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Summary

Background

High-quality mortality estimates are crucial for understanding the human cost of conflict. The Gaza Ministry of Health (MoH) has provided regular updates to their violent death toll for the Gaza Strip following Oct 7, 2023, but these reports have attracted both criticism and support. Independent estimates of both violent and non-violent deaths were needed.

Methods

We conducted a population-representative household survey, the Gaza Mortality Survey, between Dec 30, 2024, and Jan 5, 2025. We surveyed 2000 households across 200 primary sampling units, documenting the vital status of 9729 household members as of Oct 6, 2023, plus newborns. The sample was stratified by dwelling type and Governorate of origin. We used raking procedures to adjust for demographic characteristics and calculated confidence intervals using Taylor series linearisation. Sampling occurred in accessible areas, with displaced populations representing inaccessible Governorates.

Findings

We estimated 75 200 violent deaths (95% CI 63 600–86 800) between Oct 7, 2023, and Jan 5, 2025, representing approximately 3·4% of the Gaza Strip's pre-conflict population. Women, children (ie, younger than 18 years), and older people (ie, older than 64 years) comprised 56·2% (95% CI 50·4–61·9) of violent deaths, totalling 42 200 deaths (95% CI 33 100–51 300). We also estimated 16 300 non-violent deaths (12 300–20 200), of which 8540 (4540–12 500) represent excess deaths above pre-conflict projections. The MoH figure for this period (49 090 violent deaths) was 34·7% below our central estimate.

Interpretation

This first independent population survey of mortality in the Gaza Strip shows that violent deaths have substantially exceeded official figures whereas the demographic composition of casualties aligns with MoH reporting. Non-violent excess deaths, although substantial, are lower than some projections have suggested. These findings show the feasibility of mortality surveillance in active conflict zones and provide crucial empirical foundations for assessing the true human cost of the conflict.

Funding

European Research Council Grant 101055176, ANTICIPATE, and the Center for Research on the Epidemiology of Disaster at Université Catholique de Louvain.

Translation

For the Arabic translation of the abstract see Supplementary Materials section.

Introduction

High-quality war mortality estimates play a crucial role in illuminating the human cost of conflict, as shown by studies in Kosovo, Iraq, and Darfur.1–3 During active conflict, however, such estimates are challenging to obtain due to security constraints and population displacement. The Gaza Ministry of Health (MoH) has provided regular updates to the violent death toll in the Gaza Strip since Oct 7, 2023. However, MoH reports have attracted both criticism4 and support.5,6

A capture–recapture analysis published in 2025 by Jamaluddine and colleagues5 estimated 64 260 deaths (95% CI 55 298–78 525) due to traumatic injury to June 30, 2024. However, two of three data sources were MoH-generated, limiting the study's independence from official figures. Multiple plausible models using the three data sources estimated wide-ranging confidence intervals (47 457 to 88 332 deaths). Moreover, MoH-based studies5,6 do not address non-violent excess deaths.

Information on non-violent excess deaths in the Gaza Strip remains scant. One analysis7 projected that non-violent deaths could be four times as high as violent deaths, whereas physicians working in the Gaza Strip8 claimed tens of thousands of deaths due to starvation and its complications. However, these estimates do not have empirical foundation. Médecins Sans Frontières surveyed 2523 staff and family members, finding a death rate of just over 2% with 48% of blast-related deaths occurring in children.9 However, this staff census was not population-representative. To date, no population-representative survey has provided independent estimates of either violent or non-violent deaths for the Gaza conflict.

We present results from the Gaza Mortality Survey (GMS), which is, to our knowledge, the first population-representative household survey conducted during the current Gaza conflict. Our aims were to: (1) provide an independent estimate of violent deaths; (2) assess the demographic composition of casualties; and (3) estimate non-violent excess mortality.

Research in context

Evidence before this study

We searched PubMed, Google Scholar, and grey literature from Oct 7, 2023, to Dec 30, 2024, using terms including “Gaza mortality”, “Gaza death toll”, “Palestine conflict casualties”, “war mortality estimation”, and “household mortality surveys”. Before this study, mortality estimates for the Gaza conflict relied primarily on administrative records from the Gaza Ministry of Health (MoH), which some analysts have contested. Thus, independent assessment of the conflict's death toll is needed, a gap partially filled by a capture–recapture analysis that used MoH data combined with social media obituaries to estimate 64 260 (95% CI 55 298–78 525) violent deaths to June, 2024. However, two of the three data sources in that analysis were components of the MoH database itself, restricting the study's independence. No population-based household surveys had been conducted to provide fully independent mortality estimates for the Gaza conflict, and no empirically grounded estimates existed for non-violent excess deaths caused indirectly by the war.

Added value of this study

This study provides the first independent, population-based household survey estimate of mortality in Gaza during the current conflict. We surveyed 2000 households representing 9729 individuals and estimated 75 200 violent deaths (95% CI 63 600–86 800) and 8540 excess non-violent deaths (4540–12 500) between Oct 7, 2023, and Jan 5, 2025. The MoH figureis 34·7% below our central estimate, closely aligning with the capture–recapture analysis, which found that the MoH figure was 39·1% below their estimate for their coverage period, providing rare cross-methodology validation. We found that 56·2% of violent deaths were among women, children, and older people (older than 64 years), consistent with MoH demographic reporting. The study showed that rigorous household mortality surveys are feasible even in extremely challenging conflict environments and challenges assumptions about inevitably high ratios of indirect to direct deaths in modern conflicts.

Implications of all the available evidence

The combined evidence suggests that, as of Jan 5, 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 validation of MoH reporting through multiple independent methodologies supports the reliability of its administrative casualty recording systems even under extreme conditions. The demonstration that household surveys remain feasible in active conflict zones should encourage similar data collection efforts in other conflicts where administrative systems might be compromised. These findings underscore the crucial importance of maintaining multiple, independent mortality estimation approaches and continued international monitoring of civilian casualties in conflict zones.

اﻟﻣُﻠَﺧﱠص

ﺧﻠﻔﯿﺔ:

ﺗﻌﺘﺒﺮﻋﻤﻠﯿﺔﺗﻘﺪﯾﺮ اﻟﻮﻓﯿﺎت ﻋﺎﻟﯿﺔ اﻟﺠﻮدة أﻣﺮا ﺑﺎﻟﻎ اﻷھﻤﯿﺔ ﻟﻔﮭﻢ اﻟﺘﻜﻠﻔﺔ اﻟﺒﺸﺮﯾﺔ ﻟﻠﺤﺮب.ﻗﺎﻣﺖوزارة اﻟﺼﺤﺔاﻟﻔﻠﺴﻄﯿﻨﯿﺔﻓﻲﻗﻄﺎعﻏﺰةﺑﻨﺸﺮ أﻋﺪاد اﻟﻘﺘﻠﻰاﻟﻨﺎﺟﻤﺔ ﻋﻦ اﻟﻌﻨﻒﻓﻲ ﻗﻄﺎع ﻏﺰة ﺑﻌﺪاﻟﺴﺎﺑﻊ ﻣﻦﺗﺸﺮﯾﻦ اﻷول/أﻛﺘﻮﺑﺮ2023، ﻟﻜﻦ ھﺬه اﻟﺘﻘﺎرﯾﺮ أﺛﺎرتﺗﺤﻔﻈﺎتودﻋﻤﺎ ﻋﻠﻰ ﺣﺪ ﺳﻮاء. ﺑﺎﻟﺘﺎﻟﻲ،ﻛﺎﻧﺖ ھﻨﺎك ﺣﺎﺟﺔ إﻟﻰ ﺗﻘﺪﯾﺮات ﻣﺴﺘﻘﻠﺔ ﻟﻜﻞ ﻣﻦ اﻟﻮﻓﯿﺎت اﻟﻌﻨﯿﻔﺔوﻏﯿﺮاﻟﻌﻨﯿﻔﺔ.

اﻟﻤﻨﮭﺠﯿﺔ:

أﺟﺮﯾﻨﺎﻣﺴﺤﺎﻟﻌﯿﻨﺔﺳﻜﺎﻧﯿﺔﻣﻤﺜﻠﺔﻟﻸﺳﺮاﻟﻔﻠﺴﻄﯿﻨﯿﺔ،وھﻮﻣﺴﺢ وﻓﯿﺎت ﻏﺰة،وذﻟﻚ ﻓﻲ اﻟﻔﺘﺮة اﻟﻮاﻗﻌﺔﺑﯿﻦ30ﻛﺎﻧﻮن اﻷول/دﯾﺴﻤﺒﺮ2024و5ﻛﺎﻧﻮن اﻟﺜﺎﻧﻲ/ﯾﻨﺎﯾﺮ2025.ﻗﻤﻨﺎﺑﻤﻘﺎﺑﻠﺔ2,000أﺳﺮةﻓﻲ 200ﻣﻨﻄﻘﺔاو ﺗﺠﻤﻊﺳﻜﺎﻧﻲ،ﺣﯿﺚ ﻗﻤﻨﺎﺑﺘﻮﺛﯿﻖاﻟﺤﺎﻟﺔ اﻟﺤﯿﻮﯾﺔ ل9,729ﻓﺮدا ﻣﻦ أﻓﺮاد اﻷﺳﺮوذﻟﻚاﻋﺘﺒﺎرا ﻣﻦﺗﺎرﯾﺦ6أﻛﺘﻮﺑﺮ2023،ﺑﺎﻹﺿﺎﻓﺔﻟﻸطﻔﺎل ﺣﺪﯾﺜﻲ اﻟﻮﻻدة.ﺗﻢ ﺗﻘﺴﯿﻢ اﻟﻌﯿﻨﺔ إﻟﻰ طﺒﻘﺎت ﺣﺴﺐ ﻧﻮع اﻟﻤﺴﻜﻦ وﻣﺤﺎﻓﻈﺔ اﻟﻤﻨﺸﺄ.اﺳﺘﺨﺪﻣﻨﺎ إﺟﺮاءاتاﻟﺘﺼﻨﯿﻒ-raking proceduresﻟﻀﺒﻂ اﻟﺨﺼﺎﺋﺺ اﻟﺪﯾﻤﻮﻏﺮاﻓﯿﺔ وﺣﺴﺎب ﻓﺘﺮات اﻟﺜﻘﺔ ﺑﺎﺳﺘﺨﺪامﺗﺨﻄﯿﻂ ﻣﺘﺴﻠﺴﻠﺔﺗﺎﯾﻠﻮرـTaylor series linearization.ﺗﻢ أﺧﺬ اﻟﻌﯿﻨﺎتﻣﻦ اﻟﻤﻨﺎطﻖاﻟﺴﻜﻨﯿﺔاﻟﺘﻲﺗﻤﻜﻨﺎ ﻣﻦ اﻟﻮﺻﻮل إﻟﯿﮭﺎ،وﻣﻦ ﻣﻨﺎطﻖ اﻟﻨﺰوحﻟﺘﻠﻚاﻟﻤﺤﺎﻓﻈﺎتاﻟﺘﻲ ﻟﻢ ﯾﻜﻦ ﻣﺘﺎﺣﺎ اﻟﻮﺻﻮل إﻟﯿﮭﺎ.

اﻟﻨﺘﺎﺋﺞ:

ﻧﻘﺪرﺣﺪوث75,200ﺣﺎﻟﺔ وﻓﺎةﻧﺎﺗﺠﺔ ﻋﻦ اﻟﻌﻨﻒ)ﺑﺪرﺟﺔﺛﻘﺔﺗﺒﻠﻎ95٪ﺑﺤﯿﺚ ﯾﻤﻜﻦ ﻟﻠﻌﺪداﻟﻔﻌﻠﻲأن ﯾﺘﺮاوحﺑﯿﻦ63,600و86,800(وذﻟﻚ ﻓﻲ اﻟﻔﺘﺮة ﻣﻦ7أﻛﺘﻮﺑﺮ/ﺗﺸﺮﯾﻦ اﻷول2023و5ﻛﺎﻧﻮن اﻟﺜﺎﻧﻲ/ﯾﻨﺎﯾﺮ 2025، وھﻮ ﻣﺎ ﯾﻤﺜﻞ ﺣﻮاﻟﻲ3.4٪ ﻣﻦإﺟﻤﺎﻟﻲﺳﻜﺎن ﻏﺰةاﻟﻤﺴﺠﻠﯿﻦ ﻗﺒﻞ ﺑﺪأ اﻟﺼﺮاع.ﺷﻜﻠﺖ اﻟﻨﺴﺎء، واﻷطﻔﺎلﻣﻤﻦ ھﻢ دون اﻟﺜﺎﻣﻨﺔ ﻋﺸﺮة،وﻛﺒﺎر اﻟﺴﻦ)اﻟﺬﯾﻦ ﯾﺒﻠﻎ ﻋﻤﺮھﻢ65ﺳﻨﺔ وأﻛﺜﺮ(ﻧﺴﺒﺔ56.2٪)ﺑﺪرﺟﺔ ﺛﻘﺔﺑﻠﻐﺖ95٪ﺣﯿﺚ ﯾﻤﻜﻦ ﻟﻠﻨﺴﺒﺔ أن ﺗﺘﺮاوح ﺑﯿﻦ50.4٪و61.9٪(ﻣﻦﻣﺠﻤﻮعاﻟﻮﻓﯿﺎت اﻟﻨﺎﺟﻤﺔ ﻋﻦاﻟﻌﻨﻒ، ﺑﻌﺪدإﺟﻤﺎﻟﻲﺑﻠﻎ42,200ﺣﺎﻟﺔ وﻓﺎة)ﺑﺪرﺟﺔﺛﻘﺔﺗﺒﻠﻎ95٪ﺑﺤﯿﺚ ﯾﻤﻜﻦ ﻟﻠﻌﺪد أن ﯾﺘﺮاوح ﺑﯿﻦ33,100 و51,300(.ﻧﻘﺪر أﯾﻀﺎﺣﺪوث16,300ﺣﺎﻟﺔ وﻓﺎة ﻏﯿﺮﻧﺎﺗﺠﺔ ﻋﻦاﻟﻌﻨﻒ)12,300-20,200(، ﻣﻨﮭﺎ 8,540ﺣﺎﻟﺔ)4,540-12,500(ﺗﻤﺜﻞ وﻓﯿﺎتإﺿﺎﻓﯿﺔ ﺗﺰﯾﺪ ﻋﻦﺗﻮﻗﻌﺎت ﻣﺎ ﻗﺒﻞ اﻟﺤﺮب.ﺑﮭﺬا ﯾﻜﻮنﻣﺠﻤﻞ ﻋﺪد اﻟﻮﻓﯿﺎتاﻟﻨﺎﺟﻤﺔ ﻋﻦ اﻟﺤﺮب اﻟﻮارد ﻓﻲ ﺗﻘﺎرﯾﺮ وزارة اﻟﺼﺤﺔ اﻟﻔﻠﺴﻄﯿﻨﯿﺔ ﺑﻐﺰةﻟﺘﻠﻚاﻟﻔﺘﺮة، وھﻮ 49,090،أﻗﻞ ﺑﻨﺴﺒﺔ34.7٪ ﻣﻦ ﺗﻘﺪﯾﺮﻧﺎاﻻﺳﺎﺳﻲ. اﻟﺘﻔﺴﯿﺮ:ﯾﻈﮭﺮ ھﺬا اﻟﻤﺴﺢ اﻟﺴﻜﺎﻧﻲ اﻟﻤﺴﺘﻘﻞ اﻷول ﻟﻠﻮﻓﯿﺎت ﻓﻲ ﻏﺰة أن اﻟﻮﻓﯿﺎت اﻟﻌﻨﯿﻔﺔ ﺗﺠﺎوزت اﻷرﻗﺎم اﻟﺮﺳﻤﯿﺔ ﺑﺸﻜﻞ ﻛﺒﯿﺮ ﻓﻲ ﺣﯿﻦ أن اﻟﺘﺮﻛﯿﺒﺔ اﻟﺪﯾﻤﻮﻏﺮاﻓﯿﺔ ﻟﻠﻀﺤﺎﯾﺎ ﺗﺘﻤﺎﺷﻰ ﻣﻊ ﺗﻘﺎرﯾﺮوزارة اﻟﺼﺤﺔ اﻟﻔﻠﺴﻄﯿﻨﯿﺔ ﺑﻐﺰة. أﻣﺎاﻟﻮﻓﯿﺎتاﻹﺿﺎﻓﯿﺔ ﻏﯿﺮ اﻟﻨﺎﺟﻤﺔ ﻋﻦ أﻋﻤﺎلاﻟﻌﻨﻒ،ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ ﻛﻮﻧﮭﺎﻟﯿﺴﺖ ﻗﻠﯿﻠﺔ،ﻓﺈﻧﮭﺎأﻗﻞ ﺑﻜﺜﯿﺮ ﻣﻤﺎورد ﻓﻲﺑﻌﺾ اﻟﺘﻮﻗﻌﺎت.ﺗﻮﺿﺢ ھﺬه اﻟﻨﺘﺎﺋﺞإﻣﻜﺎﻧﯿﺔﺗﻮﺛﯿﻖ أﻋﺪاداﻟﻮﻓﯿﺎت ﻓﻲ ﻣﻨﺎطﻖ اﻟﻨﺰاع اﻟﻨﺸﻄﺔ وﺗﻮﻓﺮ أﺳﺴﺎ ﺗﺠﺮﯾﺒﯿﺔﻗﻮﯾﺔﻟﺘﻘﯿﯿﻢ اﻟﺘﻜﻠﻔﺔ اﻟﺒﺸﺮﯾﺔ اﻟﺤﻘﯿﻘﯿﺔ ﻟﻠﺤﺮب.

اﻟﺘﻤﻮﯾﻞ:

ﻗﺎم ﺑﺘﻤﻮﯾﻞاﻟﺪراﺳﺔﻣﻌﮭﺪ أﺑﺤﺎث اﻟﺴﻼم ﻓﻲ أوﺳﻠﻮ وﻣﺮﻛﺰ أﺑﺤﺎث وﺑﺎﺋﯿﺎت اﻟﻜﻮارث ﻓﻲ ﺟﺎﻣﻌﺔ ﻟﻮﻓﺎن اﻟﻜﺎﺛﻮﻟﯿﻜﯿﺔ. "ھﺬه اﻟﺘﺮﺟﻤﺔ ﺑﺎﻟﻠﻐﺔ اﻟﻌﺮﺑﯿﺔ ﻣُﻘﺪﱠﻣﺔ ﻣﻦ اﻟﻤﺆﻟﻔﯿﻦ، وﻧﺤﻦ ﻧﻌﯿﺪ ﻧﺸﺮھﺎ ﻛﻤﺎ وردت. ﻟﻢ ﺗﺨﻀﻊ ھﺬه اﻟﺘﺮﺟﻤﺔ ﻟﻤﺮاﺟﻌﺔ اﻷﻗﺮان. ﻟﻘﺪ طُﺒِّﻘﺖاﻹﺟﺮاءات اﻟﺘﺤﺮﯾﺮﯾﺔ ﻟﻤﺠﻠﺔ ﻻﻧﺴﺖ ﻓﻘﻂ ﻋﻠﻰ اﻟﻨﺴﺨﺔ اﻷﺻﻠﯿﺔ ﺑﺎﻟﻠﻐﺔ اﻹﻧﺠﻠﯿﺰﯾﺔ، واﻟﺘﻲ ﯾﻨﺒﻐﻲ اﻋﺘﻤﺎدھﺎ ﻣﺮﺟﻌًﺎ ﻟﮭﺬه اﻟﻤﺨﻄﻮطﺔ."