Gaza death toll in early part of war far higher than reported, says Lancet study

More than 75,000 people were killed in the first 16 months of the two-year war in Gaza, at least 25,000 more than the death toll announced by local authorities at the time, according to a study published on Wednesday in the Lancet medical journal.The research also found that reporting by the Gaza health ministry about the proportion of women, children and elderly people among those killed was accurate.A total of 42,200 women, children and elderly people died between 7 October 2023, when Hamas launched a surprise attack into Israel that prompted a devastating Israeli offensive into Gaza, and 5 January 2025, the study found. These deaths comprised 56% of violent deaths in Gaza.“The combined evidence suggests that, as of 5 January 2025, 3-4% of the population of the Gaza Strip had been killed violently and there have been a substantial number of non-violent deaths caused indirectly by the conflict,” the authors of the study, a team including an economist, demographer, epidemiologist and survey specialists, wrote in the Lancet Global Health.The exact death toll in Gaza has been bitterly disputed, although last month a senior Israeli security officer told Israeli journalists that figures compiled by health authorities in Gaza were broadly accurate, marking a U-turn after years of official attacks on the data.The officer was quoted as saying that about 70,000 Palestinians had been killed by Israeli attacks on the territory since October 2023, excluding those missing.Graph showing estimated cumulative deaths in Gaza as a result of violenceGaza health authorities now say the direct toll from Israeli attacks has exceeded 71,660 people, including more than 570 killed since a ceasefire came into effect in October 2025.Researchers who published a study in the Lancet last year estimated the death toll in Gaza during the first nine months of the war given by the Palestinian territory’s health ministry was about 40% lower than their estimate.The new research also suggests that official death toll was a substantial undercount, and by a roughly similar margin. It was based on a survey of 2,000 families in Gaza, carefully selected to be representative of the territory’s population, who were asked to give details of deaths among their members. The survey was run by experienced Palestinian pollsters known for their work in Palestine and elsewhere in the region.“This is a very sensitive survey, and potentially very upsetting [for respondents], so it was important to have Palestinians both asking and answering the questions,” said Michael Spagat, a professor of economics at Royal Holloway, University of London, one of the authors of the peer-reviewed study.Spagat, who has worked on the calculation of casualties of conflicts for more than 20 years, said the new research suggested 8,200 deaths in Gaza from October 2023 to January 2025 were attributable to indirect effects , such as malnutrition or untreated disease. He questioned another study published in the Lancet in 2024 that estimated there would be four “indirect” deaths for every “direct” death.“There is a huge variation depending on the specific circumstances of every conflict. In Kosovo [conflict of 1998-99] almost all the deaths were violent. In somewhere like Darfur, you see something very different. In Gaza, at least initially, there were resources in terms of well-trained doctors and a health system … Also, the territory is very small, so when aid does flow you can reach people,” Spagat said.“I would push back on the notion that this is a small number of deaths. I think we’re experiencing desensitisation effects …. But, yes, it’s much lower than what many people say and believe.”The Hamas raid of October 2023 killed about 1,200 people, mostly civilians, while 250 were taken hostage by the militant Islamist organisation. Israel launched its retaliatory assault within hours, devastating much of Gaza with airstrikes, tank shelling and artillery bombardment.The study covers the most intense and lethal period of Israel’s offensive, but not the most acute period of the humanitarian crisis in the territory. Famine in Gaza was declared by UN-backed experts in August last year.The proportion of combatants to non-combatants among those killed in Gaza has also been bitterly disputed. Israeli officials have claimed their attacks killed an almost equal number of each. The new study contradicts this claim.In November, a research team from the Max Planck Institute for Demographic Research estimated that 78,318 people had been killed in Gaza between 7 October 2023 and 31 December 2024 – almost exactly the same period as the new study. But that research also suggested a much higher number of indirect deaths, which contributed to a reduction of life expectancy in Gaza by 44% in 2023 and by 47% in 2024.Spagat said reaching a definitive figure of those killed in the conflict would take a long time and significant resources. Figures given even in the most recent study published this week have significant margins of error.“It is not a given that there will be a multimillion-pound research project to reconstruct what actually happened. It will be a long time before we get to a full accounting of all the people killed in Gaza, if we ever get there,” he said.