genocide supporter.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02713-7/fulltext



Volume 403, ISSUE 10421, P23-24, January 06, 2024

No evidence of inflated mortality reporting from the Gaza Ministry of Health

• Benjamin Q Huynh
• Elizabeth T Chin
• Paul B Spiegel

Mortality reporting is a crucial indicator of the severity of a conflict setting, but it can also be inflated or under-reported for political purposes. Amidst the ongoing conflict in Gaza, some political parties have indicated scepticism about the reporting of fatalities by the Gaza Ministry of Health (MoH).^,

The Gaza MoH has historically reported accurate mortality data, with discrepancies between MoH reporting and independent United Nations analyses ranging from 1·5% to 3·8% in previous conflicts. A comparison between the Gaza MoH and Israeli Foreign Ministry mortality figures for the 2014 war yielded an 8·0% discrepancy.

Public scepticism of the current reports by the Gaza MoH might undermine the efforts to reduce civilian harm and provide life-saving assistance.Using publicly available information,

we compared the Gaza MoH's mortality reports with a separate source of mortality reporting and found no evidence of inflated rates. We conducted a temporal analysis of cumulative-reported mortality within Gaza for deaths of Gazans as reported by the MoH and reported staff member deaths from the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), from Oct 7 to Nov 10, 2023. These two data sources used independent methods of mortality verification, enabling assessment of reporting consistency.

We observed similar daily trends, indicating temporal consistency in response to bombing events until a spike of UNRWA staff deaths occurred on Oct 26, 2023, when 14 UNRWA staff members were killed, of whom 13 died in their homes due to bombings (figure). Subsequent attacks raised the UNRWA death rate while MoH hospital services diminished until MoH communications and mortality reporting collapsed on Nov 10, 2023. During this period, mortality might have been under-reported by the Gaza MoH due to decreased capacity. Cumulative reported deaths were 101 UNRWA staff members and 11 078 Gazans over 35 days (appendix p 3). By comparison, an average of 4884 registered deaths occurred per year in 2015–19 in Gaza.

If MoH mortality figures were substantially inflated, the MoH mortality rates would be expected to be higher than the UNRWA mortality rates. Instead, the MoH mortality rates are lower than the rates reported for UNRWA staff (5·3 deaths per 1000 vs 7·8 deaths per 1000, as of Nov 10, 2023). Hypothetically, if MoH mortality data were inflated from, for example, an underlying value of 2–4 deaths per 1000, it would imply that UNRWA staff mortality risk is 2·0–3·9 times higher than that of the public. This scenario is unlikely as many UNRWA staff deaths occurred at home or in areas with high civilian populations, such as in schools or shelters.

Mortality reporting is difficult to conduct in ongoing conflicts. Initial news reports might be imprecise, and subsequent verified reports might undercount deaths that are not recorded by hospitals or morgues, such as persons buried under rubble (). However, difficulties obtaining accurate mortality figures should not be interpreted as intentionally misreported data.

Although valid mortality counts are important, the situation in Gaza is severe, with high levels of civilian harm and extremely restricted access to aid. Efforts to dispute mortality reporting should not distract from the humanitarian imperative to save civilian lives by ensuring appropriate medical supplies, food, water, and fuel are provided immediately.

Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published text and institutional affiliations.

BQH and ETC conceived of the research plan, collected the data, carried out the analysis, and have directly accessed and verified the underlying data reported in the manuscript. BQH wrote the initial draft. ETC created the figures. PBS provided clinical and operational context. BQH and ETC contributed equally. All authors reviewed and contributed to the final version of the manuscript. Authors were not precluded from accessing data in the study and accept responsibility to submit for publication. The authors declare no competing interests. All data used in this Correspondence are publicly available from the Gaza Ministry of Health, UNRWA, and United Nations Office for the Coordination of Humanitarian Affairs. Further details of our data usage and an aggregate table of all data used are in the .