It’s Not What You Think! How Gaza’s “Hamas-run” Health Ministry Undercounts the True Cost of the Occupation.

Middle East ConflictInternational RelationsAnalysis
Written By Daniel Woods

After years of hammering both politically and militarily, Gaza Ministry of Health officials have been forced into collaborating in Western efforts to minimalize casualties in the Gaza Strip.

 

Wherever you get your news, if it is discussing the ongoing siege of the Gaza Strip, you have likely heard or read something along the lines of “the Palestinian death toll in the Israel-Hamas war surpassed 65,000, local health officials said.” You have likely seen concern in your political channels, sensed the perturbation caused as the number of massacred civilians continues to creep higher. Indeed, you might even think to yourself: well that doesn’t seem as bad as all that, a 12,000 jump from the ~53,000 dead reported in May of this year in a population of some 2.1 million people. Compared to the omnipresent war for Ukraine which was averaging around 2,000 deaths/week around the same time (a loose average of ~40,000 dead in the time since), the Western mind might not think too much of the change for Gazans. It is a war after all, right?

Bodies of German civilians killed in the allied bombing raid on Dresden, February 1945

Perhaps then, it would be helpful to look at how the Health Ministry of Gaza goes about counting the casualties in a world rendered alien and inhospitable by more than 100,000 tons of (largely) US bombs and rockets. Imagine trying to count the dead from a half-collapsed hospital in a sea of destruction equivalent to 25.5 Dresden fire-bombings. The easiest and most certain way to do this is perhaps the most obvious: count the bodies you can see.

As of this morning (September 20, 2025), Jordanian news media citing medical sources in Gaza report a death toll of 65,208 since October 7, 2023. While this aligns with the AP article above, a few things are made more apparent by three quotes:

1.      Medical sources “also noted that a number of victims remain trapped under the rubble and in the streets, as ambulance and civil defense crews are still unable to reach them.”

2.      “Meanwhile, during the past 24 hours, hospitals recorded 4 martyrs and 18 injuries among aid workers, bringing the total number of aid-related victims who arrived at hospitals to 2,518 martyrs and more than 18,449 injured.”

3.      “Gaza hospitals registered two deaths due to famine and malnutrition in the last 24 hours, raising the total to 442, including 147 children.”

These figures are horrific on their face, a bald accounting of the ongoing atrocity in so many numbers. But they provide a look at how casualties are counted and recognized within the Strip. The injured or dead are brought to a hospital or medical site, an aid worker records their identity and condition, and they are moved along as appropriate. A quote from Arena’s “Skewering History: The Odious Politics of Counting Gaza’s Dead” by Gideon Polya and Richard Hil illustrates:

“An office at Shifa Hospital in Gaza City, al-Qidra receives a constant flow of data from every hospital in the Strip … Hospital administrators say they keep records of every wounded person occupying a bed and every dead body arriving at a morgue. They enter this data into a computerized system shared with al-Qidra and colleagues.”

With hospital morgues overflowing, the bodies of Palestinians killed in Israeli attacks undergo rushed funeral rites [Ashraf Amra/Al Jazeera]

Besieged in every possible way, the health and aid establishment is all but paralyzed by problems which would be difficult outside direct wartime occupation. Between losing vital equipment to dig out trapped survivors, a total blockade of all international aid and trade, the ever-present drone swarms hunting for government officials and their families, and the slow starvation of the surviving population at large, counting the dead which cross their doorstep is the only thing the overladen Gazan government can truly do after two years of daily bombardment.

As the offensive to conquer Gaza City ramps up once more, almost 80% of the Strip’s buildings have been damaged or destroyed – some 247,000 structures rendered unusable and collapsed regardless of civilian occupancy or cultural relevance. So, what about those trapped under any of the hundreds of thousands of structures which have been systematically destroyed across Gaza? What about those dying from rampant diseases enabled or exacerbated by the ongoing famine of the occupied city?

Altogether, a grim painting appears which makes the idea of ~68,000 dead seem unlikely. A population of 2.1 million - 80% of whose homes, business, and cultural structures have been flattened, their territory 75% under Israeli occupation or part of the militarized “buffer zone” area, and themselves forced into tent cities in three barren coastal zones at the ends of rocket tubes and bomb-bay doors.

Indeed, setting a concrete foundation for the Polya-Hil report above, a Lancet study from February 2025 argued the Gazan Ministry of Health was under-reporting deaths by a 41%, arriving at their own casualty figure for the time of 64,260 killed since October 7th in the Strip – a projected 136,000 by April 25, 2025 (5 months ago).

Polya and Hil note that the Lancet analysis has limitations in its grounding in data from the first 9 months of the post-October 7th occupation and a clear lack of epidemiological analysis to ground the study in real  world conditions. Pointing to the health effects which become increasingly relevant to non-violent civilian deaths in wartime, they argue that we must look to imposed deprivation to adequately capture the number of casualties.

Looking to wars in recent decades, the authors find an average of nonviolent deaths from imposed deprivation (deaths which result from lack of basic necessities under avoidable circumstances) ranging from 2 to 16 for every 1 violent death:

“…estimates of violent deaths and non-violent deaths from deprivation drawn from UN Population Division data, reveal direct deaths in the Iraq War (2003-2011) of 1.5 million and indirect deaths of 1.2 million, yielding a total of around 2.7 million deaths, a ratio of 1.5:1.2. The ratio of direct deaths/indirect deaths in the Afghan War (2001–2021) is estimated to be 0.4 million/6.4 million, that is deaths from deprivation 16 times the death toll of violent deaths.”

Using this data to find an appropriate average alongside the widely credited and cited Gazan Health Ministry’s figures for violent deaths in the Strip, and accounting for Gaza's unique conditions of density and confinement, the researchers arrive at a shocking figure: 1:4. For every one violent, direct death, four indirect.  ~680,000 Palestinians killed by either direct or indirect Israeli violence since October 7th.

All in all, this represents an undercount of more than 600,000 people – around 90%. The number is horrifying. Worse, it is believable considering a fraction of what I described and cited above. Let alone Trump hinting at this with his own words at a February 4th press conference with Benjamin Netanyahu in which he cited a population of 1.8 million Palestinians living in Gaza – a number disturbingly prescient considering the pre-invasion population of 2.4 million and the Polya-Hil report findings 5 months later.

As these authors so aptly put:

“The glossing over of mortality figures, or undermining attempts at recording them, should be considered in the context of efforts by the powerful to obscure realities on the ground. In the case of Gaza, these efforts have been deployed to subdue growing public criticism in respect of war crimes and crimes against humanity—documented claims which suggest that the IDF may not be the most “moral army in the world”.

 

Buildings lie in ruin, following a ceasefire between Israel and Hamas, in Jabalia in the northern Gaza Strip, on Jan. 21, 2025. Photo by Dawoud Abu Alkas/ Reuters

Taking all of the above into consideration – a two-year siege of 2.4 million people confined to a thin, 141mi2 strip of land on the edge of their ancestral territory, 6 Hiroshima nuclear explosions worth of bombs and rockets, a slow-rolling onslaught of exponential disease and deprivation, and an international community holding local officials to a standard that demands conservative estimation – I find the 680,000 figure proposed by Polya-Hil to be a grim, conservative undercount.

The ongoing decimation of the Gaza Strip is something beyond contemporary parallel, a Black Swan event which lays bare the realities of modern warfare exercised against urban populations. With nowhere to go, the population of Gaza has been subjected to the most intense, devastating bombardment in history; a landscape with more than 17,000 people per square-mile in areas crushed beneath their homes, businesses, and schools.







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Daniel Woods
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