Gazan health officials say that more than 38,000 people have been killed in nine months of fighting between Israel and Hamas, but researchers are also studying how many people have died as an indirect result of the conflict.
Scientists say that this measurement, known as excess deaths, can provide a truer indication of the toll and scale of conflicts and other social upheaval. They say, for example, that if a person dies from a chronic illness because they are unable to get treatment in a medical facility overburdened by war, that death can be attributed to the conflict.
The question of excess deaths in Gaza was raised in a letter published last week in the medical journal The Lancet, in which three researchers attempted to estimate how many people had died or would die because of the war, on top of the deaths reported by the Gaza Health Ministry. The letter immediately generated debate, with other researchers arguing for caution in any such projection.
One reason to be careful, those researchers said, is that any estimate of excess deaths would rely on data from Gaza’s health sector, which has been devastated by the conflict. Another reason, they said, is that it is hard to predict how epidemics and hunger, two threats to human life that can be triggered by war, will evolve. And Israel has not permitted researchers to enter the enclave since the start of the war last October.
The letter in The Lancet, which said that counting indirect deaths in Gaza was “difficult but essential,” based its estimate on looking at previous studies of recent conflicts, which indicated that three to 15 times as many people died indirectly for every person who had died violently. Applying what they called a “conservative estimate of four indirect deaths per one direct death,” the authors wrote that it was “not implausible” to estimate that about 186,000 deaths could eventually be attributable to the conflict in Gaza.
The letter, which The Lancet said had not been peer-reviewed, as is the case with other letters it publishes, provoked a significant response. The Board of Deputies of British Jews, which represents the Jewish community in Britain, said that the estimate was “little more than conjecture.”
Col. Elad Goren, an official with COGAT, the arm of the Israeli military that implements policy in Gaza, sidestepped a question about excess deaths.
Salim Yusuf, a cardiologist and epidemiologist in Canada who co-wrote the letter, said in an email that the estimate was based on studies of past conflicts and acknowledged that, “inevitably, these are projections.” “The point is that the real numbers of dead will be very large,” he said.
Michael Spagat, a professor of economics at Royal Holloway College at the University of London, who has written about the toll of the war in Gaza, wrote in an analysis that the letter “lacks a solid foundation and is implausible.” He argued that the authors had compared Gaza with a small and unrepresentative sample of other conflicts, and that conditions in Gaza, a small territory under intense international attention, are unique.
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