Zeina Jamaluddine, PhD zeina.jamaluddine@lshtm.ac.uk , Hanan Abukmail, MD Sarah Aly, DO, Prof Oona M R Campbell, PhD ∙ Prof Francesco Checchi, PhD
Methods
We used a three-list capture–recapture analysis using data from Palestinian Ministry of Health (MoH) hospital lists, an MoH online survey, and social media obituaries. After imputing missing values, we fitted alternative generalised linear models to the three lists’ overlap structure, with each model representing different possible dependencies among lists and including covariates predictive of the probability of being listed; we averaged the models to estimate the true number of deaths in the analysis period (Oct 7, 2023, to June 30, 2024).
In the study, published in The Lancet, the researchers used a statistical method called “Capture-Recapture.” This method, which has been used to estimate the death toll in other conflicts, relies on three lists:
1) a list from the Hamas Ministry of Health, including bodies identified in hospitals or morgues.
2) an online survey published by the Ministry of Health, in which Palestinians reported the deaths of their relatives.
3) a list of death notices posted on social media platforms such as Twitter, Instagram, Facebook and WhatsApp, provided that the identity of the deceased is confirmed.
The researchers then looked for overlap across the different lists. “We looked at the overlap between the three lists (…) to get an overall estimate of the number of deaths,” says Zeina Jumadadin. Patrick Ball, a statistician at the US-based Human Rights Data Analysis Group – who was not involved in the Lancet study – has used the capture-recapture method to examine the death toll in the wars in Guatemala, Kosovo, Peru and Colombia. “The Lancet study gives a good estimate of the ‘ongoing genocide’ in the Gaza Strip,” he says. Kevin McConvoy, professor of applied statistics at the Open University in the UK, agrees. “There are always uncertainties with incomplete data,” he says, adding that the researchers’ use of three different statistical analysis methods to validate their estimates is “commendable.” “Overall, I find these estimates to be largely reliable,” she emphasizes.
Zeina Jumaeddine admits she expects “criticism from all sides” to come to the study, as the fate of Gazans is at the center of an ideological debate. However, the researcher aims to counter what she calls the “obsession” with the death toll in Gaza. “We know that the numbers are very high anyway,” she says.
Our analysis suggests high mortality rates and substantial under-reporting of mortality due to traumatic injury in the Gaza Strip during the first 9 months of the Israeli military operation. We estimated around 64 260 deaths due to traumatic injuries from Oct 7, 2023, to June 30, 2024, implying 41% under-reporting in the MoH estimate over the same period and corresponding to approximately 2·9% of Gaza’s projected pre-war population (2 227 000), or approximately one in 35 inhabitants. Although we only analysed data up to June 2024, the official MoH estimate from Oct 7, 2023, to Oct 6, 2024, was 41 909. Assuming that the level of under-reporting of 41% continued from July to October 2024, it is plausible that the true figure now exceeds 70 000. Our study demonstrates the utility of integrating existing data from alternative sources, rather than relying on any single figure, to compose an estimate of both reported and unreported deaths in contexts affected by armed conflict and extreme violence. Our use of scraped social media data extends previous efforts by Airwars, a casualty tracking organisation, who found that during the first 3 weeks of the Israeli military operation, 75% of publicly reported decedents also appeared on the MoH list.
The estimated annualised mortality from traumatic injury of 39·3 per 1000 people is exceptionally high, surpassing rates seen during earlier conflicts in the Gaza Strip.8,29 Although daily traumatic injury mortality decreased since December, 2023, both the scale and age–sex patterns of traumatic injury deaths raise grave concerns about the conduct of the military operation in Gaza despite Israel stating that it is acting to minimise civilian casualties. The majority of deaths (59·1%) occurred among women, children, and older people, groups considered particularly vulnerable in conflict-affected settings and less likely to be combatants. The age–sex pattern of mortality during violent conflicts might help investigate the motivations of combatants, albeit only within a much broader evidentiary context. A lack of discrimination in killings by age and sex would manifest itself numerically as a relatively flat age–sex risk—eg, as described by the UN Inter-Agency Group for Child Mortality Estimation during the 1994 Rwandan genocide.30 Our estimates for deaths among women and girls broadly exhibit such a pattern. Among men and boys, we cautiously propose that two processes might be at work: a level of mostly non-discriminant killing across age and sex, with higher risk among young men explained by targeting of combatants (or those presumed to be) plus greater exposures to risk among this stratum—eg, because adult men are more often outdoors procuring supplies, working, or being first responders.
Our findings underestimate the full impact of the military operation in Gaza, as they do not account for non-trauma-related deaths resulting from health service disruption, food insecurity, and inadequate water and sanitation. A recent commentary suggests a potential excess all-cause death toll of 186 000, but it applied multiplication factors from other conflicts (Burundi, 1993–2003; Timor-Leste, 1974–99) to estimate indirect deaths in the Gaza Strip, which might be inappropriate due to obvious differences in the pre-war burden of disease (compared with Burundi and Timor-Leste, the Gaza Strip featured a high burden of non-communicable disease and a very low burden of undernutrition and infectious disease, although infections have become an increasing challenge since October, 2023).31 Projections we previously coauthored suggested that in an escalation scenario, Gaza would have experienced 2680 excess deaths from non-communicable diseases, 2720 from endemic infectious diseases, 11 460 from potential epidemics, and 330 from maternal and neonatal health complications during the period from February to August, 2024. However, accurately measuring indirect mortality during an ongoing war is fraught with challenges and limitations. Although a ground survey could yield robust estimates, the highly unsafe conditions for humanitarian and health workers inside Gaza and access constraints currently make it unfeasible.
The Lancet also notes that the true number of civilians killed in Gaza is likely to be even higher, as its count only includes those who died from direct injuries and does not include indirect deaths – such as lack of medical care, food, water – nor the thousands of missing people buried under rubble. The UN Office for the Coordination of Humanitarian Affairs (OCHA) has said that around 10,000 Gazans who are still missing may be trapped under the rubble.
“We only included those whose deaths were confirmed by relatives or morgues and hospitals,” says Zeina Jum’eddine, an epidemiologist at the London School of Hygiene and Tropical Medicine and the study’s lead author. The findings undermine the credibility of the Israeli government and military – as well as much of the media, particularly French media – which has consistently questioned the figures provided by the Gaza Health Ministry, which the United Nations (UN) has previously called credible.
According to the study, published in The Lancet and the researchers. First of all, we must shed light on the courts, the existing legal authorities of the world, the United Nations, the nature of the civil and social institutions of every country, including the most democratic societies. For the lovers of the ostentatious adornment and decoration of capitalism, all of these are the achievements of the stormy struggles of the masses!! A community that never attributes any value or role to any worker, as soon as it encounters the name of these shrines, forges a mountain of memoirs to connect them to the struggles of the downtrodden!! There is also the opposite of this orientation, some are content with saying that all of these institutions are formalities, they are not the source of goodness, but what is the reality? What do workers need to know? The answer can be summarized in a few points. Whatever institution, authority, court, convention, union, center exists in the world, in the political structure of every country, in the sphere of official international relations, has finally been created and has gained credibility with the agreement of governments. There is no doubt about this. The question is, why have governments, the capitalist class of the world, or any country, seen themselves obliged to build or accept these shrines in order to solve which problem, to confront which internal problem of their class, in response to which protest of the rebellious and exploited masses, to satisfy which need of capitalist octopus’ relations? This is an important point that must be explored. Capitalism is a volcano of exploitation, separating the vast majority of the earth’s inhabitants from work, the fruits of work, removing them from involvement in determining the fate of work, life, the originator of all forms of oppression, injustice, brutality, genocide, war, apartheid, Holocaust. This system, by its very nature, is full of explosive contradictions. On the one hand, it is the target of violence, struggle, uprising, revolution of the working masses. On the other hand, it is a quagmire of war and conflicts, competition, disputes between different sections of the ruling and opposition bourgeoisie over the distribution of shares of profit, property, power. After the second imperialist war, in order to eliminate the rebellious threat of the global labor movement, resolve the internal conflicts of the world bourgeoisie, and consolidate the foundations of the hegemony of the dominant pole, the United Nations engineered a vast network and subsidiary institutions. It created and fielded the High Commissioner for Refugees, the Commissioner for Human Rights, UNICEF, the Women’s Rights Commission, the Hague Criminal Court, etc. Let us clarify again, there is no doubt that capitalism has established many of these under the pressure of the workers’ campaign. What is being consciously or unconsciously hidden is that the capitalist class and the capitalist state did not create these to solve the problem of the working masses or reduce the pressure of worker exploitation!!
Capitalism has consented to the architecture, the establishment of these institutions, the conclusion of these conventions, in order to remove from itself the danger of revolts, uprisings, and struggles of the discontented masses, to extinguish these raging struggles. So that the workers will fall in love with these institutions, consider them miraculous, and abandon their history-making organization against the Soviet power. These have emerged under the pressure of the wave of our struggles, but they play the role of a bulwark of the bourgeoisie in confronting our campaigns and a weapon of capital to suppress our anti-capitalist class struggle.
Apart from statesmen and capitalism’s mercenary intellectuals, no fair person free from capitalist brainwashing has any doubts that the criminal attack on Gaza and the massacre of many children in this country was carried out completely and totally by the Netanyahu government and with very shameless support of the United States: s government and its west allied powers. For our part, as always, we ask all workers in the world to campaign against the genocides of the rulers of Israel, America, Germany, England, France in Gaza, the West Bank or elsewhere. Capitalism’s power to kill and oppress and create annihilation must be answered with a united labor movement and international liberation force. The great cursed inhabitants of Gaza and all of Palestine are part of the working class of the world. For 75 years, Israel and predatory capitalist governments have aimed for genocide and annihilation. The release of these people is an urgent and unavoidable issue for the international labor movement, and we, as a cell of this movement, call with the loudest voice to all chained people around the world to stand up against these genocides, holocausts and the barbarism. Stop the wheel of work and production from turning. Stop the cycle of reproduction of global capital. exercise power and order the liberation of the Palestinian workers as a link in the international chain of the human liberation struggle with the great history-making power.
The audience of our voice is not the corridors of power, the profit-seeking oppositions seeking a share of sovereignty and ownership, but the workers, the subjugated, the exploited, the oppressed. With the echo of this voice, we ask free humanity to protest against the burning of people, the genocide, the massacre of tens of thousands of small children. The killing of people with hunger whips, the dropping of hundreds of thousands of tons of bombs on the two million people who fell from the shelters in Gaza by the government of Israel, the government of the United States, all supporting governments and the continued genocide for 75 years. 100 years of planned anti-humanitarian planning by the global bourgeoisie has been applied against the displaced and oppressed masses of Palestine, recognize all this as a holocaust as great as the Nazi holocaust in the second imperialist war, and fight together against the founders, perpetrators, supporters and partners of this holocaust.
With the issuance of this indictment. A field is opened for discussion, analysis, criticism, support, opposition and controversy in different languages, with different approaches. Sites can be used in this area; we take the help of the sites and channels we have to move the work forward. Let’s try so that more people and groups start collecting pictures of the most heartbreaking, terrible and sad scenes of this holocaust. They should try to expose the crimes of the governments as widely as possible. Photographers, journalists, political activists protesting against genocide and barbarism show everything they have. Everyone, including us a group of the anti-capitalist Iranian workers and activists in the movement for the abolition of wage labor has a report, has written an article or given an interview. Whoever did a translation, it has unspoken words, everyone wrote an analysis, whoever found a place for collective active influence.
One of the greatest conquests of capitalism is that the entire social possibilities have stamped the issue of the class struggle of the world’s workers with the seal of impossibility and have engraved this impossibility on the consciousness of the working masses. In this, of course, the left has also claimed to be the standard-bearer of the liberation of the working class. The impossibility of fusing the liberation of the accursed Palestinians with the class struggle of the world’s workers has also been of the same kind and a product of the brainwashing machine of capital. It was under the influence of this engineering of capitalist ideas that what was formed under the name of the Palestine Liberation Movement was actually devoid of all indicators that guaranteed victory. Beating the drum of nationalist anti-occupation, a Palestinian homeland, the formation of two states, and similar illusions was not only not a path to any victory, but it also continuously wore out this movement, drove it into the abyss of ruin, trapped it in defeat after defeat, and led it towards disaster. All Palestinian organizations, groups, and political forces from left to right, secular to religious, did this. There is no question of denying the differences; the distinction between Islamic reaction and secular leftist nationalism is evident. The discussion is not about denying these differences. The main point is that they are all equally dependent on capital, buried in the winding prescriptions of capital, peering from the vantage point of capitalist observation at the world, history, the horizon of the campaign, the path to liberation. Worse and beyond, from the beginning until today, they have been waiting for the miracles of governments, the poles of power, staring at the corridors of decision-making and the role-playing of the beasts that guard the survival of capitalism. They expect the designers, planners, and founders of genocides to turn off the crematoriums. They seek refuge from this court to another, from one shrine to the next. What is missing in their calculations is a conscious, planned, organized, and strategic reference to the vast masses of the working class of the world, to all layers, approaches, and sections of this class, to workers in factories, farms, transportation, the media, the young generation, to workers in education at all levels, treatment, medicine, or any other field. The Palestinian resistance and liberation movement did not and does not have a nationalist solution.
The liberation of the Palestinian workers is the cause of the protesting masses of the world working class. This protest has now flared up and can become more intense every day. The tragedy is that even the young generation of the Palestinian working class has not yet understood the intensity, the greatness of the miraculous power of this blaze. At least on a global level, this generation has played every role in the last 14 months, every success it has achieved has been in the light of the companionship, solidarity, and comradery of the world’s working masses. It was the workers who stopped the trains carrying weapons from the governments to Israel from moving, forced the ships carrying ammunition from the governments to Israel to stop and unload them in ports. It was the workers who, on May 1 this year in Chicago, the birthplace of International Workers’ Day, made this day a day of campaign against any aid from capitalist governments to Israel, the genocide of the world bourgeoisie in Palestine.
Anti-Capitalist Workers, Activists of the Movement for the Abolition of Wage Labor