Israeli Campaign against Gaza may Kill 186,000 or More — 8% of Population: The Lancet

Ann Arbor (Informed Comment) – Rasha Khatib, Martin McKee and Salim Yusuf, The Lancet calculate that 186,000 or more people may be killed* by the Israeli total war on Gaza, about 8% of the population.

If you do not see this study reported on your cable “news” channel, you may conclude that the corporation that owns it is complicit in genocide.

One of the paper’s authors, Martin McKee, “is a member of the editorial board of the Israel Journal of Health Policy Research and of the International Advisory Committee of the Israel National Institute for Health Policy Research.” Although McKee says he is writing solely in a personal capacity, I think we may conclude that some members of the professional Israeli public health community have their hair on fire about the prosecution of the Gaza War.

The Gaza Ministry of Health now says that over 38,000 Palestinians have been killed by the Israelis. As The Lancet notes, the World Health Organization and even the Israeli intelligence services accept these figures. Since the Israeli Air Force has dropped as many as five hundred two-thousand-pound bombs and by now has destroyed or damaged a majority of the buildings in the Gaza Strip, it is likely that at least 10,000 uncounted dead are under the rubble.

The 38,000 dead are the result of what is called direct gathering of the figures. Initially the dead were identified and reported by hospitals. As Israel has reduced the ability of hospitals to function by its attacks on them, this direct reporting has continued, but hospitals began being unable in some cases to send along identification, though they could confirm the reception of the corpses. Some dishonest observers suggested that this inability to know the names of the dead somehow made the numbers less reliable, but the World Health Organization refuted this allegation. The dead are in makeshift morgues still gradually being identified.

Al Jazeera English Video: “Dozens killed across Gaza as Israel’s war enters 10th month”

Indirect counting of the dead attempts to calculate the missing people using statistical methods. Sometimes public health experts have attempted to interview people to collect data on dead family members and friends, and then projected totals based on these surveys. That method is not available in Gaza, where the Israeli authorities will not permit journalists and other observers, and where it is dangerous to be because there are no real safe zones, with those regions declared safe zones often having been bombed.

Muhammad Jawad et al., in a survey of 118 unique armed conflicts affecting 102 countries from 1990 to 2017 found that they produced an average of 19.2 battle-related deaths per 100,000 population (54.7 for those in war as opposed to minor conflict). There were in addition an average of 311 excess deaths per 100,000 population from causes other than being immediately killed by a bomb or bullet. So, 16 civilians died of starvation, communicable, maternal, neonatal, and nutritional diseases and injuries, for every direct death in combat.

And this seems important, in the Jawad et al. study: “Effect estimates were disproportionately larger for children aged under 5 years, regardless of the cause of death.” Gaza had some 350,000 children under 5. UNICEF reported in May, “9 out of 10 children under 5 in Gaza are suffering from one or more infectious diseases. Levels of acute watery diarrhea are 20 times higher than typical.” Already last March, 1 in 3 children under 2 were acutely malnourished, a condition that produces permanent cognitive and emotional damage.

The Lancet authors used a much smaller multiplier, of four indirect deaths for each direct death. Based on the death toll known when the paper was written, they arrived at 186,000 dead for this war over the coming months. They admit that the estimate of four indirect deaths for every direct one is conservative, so the number could be substantially greater.

Khatib et al. point out that public health officials as early as last February were predicting 90,000 deaths, at least, by August 6 if the war escalated and an epidemic broke out. There certainly has been a vast escalation, with a full bore Israeli attack on Rafah during the past two months, the last of the so-called safe zones, to which over a million people had been displaced.

The Lancet authors make these points:

A ceasefire is required without a second’s delay.

Medical supplies, food, and clean water must be flowed into the Strip immediately.

The scale and character of the suffering in this conflict must be documented. That is important for establishing historical accountability and for estimating the full cost of this war. Such documentation is, moreover, legally required of Israel by the January 26, 2024 ruling on interim measures by the International Court of Justice as part of its deliberations on whether Israel is committing genocide, to which Israel has not been responsive.

“Furthermore, these data will be crucial for post-war recovery, restoring infrastructure, and planning humanitarian aid.”

I have pointed out that given the definition of famine and the identification of 500,000 Palestinians in Gaza as being in a stage 5 famine zone, nearly 20,000 Palestinians could be starving each month. If the zone were defined by only 20% of it seeing that level of death, then that would still be 5,000 dead of famine each month, on top of those killed by bombs and airstrikes and those falling ill to rampant disease, malnutrition and dehydration. The Lancet study is consistent with total deaths of nearly 21,000 a month, though, again, this is a conservative estimate.

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*Note, thanks to a kind comment by Jeffrey Sachs at Columbia, I have slightly revised this essay to reflect that The Lancet piece is not saying that 186,000 are already dead but that this is a not implausible death toll out of the war over the coming months.