CORRESPONDENCE PUBLISHED IN The Lancet has warned that the death toll in Gaza could reach 186,000.

The Lancet is a weekly peer-reviewed medical journal, and one of the highest-impact academic journals.

In correspondence it published last week, titled ‘Counting the death in Gaza: difficult buy essential’, it was noted that the Gaza Health Ministry faces a difficult task in collecting this data.

The Lancet publishes correspondence as a reflection on content published in the journals, and such correspondance is not normally externally peer reviewed.

The health ministry is currently the only organisation counting the dead in the region.

Some Israeli authorities have attempted to dispute the figures provided by the Gaza health ministry, but they have been repeatedly supported by independent analyses.

However, the correspondence points to the destruction of much of the infrastructure in Gaza as one of the main barriers to gathering this information.

As of yesterday, the health ministry in Gaza said at least 38,153 people had been killed in the region since 7 October.

“The Ministry has had to augment its usual reporting, based on people dying in its hospitals or brought in dead, with information from reliable media sources and first responders,” said the report in The Lancet.

The authors said this change has “degraded the detailed data previously recorded” and that the number of reported deaths is “likely an underestimate”.

For example, Airwars, a not-for-profit that tracks and assesses civilian casualties from war, has noted that the names of unidentified victims are often not included in the list of the deceased from the Gaza health ministry.

Meanwhile, the UN warned in May that more than 10,000 people could be under the rubble in Gaza and that it could take up to three years to retrieve their bodies.

As of the end of February, 35% of buildings in the Gaza Strip had been destroyed.

The authors also pointed to “indirect health implications beyond the direct harm from violence”.

The authors stated that even if the conflict in Gaza were to end immediately, there would continue to be many indirect deaths in the coming years.

“The total death toll is expected to be large given the intensity of this conflict; destroyed health-care infrastructure; severe shortages of food, water, and shelter; the population’s inability to flee to safe places; and the loss of funding to UNRWA, one of the very few humanitarian organisations still active in the Gaza Strip,” said the authors.

The correspondance stated that in recent conflicts, “indirect deaths” are three to 15 times greater than the number of direct deaths.

As of 19 June, the Gaza health ministry reported that 37,396 people had been killed in the region.

By applying what the authors describe as a “conservative estimate of four indirect deaths per one direct death” to these figures as of 19 June, they said it is “not implausible to estimate that up to 186,000 or even more deaths could be attributable to the current conflict in Gaza”.

This would equate to 7.9% of the Gaza Strip population, according to the 2022 census estimate.

The authors said an immediate and urgent ceasefire is essential, alongside measures to enable medical supplies, food, and water into the region.

They add that providing a true count of the death toll in Gaza is vital for ensuring “historical accountability and acknowledging the full cost of the war”.

An earlier version of this article incorrectly described the ‘correspondence’ as a ‘study’. The article has also been updated to note that the 186,000 figure is what the death toll from the current conflict could rise to, rather than being a current figure.