After months of failed negotiations to end the deadliest war in the Gaza Strip’s history, the ceasefire between Hamas and Israel, which took effect on Sunday, brought a mix of relief and sorrow.
As the three-phase agreement comes into force, Palestinians in Gaza are now grappling with the painful reality of mourning countless loved ones lost during Israel’s 15-month war, while also coming to terms with the widespread destruction around them.
With any permanent cessation of hostilities, there is also the opportunity to finally uncover the true scale of Gaza’s death toll, as bodies are found under the rubble and the missing are accounted for.
The Palestinian Ministry of Health (MoH) says Israel’s ground and air campaign in Gaza has killed more than 47,000 people since October 2023, with over half of those women, children, or the elderly.
Other estimates, however, have put those numbers as significantly higher. For example, research published earlier this month by The Lancet, a medical journal, found that 64,260 people had died from traumatic injury during the first nine months of the war.
These findings suggest that traumatic injury deaths are around 41% higher than the official figures reported by Palestinian health authorities, who put the figure at 37,877 at the time. The analysis projected that as of October 2024, over 70,000 Gazans had been killed by violence, accounting for the expected underreporting rate.
The research also estimated that about 3% of Gaza’s population has died due to Israeli violence, and 59% of the 28,257 deaths with available data on sex and age were women, children under 18, and adults aged 65 and older.
Researchers from the London School of Hygiene & Tropical Medicine (LSHTM), who conducted the latest study, employed a “capture-recapture” statistical method, using data from the health ministry, an online survey of relatives reporting fatalities, and social media obituaries.
The report said the total death toll from Israel’s military operation is likely even higher, as its analysis does not include non-trauma-related deaths caused by disruption to healthcare, lack of food, clean water and sanitation, and disease outbreaks.
Accurately calculating indirect mortality during an ongoing war comes with numerous challenges and constraints, considering the extremely insecure conditions for humanitarian and health workers in Gaza, along with access restrictions.
“Hopefully, if there’s a lasting ceasefire, people on the ground will finally be able to properly estimate the true numbers, with more accuracy than we have so far,” Francesco Checchi, a professor of epidemiology and international health at LSHTM who co-authored the report in The Lancet, told The New Arab.
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He highlighted a general “obfuscation of evidence” due to insecurity throughout the war, with people unable to gather information and local journalists facing threats and attacks.
At the beginning of the current conflict, the Palestinian MoH reliably tracked deaths from traumatic injuries by counting bodies that arrived in hospitals, and recording into an electronic database the names, ages, genders and ID numbers of the dead.
Yet, since October 2023 the quality of mortality data from the health ministry has deteriorated. Israeli military actions and strikes on health facilities have disrupted electronic death records, forcing the ministry to use less structured methods. As the fighting continued, fewer hospitals and morgues remained operational, and those functioning were so overwhelmed with the influx of patients that they could not maintain accurate records.
The UN human rights office has also said the Palestinian authorities’ tallies are likely an undercount.
“Data availability and reliability have decreased over time because the MoH is no longer able to confirm mortality figures as before,” Sarah Aly, a global emergency medicine fellow at Yale University, who also contributed to The Lancet study, told TNA.
The scholar, who is interested in emergency medicine in the MENA region, observed how Gaza’s hospitals have struggled to report reliable accounts of deaths, or even communicate at a central level as a result of widespread communication blackouts and destruction of health infrastructure, alongside the killing and detention of key medical personnel.
“Still, what the Palestinian Ministry of Health has been able to do is quite impressive, given the under-reporting and the circumstances they’ve had to go through,” Aly said.
A halt to the fighting in Gaza offers Palestinians a window of opportunity to retrieve and fully count the bodies of the dead, many of which have been buried under the war rubble for weeks and months.
On Monday, emergency services and families began searching for the missing and recovered dozens of remains throughout the north and south of the besieged strip. The civil defence service said that at least 10,000 bodies are estimated to lie in the ruins. Civil defence workers have reportedly recovered 120 decomposed bodies from the rubble since the start of the truce.
“The ceasefire will hopefully give people the space to grapple with the scale of what they’ve lost, which is going to be as painful as the last 15 months,” Jehad Abusalim, executive director of the Washington-based Institute for Palestine Studies (IPS) told The New Arab, reflecting on what he called a huge “collective trauma”.
The IPS-USA director discussed several challenges in retrieving the bodies of the missing and identifying the deceased in the aftermath of Israel’s most devastating war on the Palestinian territory.
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Considering Israel’s extensive targeting of public infrastructure, resources, and capabilities, Gaza currently lacks the equipment and technical know-how needed for DNA testing and matching, Abusalim said.
The rubble, where up to 10,000 people are thought to be buried, contains unexploded ordnance and harmful substances. UNRWA has already said it could take up to 15 years to clear the debris in Gaza.
There have also been many accounts of victims whose bodies have simply vanished without a trace after the Israeli bombing of residential buildings, raising questions about what type of bombs were used in the attacks.
Other bodies have been reportedly taken by the Israeli army and then returned decomposed with no identification.
In many instances, Abusalim continued, makeshift burial sites where Gazans temporarily buried their family members may no longer exist after Israeli troops raided, hit, or flattened them, shifting the ground.
“Palestinians will be left with thousands of remains, and won’t know where their loved ones are buried,” Abusalim said, alluding to the likely discovery of new mass graves across Gaza.
Checchi said that under a sustained ceasefire, an accurate death toll could be established which would also include non-injury-related fatalities resulting from the indirect effects of the conflict.
“The number of war casualties can be established fairly robustly through household surveys using standard demographic methods,” the epidemiologist noted. He stressed that people in Gaza will play a critical role in leading the data collection, forensic analysis, and documentation regarding war victims, with international relief groups supporting their work when necessary.
Aly pointed out that a ceasefire is expected to facilitate the accurate accounting of casualties, however, field researchers will face a two-fold hurdle of conducting mortality surveys with a highly “mobile” displaced population returning home and dealing with an “increase” in deaths from untreated chronic illnesses and war injuries due to the prolonged lack of access to healthcare.
For the academic, while recovering the bodies of the missing will add to the mental distress that civilians in Gaza have been experiencing in more than a year of incessant military assault, ensuring complete death toll tracking during the ceasefire may also bring a “sense of closure”.
Abusalim maintained that there needs to be a “thoughtful” effort by the international community to provide the necessary resources for identifying the missing and to ensure a humane, dignified burial for the dead.
“The international community failed to prevent these atrocities. Now, it should support efforts that at least provide a humane closure for the deceased,” he said.
Alessandra Bajec is a freelance journalist currently based in Tunis.
Follow her on Twitter: @AlessandraBajec