The study finds that factors such as disease will cause many more indirect deaths in the long term, even if the war stops now.
The cumulative effects of Israel’s war on Gaza could mean the true death toll could reach more than 186,000, according to a study published in the journal Lancet.
According to the Gaza Health Ministry, more than 38,000 Palestinians have been killed since Israel launched its military offensive on October 7 following deadly Hamas attacks.
The study points out that the death toll is higher because the official toll does not take into account the thousands of dead buried under the rubble and indirect deaths due to the destruction of health facilities, food distribution systems and other public infrastructure.
Conflicts have indirect health consequences beyond the direct harm caused by violence, the study said, and even if the Gaza war ends immediately, it will continue to cause many indirect deaths in the months and years to come, particularly from disease.
The study said the death toll is likely to be much higher given that much of Gaza’s infrastructure has been destroyed, there are shortages of food, water and shelter, and the United Nations Relief and Works Agency for Palestine Refugees in the Near East has seen its funding cut.
“In recent conflicts, these indirect deaths are three to fifteen times more numerous than direct deaths,” he said.
After applying a “conservative estimate” of four indirect deaths for every one direct death, “it is not implausible to estimate that up to 186,000 deaths, or even more, could be attributable” to the Gaza war, the study said.
Such a figure would represent nearly 8 percent of Gaza’s pre-war population of 2.3 million.
The Lancet study noted that Israeli intelligence, the UN and the World Health Organization all agree that allegations of data fabrication made against Palestinian authorities in Gaza over its death toll are “implausible.”
He stressed that the toll is likely much higher because the destruction of infrastructure in Gaza has made it extremely difficult to maintain a count that is not lower than the actual number of dead.
“Documenting the true scale of events is essential to ensure historical accountability and to recognize the full cost of war. It is also a legal obligation,” he said.
The study notes that the International Court of Justice said in interim rulings issued in January in a genocide case against Israel that it must “take effective measures to prevent the destruction and ensure the preservation of evidence relevant to the alleged acts” under the Genocide Convention.
The study was published in the correspondence section of the journal, which means it has not been peer-reviewed.
