The death toll from Israel's war on Gaza is more than 50 per cent higher than the figures published by the enclave's Ministry of Health, said a report published on Wednesday.
The Lancet report recorded 75,200 violent deaths as of early last year at a time when the ministry's figure was 49,090. A further 16,300 non-violent deaths were also recorded during the period covered by the medical journal's study – October 7, 2023, when the Hamas-led attack on Israel killed about 1,200 people, to January 5, 2025.
Israel has consistently refuted the ministry's figures – which put the current death toll at more than 72,000 – claiming they are higher than reality, despite being widely accepted by the UN and international NGOs.
There are several challenges to producing accurate figures. First, bodies must be recovered as thousands remain missing or under rubble with not enough equipment allowed into the enclave to recover them. Then, the identity of the bodies must be established, the report said. “Bodies can be mutilated beyond recognition or there might be no surviving family members to confirm their identity,” it said.
“Documentation must be produced (physical documents are often burnt or lost and electronic systems are difficult to access), and records must be transmitted in a context of intermittent electricity, communications blackouts and displacement.”
In Gaza, nine out of 10 people were displaced more than once during the war. This has fractured social networks that would help in confirming and reporting deaths.
Israel's bombardment has damaged or destroyed every hospital in the strip, hindering access to paper records and creating “discontinuities in reporting”, the report said.
The report considers indirect deaths as those caused by the deterioration of health systems and living conditions – a by-product of direct physical violence. But the classification is not always clear.
“People who die of sepsis after injury, renal failure after a crushing blast wound or those who die after being unable to access surgery – because of resource limitations, the inability to reach a hospital or the unavailability of a surgeon – could occupy a grey zone between direct and indirect mortality classifications,” it said.
Medical shortages meant operations had to be performed without anaesthesia, or amputations without the right tools. This resulted in major infections and the need to do the surgery again. Doctors in Gaza have been killed and detained by Israel, reducing the number of specialists available and limiting the assistance available.
By not including these cases as “direct deaths”, the toll is underestimated.
Since January 2025, when the period covered by the report ended, Israel has continued to strike the enclave, including after a ceasefire was reached in October.
The Ministry of Health said 603 people have been killed in Israeli attacks since the ceasefire was agreed.
