Counting the dead

 According to Joe Lauria, writing on the 24 July, Netanyahu ‘has already officially killed more than 39,000 Palestinians [nearly 200,000 according to The Lancet]’. In an otherwise insightful article on the 19^th, Randa Abdel-Fattah, wrote of, ‘a genocide that has so far, on a recent conservative [sic] by the Lancet,...caused an estimated 186,000 deaths and counting’. Similarly, on 16 July, Michael Arria said, ‘A recent report from The Lancet estimates that the actual death toll in Gaza could be more than 186,000. So far.’ [my emphasis]

By the 24^th, he revised his approach, writing, ‘The British medical journal The Lancet estimates that the death toll of Israel’s genocidal onslaught on Gaza will reach at least an estimated 186,000 Palestinians.’ The next day, he toned his allegations down further, ‘The Lancet recently published a study estimating that the death toll in Gaza will reach at least 186,000.’

In reality, the document at issue is not the Lancet’s work, but a letter from three researchers, Rasha Khatib, Martin McKee, and Salim Yusuf. The central claim in the six paragraph letter, was,

In recent conflicts, such indirect deaths range from three to 15 times the number of direct deaths. Applying a conservative estimate of four indirect deaths per one direct death to the 37 396 deaths reported, it is not implausible to estimate that up to 186 000 or even more deaths could be attributable to the current conflict in Gaza. [my emphasis]

An assertion that something is ‘not implausible’ inspires little confidence. It’s important to note that in the Lancet ‘letters are not normally externally peer reviewed’ and the letter does not report a study, per se, but merely a calculation based on the Ministry of Health’s report of total direct fatalities as at 19 June. The authors multiplied that number, 37 396, by a factor of four to arrive at a number of indirect fatalities. The source of the multiplier is a 2008 report on the Global Burden of Armed Violence, which actually reports the ratio between direct and indirect deaths in 13 specific conflicts as ranging from 0 (Kosovo 1998-99) to 15.7 (Sierra Leone 1991-2002) (Table 2.3, p. 40). Khatib et al. do not specify how they decided to select a factor of four other than that it seemed conservative to them.

Michael Spagat, a University of London economist, analysed their approach and pointed out that the 13 conflicts may not be representative, that the ratios reported may not be robust, and in any case, factors like Gaza’s population density and the level of attention it has attracted make the situation there unique.

Spagat expresses doubt whether the figure of 186 000 is a projection. But Khatib et al. write, ‘Even if the conflict ends immediately, there will continue to be many indirect deaths in the coming months and years from causes such as reproductive, communicable, and non-communicable diseases. The total death toll is expected to be large…’ [my emphasis], strongly suggesting that it is.

So it’s a distortion to write of ‘186,000 deaths and counting’ or ‘so far’, apart from the other exaggerations. Media Lens reports more accurately, ‘A recent study...points out that there will be many additional indirect deaths...the total death toll in Gaza may even exceed 186,000’. Even the New York Times manages a more cautious approach.

Back in February, Zeina Jamaluddine, et al. published a series of ‘Scenario-based health impact projections’, disaggregating fatalities into five categories: traumatic injuries, infections, maternal and neonatal deaths and stillbirths, non-communicable diseases (NCDs), and those attributable to malnutrition. They project deaths from these causes as of 6 August 2024 under three scenarios: an immediate ceasefire, the status quo, and escalation of military operations, arriving at estimates of up to 85 750, in the worst case, with very broad 95% uncertainty intervals. Ironically, Khatib, et al. cite the report, raising the questions of why they even bothered with their more hamfisted approach and why everyone has now latched onto Khatib, et al. when more plausible projections were already on the record.

The point is that misrepresenting the authorship and nature of the source, exaggerating the robustness of the data, and confusing a projection with a current estimate all invite scepticism of anything else one might have to say.

The real issue is that, for one thing, whatever may have transpired on 7 October can never justify any harm to even one uninvolved person, much less demolition of entire cities. For another, the dead are far from the only victims. Recent reports indicate 90,403 people injured, including children, some of whom may be disabled for life. Furthermore, as Khatib et al. and all other sources point out, Israel’s systematic demolition of Gaza’s medical infrastructure has made it increasingly difficult to keep track of both fatalities and injuries. And it’s worth noting that those treating life threatening injuries are likely to prioritise that work over recording accurate statistics.

As the Israeli military continue to wreak death and injury, increasing the number of direct casualties daily, the ‘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’ (Khatib, et al.) will go on multiplying the number of indirect victims by an unknown factor. The US, which had provided UNRWA with some 30% of its funding, has enacted legislation barring further contributions until next March.

The actual death toll from direct and indirect causes could end up exceeding Khatib, et al.’s guesstimate. Indeed, on 25 July, Feroze Sidhwa, et al. released their estimates, based on analysis of a wide range of publicly available sources.

With the known violent deaths [39,145], the estimated ten thousand people buried under the rubble and certainly dead, a conservative estimate of 38,000 deaths from malnutrition and disease, and a conservative estimate of 5,000 deaths in patients with chronic diseases, we estimate that the current death toll is likely upwards of 92,000...These are the most conservative estimates of the death toll that can be made with the given available data as of July 24, 2024. It is highly likely that the real number of deaths in Gaza from this conflict is far higher, and without an immediate ceasefire the death toll will only continue to mount.

And that will just be the tip of the iceberg. If Israel should fail to achieve the stated goal of forcing the population of Gaza into Egypt in a second Nakba, life among the ruins promises little but misery for the survivors, even the uninjured.

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Update:

According to a report on 25 July, Euro-Med Monitor estimates 

based on data and statistics gathered by its field teams in neighbourhoods and camps located within the Gaza Strip, as well as from information received from relevant authorities and institutions, including several hospitals and medical teams. These indicate that at least 51,000 people have died as a result of the Israeli blockade of the entire Strip; denial of medical care; collapse of the health sector due to Israel’s targeting and blockade; insufficient ambulance services due to said targeting and blockade, as well as a severe shortage of basic medicines, particularly for patients with chronic illnesses and cancer; prevention of the ability to travel abroad for treatment; and the spread of infectious diseases and epidemics. Accordingly, the natural death rate increased from an estimated 3.5 per 1,000 people prior to the start of the genocide to 22 per 1,000 people during the genocide.