On Monday of this week, [the] Health Ministry in the Gaza Strip published an updated list of those killed in the war, a 1,227-page chart, arranged from youngest to oldest. The Arabic-language document includes the deceased person's full name, the names of the father and grandfather, date of birth and ID number.
Unlike previous lists, this compilation notes the precise age of children who were under the age of one year when they were killed. Mahmoud al-Maranakh and seven more children died on the same day they were born. Four more children were killed on the day after they entered the world, five others lived to the age of two days. Not until page 11, following 486 names, does the name appear of the first child who was more than six months old when he was killed.
The names of the children under the age of 18 cover 381 pages and amount to 17,121 children, all told. Of the total of 55,202 dead people, 9,126 were women.
Israeli spokespersons, journalists and influencers reject with knee-jerk disgust the data of the Palestinian Health Ministry, claiming that it's inflated and exaggerated. But more and more international experts are stating that not only is this list, with all the horror it embodies, reliable — but that it may even be very conservative in relation to reality.
Prof. Michael Spagat, an economist at Holloway College at the University of London, is a world-class expert on mortality in violent conflicts. He's written dozens of articles on the wars in Iraq, Syria and Kosovo, among others. This week he and a team of researchers published the most comprehensive study to date on the subject of mortality in the Gaza Strip.
With the aid of Palestinian political scientist Dr. Khalil Shikaki, the team surveyed 2,000 households in Gaza, comprising almost 10,000 people. They concluded that, as of January 2025, some 75,200 people died a violent death in Gaza during the war, the vast majority caused by Israeli munitions.
At that time, the Health Ministry in the Gaza Strip placed the number of those killed since the war's start at 45,660. In other words, the Health Ministry's data undercounted the true total by about 40 percent.
The study hasn't yet undergone peer review — it was published as a "preprint" — but its results are very similar to those of a study conducted by completely different methods and published last January by researchers from the London School of Hygiene and Tropical Medicine. That group also estimated the disparity between the Health Ministry data and the true figures to be about 40 percent.
Another report, published this week by Matthew Ghobrial Cockerill, a history doctoral student at the London School of Economics, carried out for the organization Action on Armed Violence, also cites larger numbers than those of the Gaza Health Ministry. Cockerill and his team examined the names of 1,000 children out of 3,000 that the Health Ministry erased from its lists, and concluded that, despite the erasure, solid evidence exists that most of those children were killed.
The study by Spagat and his colleagues also tries, for the first time, to answer the question of excess mortality in the Strip. In other words, how many people died from the indirect effects of war: hunger, cold, diseases that could not be treated because of the destruction of the health system, and other factors.
During the first year of the war, various estimates about the excess mortality rate were published by researchers and physicians, most of which turned out to be highly exaggerated. According to the new survey, the number of excess deaths until January stood at 8,540. That's a huge number by any standard, but low compared to the estimates that tens of thousands would die in Gaza due to hunger and disease.
Haaretz spoke to a number of experts on this subject. The conventional answer is that before the war, the health of the Gaza Strip's population and the condition of the health-care system there were relatively good, certainly compared to other places plagued with ongoing conflicts, such as Africa or Yemen. For example, the vaccination rate in Gaza was very high, in part thanks to a multi-year effort by UNRWA, the United Nations refugee agency.
Another explanation the researchers offer for what was previously a relatively low excess mortality rate is Gaza's social and communal structure. The family support networks proved their effectiveness in times of hunger and deprivation, and apparently saved many Gazans from death. Spagat also notes favorably the activity of the UN and the other aid organizations, which during the war's first year were successful in feeding the population and looking after the state of its health.
But all those protections, Spagat emphasizes, were effective only during that first year. During the past half-year, it's been evident that the Gazan population increasingly lacks the ability to protect itself against excess mortality.
For one, the displacement of 90 percent of the Strip's residents and the collapse of the health system led to a decline in the vaccination rate. Additionally, exposure to cold, heat, accidents, crowding and diseases in the tent cities in which the majority of Gaza's inhabitants now live has left them increasingly vulnerable.
The shortage of food and the neutralization of a large proportion of the UN's activity in Gaza, in the wake of the full siege of 78 days (March 2–May 19), and the partial siege that has continued for more than a month since then, are causing a deficiency of vitamins, minerals and proteins, affecting Gazans' immune systems. The ongoing destruction of the hospitals and the rest of the Strip's medical infrastructure has increased extensively since the resumption of hostilities.
The conclusion from these developments is that it's very likely that Gaza will continue to experience waves of excess mortality in the near future. "I would speculate that the ratio of nonviolent to violent deaths has gone up since [the January study]," Spagat says.
In the 'Africa league'
In the meantime, even without the anticipated future waves of excess mortality, the combination of casualties from violence and those who died from diseases and hunger led to the death of 83,740 people prior to January, taking into account the survey and the excess mortality. Since then, according to the Gaza Health Ministry, more than 10,000 people have been killed, and that doesn't include those in the category of excess mortality. The upshot is that even if the war hasn't yet crossed the line of 100,000 dead, it's very close.
These data, says Prof. Spagat, position the war in the Gaza Strip as one of the bloodiest conflicts of the 21st century. Even if the overall number of war victims in Syria, Ukraine and Sudan is higher in each case, Gaza is apparently in first place in terms of the ratio of combatants to noncombatants killed, as well as in terms of rate of death relative to population size.
According to the survey's data, which is consistent with those of the Palestinian Health Ministry, 56 percent of those killed have been either children up to the age of 18, or women. That's an exceptional figure when compared with almost every other conflict since World War II.
Data compiled and published by Spagat indicates that the proportion of women and children killed via a violent death in Gaza is more than double the proportion in almost every other recent conflict, including, for example, the civil wars in Kosovo (20 percent), northern Ethiopia (9 percent), Syria (20 percent), Colombia (21 percent), Iraq (17 percent) and Sudan (23 percent).
Another extreme datum found in the study is the proportion of those killed relative to the population. "I think we're probably at something like 4 percent of the population killed," Spagat says, adding, "I'm not sure that there's another case in the 21st century that's reached that high.
"I should have another look at the new data coming out of Sudan, and there's controversy regarding the Democratic Republic of Congo. But we are in the league of Africa, not the Middle East." That's not good company.
Despite these numbers, Spagat is in no hurry to employ the term "genocide," which has been adopted by a large part of the international community of conflict researchers about the war in Gaza. "I don't think this survey can give a verdict [on this question]," he says. It's still necessary to prove Israel's intention to perpetrate genocide, he adds, but "I think that South Africa had a pretty strong case to make" at the International Court of Justice.
The best scenario, he says, is that what's taking place in Gaza amounts to "only" ethnic cleansing.
In contrast to the richness of the data, offered by the official ministry lists and the research studies, that corroborate the numbers of the Gaza Health Ministry, the silence of official Israeli spokespeople about the number of those killed is striking. The October 7 war is the first in which the Israel Defense Forces has not provided estimates of the number of enemy civilians killed.
The only figure that the IDF Spokesperson's Unit and other official Israeli spokespersons repeat is of 20,000 terrorists from Hamas and other organizations who were killed. That figure is not backed up by a list of names or other proof or sourcing.
According to Spagat, there was an attempt to count the number of names of terrorists that were published by Israel. His team managed to arrive at a few hundred, but it's difficult to compile a list of even a thousand, he says.
Cockerill, too, maintains that that number is not credible. "Based on an overwhelmingly consistent historical pattern," he says, "we know that [in general,] at least twice as many combatants will be wounded as killed. So if Israel says 20,000 have been killed, we assume at least 40,000 have been injured, and it doesn't make sense that Hamas had 60,000 militants."
Cockerill says that Israel is “engineering the combatants figure” by two main means. “One is by redefining civilians who work for the government as combatants, the other is ‘kill zones,’” in which everyone who is killed is considered a combatant.
One way or the other, even if we accept the official figure, it still comes down to a ratio of four noncombatants killed for every Hamas militant. That's very far from the statements of Israeli spokespersons, who talk about a 1:1 proportion.
The recent research raises a question: If the number of dead is indeed significantly greater than what's reported by the Gaza Health Ministry, where are the bodies? The ministry's records are based primarily on bodies that have been brought to hospital morgues.
Spagat and other researchers think that thousands of people are still buried under the rubble of tens of thousands of buildings in the Strip, and therefore their names do not appear on the lists. Some people were close to the epicenter of explosions and nothing remains of them. But that cannot account fully for the disparity between the Health Ministry and the survey.
Another explanation suggested by Spagat is that families who lost loved ones simply buried them without bringing the bodies to the hospitals and without reporting the deaths to the Health Ministry. "Some families just don't want to report or are unable to report," Korkil avers. "Maybe the parents die, and the children, and an 8-year-old remains. How is the 8-year-old going to report this?"
'Can I die, please?'
At Nasser Hospital, in the city of Khan Yunis, the statistics take on real form. "You cope every day with cases of trauma, blast injuries and shrapnel," says Dr. Goher Rahbour, a British surgeon who returned home last week from a month at the Gaza hospital. "Every two or three days, there was a mass-casualty event, and then the ER was totally flooded, complete chaos."
One case that remains engraved indelibly in Rahbour’s memory is that of a 15-year-old boy whose entire family was killed and who had himself been wounded and left paralyzed. “He has shrapnel going through the spinal cord, so he is paraplegic, which means he’s got no sensation below the waist or the belly button.
“He’s lived in Gaza for 15 years, he knows what’s coming next, what’s waiting in Gaza for a 15-year-old boy in a wheelchair. No family, no physiotherapy, all these things that we take for granted.
“So he goes around in the hospital and says to us, ‘Can I die, please?’”
Even though Israel has for the past month been allowing the entry into Gaza of a limited supply of food via the UN and the Israeli-American Gaza Humanitarian Foundation, the nutrition situation in the Strip continues to worsen. Last month, 5,452 children were hospitalized because of severe malnutrition, according to the UN's Office for the Coordination of Humanitarian Affairs.
“People are simply gaunt,” says Rahabour. “You can see the bones on their face, the bent appearance, the protruding jawbones. For a month, I haven’t seen fruits, vegetables, meat or fish here.
"They have formula which they can give to children from the age of six months to five years. So I asked what happens if a hungry child of seven arrives. Sorry, we have to say bye-bye and send them home to die."
Dr. Rahabour and other physicians in the Strip say that the general health situation of the population is deteriorating steadily, because of the hunger and displacement. "You see that the body has no wound-healing capabilities," says Dr. Victoria Rose, a British surgeon who was a volunteer in the Gaza Strip until three weeks ago.
"One of the first things you lose in malnutrition is your ability to fight infection," she adds. "The children have very little healing ability left, and they're living in tents. There's no sanitation, there's no sewage [treatment] or anything like that. Everything has been destroyed and clean water is running out. All of that combined means that you just can't get anything clean, so it can't heal without infection."
If the hunger itself were not enough, hundreds of people have been killed in recent weeks by Israeli gunfire while on their way to collect food from the distribution centers.
Two weeks after Goher Rahabour arrived at Nasser Hospital, on June 1, he observed that the profile of the wounds had changed. Instead of blast and detonation injuries, many more people began arriving with bullets in their body, after Israeli troops opened fire at the starved crowd.
On the first day, he recalls, 150 or 200 wounded people arrived, in addition to 30 dead. “With some of them you can see that they were shot while they lay on the ground, trying to evade being shot. Most of them were young men, but there was one woman in her early 30s, who was 24 weeks pregnant. The bullet went through the fetus. She survived but needed a hysterectomy, so no more children. When we opened the abdomen, we could see the hand and the formed foot of the dead fetus.
“I'm just staring, like what the hell, but the [Palestinian] anesthetist, gynecologist and scrub nurse are carrying on as though this is normal. It's because they've seen this again and again. You just become numb to it.
“It’s as if it’s just normal, you know?”