According to a "letter" published on the website of the British medical journal The Lancet, "186,000 or even more deaths could be attributable to the current conflict in Gaza". This is a significantly higher death toll than the 38,345 announced by the Hamas-run territory’s health ministry on Thursday. FRANCE 24 takes a look at how the authors arrived at this estimate and whether their figure is credible.
According to a "letter" published on July 5 on the website of the renowned British medical journal The Lancet entitled "Counting the dead in Gaza: difficult but essential", "it is not implausible to estimate that up to 186,000 or even more deaths could be attributable to the current conflict in Gaza".
Based on "the 2022 Gaza Strip population estimate of 2,375,259, this would translate to 7.9% of the total population in the Gaza Strip", write the co-authors of this letter published in the "correspondence" section of the website.
These figures are significantly higher than the death toll of 38,345 announced on Thursday July 11 by the Gaza Health Ministry, which has been publishing daily figures since the start of Israel’s offensive against Hamas in the besieged Palestinian territory, in response to the Islamist militant group’s October 7 attack on Israeli soil.
Direct and indirect deaths
This letter was co-written by Rasha Khatib, researcher at the US-based Advocate Aurora Research Institute and the Institute of Community and Public Health at Birzeit University in the occupied West Bank; Martin McKee, professor of European Public Health at the London School of Hygiene & Tropical Medicine and member of the International Advisory Committee of the Israel National Institute for Health Policy and Health Services Research; and, Salim Yusuf, distinguished professor of medicine at McMaster University and Hamilton Health Sciences in Canada. Despite it not being either a report or scientific study, this letter, which includes an estimated number of direct and indirect deaths as a result of this conflict, has made global headlines.
The Lancet explains that correspondence or "letters" are "reflections" from readers on "content published in The Lancet or on other topics of interest to our readers" that are "not usually peer reviewed". Peer review is the standard method for validating the results of scientific research, carried out by qualified experts.
The co-authors write that they started from the principle that "armed conflicts have indirect health implications beyond the direct harm from violence" to arrive at the death toll of 186,000. They therefore applied a "conservative estimate" of four indirect deaths per one direct death, basing their calculation on the figure of 37,396 deaths recorded on June 19 by the Gaza Health Ministry – the Palestinian territory has been run by the militant group Hamas since its June 2007 coup. It is difficult to gather accurate figures, write the co-authors, due to the difficulties encountered in carrying out daily assessments on the ground.
To arrive at their estimate of "four indirect deaths per one direct death", the co-authors relied on a report published by the Secretariat of the Geneva Declaration on Armed Violence and Development in 2008. The document states that in areas where there is armed conflict "studies show that between three and 15 times as many people die indirectly for every person who dies violently". However, the letter’s signatories did not say why they chose four for their "conservative estimate". In line with the controversy surrounding the death toll in Gaza, the letter provoked a flood of reactions online.
On the one hand, the letter has been widely accused of being biased, as it relies on a questionable calculation method and hypothetical estimates. The Israeli newspaper The Jerusalem Post reported that "the platform provided by the respected magazine", The Lancet, gave the letter "a reliable atmosphere. This led anti-Israel users on social media to propagate the new libel en masse".
However, the letter, which was picked up by several international media, was welcomed by others and widely shared to express support for the Gazan population and call for an end to Israeli military operations in Gaza.
For instance, Francesca Albanese, the United Nations Special Rapporteur on the Palestinian Territories, shared it on her X account as evidence of what she described as "9 months of genocide" taking place in Gaza.
A ‘credible’ estimate, according to Doctors of the World
Some NGOs active in the Palestinian territory certainly feel that the estimate put forward in this letter is credible.
"The death toll of 186,000 mentioned in The Lancet is consistent with the health, military and geopolitical situation due to the sea, air and land blockade imposed on the Gaza Strip," says Jean-François Corty, a humanitarian doctor and president of the NGO Doctors of the World. "This estimate is a true reflection of the absolute tragedy being experienced on the ground by the population."
"I have been saying as recently as November/December that the figures being put forward are underestimated in relation to reality, in a context where there is a lot of propaganda surrounding the death toll, as is the case in many conflicts and not exclusively in Gaza. Since the beginning of the controversy over the Hamas Ministry of Health's figures, which are probably wrong, I have said that they are probably wrong, but because they are underestimated."
Corty asserts that the Gaza Health Ministry's figures take into account the identified dead, "without taking into account all the dead left under the rubble of the bombardments, or the indirect victims who died because of a lack of care or access to care, or from being transported to a health centre".
The president of Doctors of the World – which currently has a team of around 50 people in Deir Al-Balah, in the centre of the Gaza Strip – points out that there were 35 hospitals operating in Gaza before October 7, "with a good level of medical care and dozens, if not hundreds, of local health centres".
"But today, most of these hospitals are no longer functional, there are only between 5 and 10 left, and they are saturated with patients," says Corty. "They don't just take in patients, they also house families of displaced people, and they're running out of everything – fuel for their generators, medicines and medical and surgical equipment."
Corty concludes: "If you add those who are likely to die of malnutrition or as a result of wounds inflicted by Israeli bombardments in the weeks and months to come, because of the risks of superinfection and because their pathology will be treated late, then yes, the figure of 186,000 deaths mentioned in The Lancet is credible."
This article has been translated from the original in French.
