No evidence of inflated mortality reporting from the Gaza MoH: Report

In the ongoing conflict in Gaza, various political parties have indicated skepticism about the reporting of fatalities by the Gaza Ministry of Health (MoH).

According to the reports, at least 17,487 Palestinians have been killed in Gaza since 7 October. In Israel, the revised official death toll stands at about 1,147.

Mortality reporting is a crucial indicator of the severity of a conflict setting, but it can also be inflated or underreported for political purposes, says The Lancet. Gaza's MoH has been known to report accurate mortality data, with discrepancies between MoH reporting and independent United Nations analyses ranging from 1.5% to 3.8% in previous conflicts.

Meanwhile, a comparison between the Gaza MoH and Israeli Foreign Ministry mortality figures for the 2014 war yielded an 8.0% discrepancy.

It is believed that public skepticism of the current reports by the Gaza MoH might undermine efforts to reduce civilian harm and provide life-saving assistance, says The Lancet.

Using publicly available information, The Lancet compared the Gaza MoH's mortality reports with a separate source of mortality reporting and found no evidence of inflated rates.

With the help of data publicly available from the Gaza Ministry of Health, UNRWA, and United Nations Office for the Coordination of Humanitarian Affairs, the report 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 7 October to 10 November, 2023.

Two of these data sources used independent methods of mortality verification, enabling assessment of reporting consistency.

The results indicated temporal consistency in response to bombing events until a spike of UNRWA staff deaths occurred on 26 October, 2023, when 14 UNRWA staff members were killed, of whom 13 died in their homes due to bombings. Subsequent attacks raised the UNRWA death rate while MoH hospital services diminished until MoH communications and mortality reporting collapsed on November 10, 2023.

According to The Lancet, during this period, mortality might have been underreported by the Gaza MoH due to decreased capacity. Cumulative reported deaths were 101 UNRWA staff members and 11,078 Gazans over 35 days. By comparison, an average of 4,884 registered deaths occurred per year in Gaza from 2015 to 2019.

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 November 10, 2023).

The report states that if MoH mortality data were inflated, for example, from 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. 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.

BQH and ETC conceived the research plan, collected the data, carried out the analysis, and have directly accessed and verified the underlying data reported in the manuscript.