Accounting For the Gaza Dead – The Ministry of Health's Tragic Responsibility

Life for the 2.2 million Palestinians (2023 estimate) is a tenuous one – fraught with uncertain supplies of food, medicines, and energy. They occupy a narrow strip of land between the State of Israel and the Mediterranean Sea. The ever-present threat of war has been part of their lives for longer than most have been alive.

For the last 17 years, the Palestinian Ministry of Health – Gaza, known locally as the Gaza Ministry of Health (MOH), has presided over the vital statistics for the Palestinians, providing the most reliable data on births, illnesses, and deaths. Never an easy task, the Gaza Ministry of Health (MOH) has emerged as the most reliable data provider in monitoring the Gazan people's welfare. The MOH is the go-to site for Gazan vital statistics for both the United Nations and the World Health Organization.

The United Nations Office for the Coordination of Human Affairs (OCHA) takes the Ministry of Health data on deaths and reports those numbers on their website here:

https://www.ochaopt.org/content/reported-impact-snapshot-gaza-strip-11-september-2024
(You'll note the reference "MOH" in the lower right corner.)

The World Health Organization, in turn, takes the same MOH statistics and reports them on their online PowerPoint presentation here:

https://app.powerbi.com/view?r=eyJrIjoiODAxNTYzMDYtMjQ3YS00OTMzLTkxMWQtOTU1NWEwMzE5NTMwIiwidCI6ImY2MTBjMGI3LWJkMjQtNGIzOS04MTBiLTNkYzI4MGFmYjU5MCIsImMiOjh9


Most of the world's press obtains statistics, especially the number of moralities, from these two sites, which they then report to their readers, viewers, and listeners around the world.

Because the mortality numbers are constantly climbing, you will often see one report leading the other as the MOH records new deaths.

How the Gaza Ministry of Health Collects Its Vital Statistics

Let's now look at how the Ministry of Health collects its data. There are no real surprises here; the MOH operates in the same manner that most advanced countries do.

Here, in the United States, the CDC (the Centers for Disease Control and Prevention) provides an online service, the National Vital Statistics System (NVSS), in which hospitals, funeral homes, and in selected circumstances individuals can access and report a death. In the United States, this method of mortality reporting has proven to be highly accurate and reliable. Until the current conflict, a similar system in Gaza proved accurate and reliable.

A side note: In past Israel-Hamas conflicts, many challenged the accuracy of the MOH mortality numbers, but the MOH was able to verify their numbers. This is why both the UN and WHO now accept the MOH statistics.

Like the American NVS System, the MOH provided online access to all 18 hospitals and morgues in Gaza to report mortality. Unfortunately, most of those institutions are now gone. Fifteen of those hospitals and their morgues have been destroyed, along with an unknown number of independent morgues. This has effectively cut off approximately three-quarters of the MOH mortality reporting system.

Two other factors have limited the accuracy of the current mortality reporting.

Principally, the sheer number of dead has been overwhelming. Early in the conflict, several reports indicated that morgues and hospitals could not keep up. Two days into the conflict, Reliefweb reported that "Morgues were overflowing." unable to process the number of bodies:

https://reliefweb.int/report/occupied-palestinian-territory/crisis-gaza-reaches-unprecedented-levels-morgues-are-already-overflowing-and-im-afraid-more-people-will-die

Early in the conflict, AP News reported that Palestinians had to dig mass graves beside the roads because the cemeteries were already overflowing.

https://apnews.com/article/palestinians-israel-graves-gaza-morgue-dead-9b0349ae914e33492c049430e6649c53

It's doubtful that any of these deaths were reported to the MOH System. And that was just two days into the conflict. We're now 11 months into this conflict, and the MOH Mortality reporting system's challenge has only worsened.

The War Takes A Deadly Turn

On Tuesday, September 10, the Israelis used its most powerful bomb, presumed to be the American-made, 2,000-pound MK-84 - so powerful was its blast that it left a 40-foot crater.

https://www.nytimes.com/2024/09/10/world/middleeast/israel-strike-mawasi-bombs.html

https://www.cnn.com/world/live-news/israel-gaza-al-mawasi-strike-09-10-24/index.html

Unfortunately, this was not the first time that the refugees were attacked at al-Mawasi. Back on July 13, another bomb also struck the camp. Both times, the results were the same: although survivors found some remains, many bodies were missing, presumed vaporized in the explosion. In the recent attack, onlookers found 19 bodies, but eyewitnesses indicate that an equal number of bodies will likely never be recovered.

https://en.wikipedia.org/wiki/13_July_2024_al-Mawasi_attack


Conclusion

Regrettably, in any objective review of the mortality statistics collected during the current Conflict in Gaza, one is forced to conclude that it is probable that any death count woefully understates the number of Palestinians who have lost their lives.

Three factors contribute to this conclusion. First, the sheer number of dead bodies overwhelmed the MOH Vital Statistics Reporting System. Second, the loss of 15 out of the 19 reporting Hospitals and morgues decimated the MOH's ability to collect death records. And finally, massive ordinances, such as the MK-84, have destroyed bodies.

Of course, I'm not the first to come to this conclusion,
Rasha Khatib, Martin McKee, and Salim Yusuf made a similar point in a letter published in the Lancet. As the three researchers report:

"However, the number of reported deaths is likely an underestimate."

The Lancet Correspondence Volume 404, Issue 10449p237-238July 20, 2024

Written on July 20, their letter predates the massive destruction of 15 reporting hospitals and predates the use of the 2,000-pound bombs, with its ability to vaporize bodies. Even so, they indicate that the MOH Death statistics may UNDERSTATE the true number by between three and 15 times. Using their most conservative factor of actual deaths equaling three times reported, the current death total in Gaza would be roughly 5% of the population (or 123,000).

No matter how you look at the mortality data in Gaza, the picture that emerges is increasingly tragic.