or Unicef, but for them the priority is getting food and medicine. “They can’t call people and ask them how many people died in their home, when what those people want is food or medicine.”
The study highlights in its conclusions “the urgent need” to achieve “an immediate and sustained cessation of hostilities and a lasting agreement that includes the release of the Israeli hostages and the thousands of Palestinian civilians imprisoned by Israel.”
“Consistent data”
Eduardo Satué, president of the Spanish Society of Public Health and Health Administration (), explains in a telephone conversation from Spain that what he has done The Lancet is to study different lists and see if they are consistent with each other. “And from the data I’ve seen, I think it’s consistent.” Satué points out that this “capture-recapture” method is the most reliable, given its complexity. “It is what we have, at the moment there are no more precise alternatives. Of course, the ideal would be to undertake it in periods of peace, as was done in 2006 in the Iraq war, comparing figures before and after the invasion. Even in periods of peace we already saw during the pandemic how complicated it is to calibrate statistics, for example differentiating between dying from Covid or with Covid. But in the current conditions of Gaza this would be the best way to fine-tune.”
Satué, a pharmacist by profession, is not surprised that the number of deaths is higher than those provided directly by the health authorities. “Traditional counting methods in times of conflict are based on those provided by the military regarding those killed in combat, those provided by hospitals and morgues, and those directly observed. And the latter only become part of the official statistics if the identity of the deceased, where and how they died is known. Therefore, they tend to underestimate the number of deaths.”
The president of SESPAS points out that although the study of The Lancet focuses on the direct deaths of the conflict, it is worth remembering that “those who died due to indirect consequences of the war are more numerous than those who died violently. Whether due to malnutrition, water contamination, lack of health care… And in Gaza it can have a greater impact than in other conflicts due to the population density and because it is a kind of prison that makes care much more difficult.”
The study of The Lancet assumes that accurately measuring indirect mortality during an ongoing war presents too many “challenges and limitations.” Access limitations and “extremely unsafe conditions for health and humanitarian workers” make it unviable.
Satué remembers that his own association has published his series War conflicts and their impact on healthabout the way in which these conflicts affect vulnerable groups, such as minorities, pregnant women and children. 59% of deaths in Gaza for which data on age and sex were available, according to The Lancetoccurred among women, children and the elderly, groups considered especially vulnerable and less likely to be combatants.
