Do Gaza’s death tolls count natural deaths?

Some may be, through one identifiable channel. In the Gaza Ministry of Health’s list of named dead to 30 June 2024, 5,817 of 28,185 records entered on relatives’ notification rather than from hospital morgue records, and no column on any of its published lists records how a person died. These are the Hamas-run ministry’s own counts and are not independently verified. A ministry official told the BBC in 2025 that judicial review had found and removed some people who died naturally, yet the ministry’s own channel publishes the records its committee adds and no count of those it removes. Two measurements set the scale for any natural-death share: the Palestinian Central Bureau of Statistics registered an average of 4,884 deaths a year in Gaza in 2015 to 2019, and a peer-reviewed Lancet study puts injury deaths alone at 14.0 times Gaza’s 2022 all-cause death rate.

Key Findings

• The Gaza Ministry of Health’s list to 29 March 2024 holds 21,323 records in seven columns, and none of them is a cause of death. This is a party’s own count, not independently verified (Ministry of Health, Gaza, 2024 to 2026).
• In the ministry’s list to 30 June 2024, 5,817 of 28,185 records (20.6%) carry the ministry’s own label for notification by relatives, up from 2,478 of 21,323 (11.6%) in the March list. The labels record provenance, not cause (Ministry of Health, Gaza, 2024 to 2026).
• The Palestinian Central Bureau of Statistics registered an average of 4,884 deaths a year in Gaza in 2015 to 2019, as relayed in a Lancet correspondence letter (Huynh, Chin and Spiegel, 2024).
• Jamaluddine and colleagues (2025, peer-reviewed) estimate 64,260 traumatic-injury deaths in Gaza from 7 October 2023 to 30 June 2024 (95% CI 55,298 to 78,525). That is an annualised rate 14.0 times Gaza’s 2022 all-cause death rate.
• The Jerusalem Center for Security and Foreign Affairs (2025) sets a ceiling of at most 41,000 civilians dead of war-related causes. It is the Center’s own arithmetic, subtracting natural deaths and an Israeli fighter estimate from the ministry’s total, and both inputs are parties’ own counts.

Do the ministry’s casualty lists record how each person died?

The Gaza Ministry of Health’s list to 29 March 2024 holds 21,323 records in seven columns: serial number, name, identity number, date of birth, sex, age and source. It is a party’s own count and is not independently verified. None of the columns is a cause of death, so the document can show neither that a natural death was included nor that one was excluded.

The same holds across the four list documents the ministry posted to its media office channel between April and September 2024. The column set changes between rounds. In no round does a cause of death appear, and the heading تاريخ الاستشهاد (date of martyrdom) appears in no column header of any of the four.

The ministry posted its own statement of what the lists leave out on 7 January 2024 (message 4739) and has never withdrawn it. The statement names five exclusions:

• the missing and bodies trapped under rubble;
• the unidentified who reached hospitals;
• unidentified bodies handed over by Israel;
• people buried by their families without passing through a hospital;
• deaths in Gaza and North Gaza after the information system stopped in November 2023.

All five concern identification or the route by which a death reached the ministry. None concerns cause of death.

The ministry’s definition of its headline count points the same way. Its post of 24 July 2024 (message 5651) defines the general martyr count as everyone who reached the hospitals, and the complete-data count as everyone whose data the ministry has finished. As the ministry states it, admission turns on arrival and documentation. No field on any list shows how a person who died of illness and reached a hospital was treated. The same missing field limits what the lists can say about who caused a given death.

Who says natural deaths are folded into the total?

The Jerusalem Center for Security and Foreign Affairs, a research institute, set a ceiling in 2025 of at most 41,000 civilians in Gaza dead from war-related causes. It reached that figure by subtracting estimated natural deaths and an Israeli estimate of Hamas fighters killed from the Gaza Ministry of Health’s total. Both inputs are parties’ own counts, not independently verified, and the 41,000 is the Center’s arithmetic, not a count.

The essay is by Eugene Korn and covers the war through October 2025. It compares Gaza war death counts with those of earlier wars and genocides, and its page carries its own caveat: “Neither the Hamas claim of 67,000 total Gazan deaths nor the Israel estimate of 21,000 Hamas fighters killed has been independently confirmed, and the Hamas claim has been challenged.” On the figures the page prints, 67,000 less 21,000 is 46,000. The natural-death allowance therefore accounts for roughly the last 5,000 of the reduction to 41,000. That is a derivation from the essay’s totals, not a figure it states.

Israel’s earlier published figure is a floor. At a briefing on 29 February 2024, the war’s 146th day, the IDF Spokesperson stated that the IDF had eliminated “over 13,000” people in Gaza whom it describes as terrorists. That is the IDF’s own count, published by a party to the war and not independently verified, and the classification is its own.

The Henry Jackson Society, a London think tank, wrote in its 2024 report Questionable Counting that the ministry’s total included roughly 5,000 natural deaths a year. That is the think tank’s own estimate, not a ministry figure, and no ministry list carries a cause-of-death field against which it could be checked.

On the ministry’s own definitions, the direction of the claim holds. The count is built on everyone who reached a hospital in wartime, plus relatives’ reports, and it has no published field that would screen out an ordinary death. Some non-war deaths entering such a total is therefore plausible. The size of that share is unmeasured: the Center’s allowance and the think tank’s annual figure are both estimates, and no body publishes a cause-coded count of the ministry’s records.

How many Gazans died each year before the war?

The Palestinian Central Bureau of Statistics registered an average of 4,884 deaths a year in Gaza in 2015 to 2019. This is a peacetime civil-registration figure, relayed by Huynh, Chin and Spiegel in a 2024 Lancet correspondence letter that was editorially reviewed but not peer-reviewed. It sets the scale of ordinary mortality on which the natural-death premise rests.

Ordinary deaths therefore ran to several thousand a year before the war. Pro-rating the 2015 to 2019 average over the 268 days from 7 October 2023 to 30 June 2024 gives about 3,600 deaths. That is a derivation, not a published figure, and it indicates the order of magnitude ordinary mortality would contribute over that window if peacetime rates held. No measurement shows whether they held, and wartime conditions could move ordinary mortality in either direction.

The low annual figure reflects a young population. The Bureau’s own mid-2023 projection, built on the 2017 census, put Gaza’s population at 2,226,544. In that projection, children under 15 were 40% and people aged 65 and over were 3%. Under-18s were 47%, which is a different age cut-off rather than a competing estimate. These are the Bureau’s own figures; it is a national statistical office belonging to a party to the events, and its figures are not independently verified.

Two cautions travel with the 4,884. First, it is civil registration in peacetime, while the ministry’s war count comes from hospital and family reporting, so dividing one into the other compares unlike instruments. Second, the Bureau’s population figures for every year after 2017 are projections. On the source line of each population product it writes “Revised Estimated based on the final results of Population, Housing and Establishments Census, 2017,” so the 3% aged 65 and over is a projected share, not a counted one.

How many listed deaths were reported by relatives, not morgues?

In the Gaza Ministry of Health’s list to 30 June 2024, the ministry’s own provenance labels mark 5,817 of 28,185 records, 20.6%, as تبليغ ذوي الشهداء (notification by the martyrs’ relatives) rather than as ministry records. This is a party’s own count and is not independently verified. It is the channel through which a death never seen at a hospital morgue can enter the list.

That share grew between rounds. In the list to 29 March 2024, 2,478 of 21,323 records (11.6%) carried the relatives’ label and 18,845 carried the ministry-records label. By 30 June 2024 the relatives’ stratum had more than doubled. Jamaluddine and colleagues (2025) identify it as the ministry’s rolling online mortality survey, launched on 1 January 2024.

The ministry’s statement of 29 July 2024 (message 5663) explains how dates entered these records. The date of death was registered either on the family’s report or on the date the body reached the hospital. A committee was then formed to audit the actual date, and the ministry reported that the audit found a number of martyrs had been under 18 at death but were registered several months later.

The source column records provenance, not cause. Neither stratum carries a published count of natural deaths.

The Washington Institute for Near East Policy reached its own conclusion in a 2025 policy note, Assessing the Gaza Death Toll After Eighteen Months of War. It found that the family-registration process likely admitted “limited numbers” of natural deaths, despite the ministry’s stated policy of excluding them. That is the Washington Institute’s assessment. The ministry’s lists contain no field that would confirm it or size it.

What does the ministry’s approval committee add to the count?

The Gaza Ministry of Health added 280 records to its cumulative total on 30 August 2025, according to its own statement (message 6900). It described them as records completed and approved by the judicial committee following the notifications and missing-persons file, not as new deaths. The figure is the ministry’s own, published by a party to the war and not independently verified.

The 30 August batch was not the first.

• The ministry described 233 records added on 23 March 2025 (message 6377) in the same terms.
• It reported 160 added during August 2026 (message 7600), attributed there to a لجنة اعتماد الشهداء, a martyrs’ approval committee.

Each batch enters the cumulative total months after the deaths it records. The headline therefore rises on approval days as well as on days of newly reported deaths.

A ministry official interviewed by the BBC in 2025 described the review running in the other direction as well. Judicial reviews, the official said, had identified some people on the lists who had died naturally, and those people were removed or excluded. The official also said that deaths from lack of medical treatment, malnutrition or hypothermia were treated as indirect and not added to the lists. Both statements are the official’s account to a broadcaster.

The ministry’s own channel publishes its additions as numbers, batch by batch. None of the ministry statements cited here gives a count of records removed on cause-of-death grounds. In the published record, the review step appears only as additions, and the evidence that it removes natural deaths rests on the official’s account to the BBC.

Does the peer-reviewed estimate count only deaths from injury?

Yes.Jamaluddine and colleagues (2025), peer-reviewed in The Lancet, estimate 64,260 deaths due to traumatic injury in Gaza from 7 October 2023 to 30 June 2024 (95% CI 55,298 to 78,525). By the paper’s own scope, the estimate excludes deaths from disease, food insecurity, water and sanitation failure, and disrupted healthcare.

The study uses three-list capture-recapture, a method that estimates a total from how often the same people appear on more than one incomplete list. Its three lists are:

• the ministry’s hospital morgue records, 22,368 identified decedents;
• the ministry’s rolling online mortality survey, 5,817 decedents;
• social media obituary pages, scraped by hand.

The first two lists match exactly the two source strata in the ministry’s list to 30 June 2024. The study and the ministry are therefore not independent counts of the same deaths. The estimate is an academic reading built on a party’s own records, and the ministry figures it uses are the ministry’s own counts, not independently verified.

The authors also excluded records the ministry could not identify. The ministry’s 30 June 2024 update carried 9,692 unidentified decedents, 26% of its cumulative total, and the authors left them out of the hospital list. They likewise excluded 930 people reported missing from the survey list.

Set against the ministry’s own count of 37,877 at 30 June 2024, the estimate implies under-reporting of 41%. That 41% is a share of the 64,260 estimate: the gap of 26,383 deaths is 41% of 64,260. It is not a 41% markup on the ministry’s figure.

The paper’s injury-only scope comes from its definition of what it estimates. The ministry lists it draws on still carry no cause-of-death field, so the study does not settle how any single listed record died. What it does provide is a peer-reviewed estimate whose stated category leaves out ordinary illness. Its interval is wide, running from 55,298 to 78,525.

How far above peacetime mortality did injury deaths run?

Jamaluddine and colleagues (2025, peer-reviewed) report a rate ratio of 14.0 (95% CI 12.8 to 17.6) for traumatic-injury deaths in Gaza from October 2023 to June 2024, measured against all-cause mortality in Gaza in 2022.

That baseline includes every ordinary death from illness and old age in a peacetime year. The paper states that the ratio holds “even when ignoring non-injury excess mortality.”

The numerator is an annualised crude death rate from traumatic injury of 39.3 per 1,000 people (95% CI 35.7 to 49.4). Dividing 39.3 by 14.0 gives an implied 2022 all-cause rate of about 2.8 per 1,000. That is a derivation from the paper’s two published figures, not a rate the paper prints.

The ratio puts the natural-death premise on a scale. Suppose ordinary mortality continued at its 2022 rate during the war and every such death entered the ministry’s total. Ordinary deaths would then equal about one fourteenth of the injury deaths over the same period, roughly 7% of the injury toll. That figure is the citer’s arithmetic on the paper’s ratio. It is not a measured natural-death share, and it assumes peacetime rates held in wartime, which no source measures.

The Palestinian Central Bureau of Statistics figure gives a separate check on the same order of size. Its registered average of 4,884 deaths a year in 2015 to 2019, relayed by Huynh, Chin and Spiegel (2024), comes from civil registration rather than from the hospital and morgue reporting behind the war count. The two instruments differ, so the comparison sets an order of magnitude rather than a reconciled figure.

Two limits apply to the 14.0. It measures injury deaths only, so it sets ordinary mortality against the narrowest war category and not against a total war toll. And its numerator rests on the ministry’s own lists, which are a party’s records and not independently verified, through the capture-recapture design described above.

Where are deaths from hunger and disease counted?

Spagat, Pedersen, Shikaki, Robbins, Bendavid, Hegre and Guha-Sapir, in a medRxiv preprint, estimate 4,540 to 12,500 indirect deaths in Gaza from 7 October 2023 to 5 January 2025. Indirect deaths are deaths from causes such as hunger, disease and lost medical care, as distinct from deaths from violence. Crawford (2025) relays the range for the Costs of War project at Brown University, in a report that is not peer-reviewed.

Crawford makes no indirect-death estimate of his own. His headline figure, 67,075 killed in Gaza as of 3 October 2025, is the Gaza Ministry of Health’s own count, relayed to him through a United Nations dashboard and not independently verified. He also cites public health research describing the ministry’s count as one that “may be a significant undercount of the violent deaths.” His report thus treats indirect deaths as a separately estimated category alongside the ministry’s count, not as part of it. That matches the account a ministry official gave the BBC in 2025, that such deaths are kept off the lists.

One named estimate adds non-violent deaths explicitly. In an open letter dated 2 October 2024, 99 American medical professionals who had volunteered in Gaza presented an estimate of 118,908 total deaths to 30 September 2024. The letter is an advocacy document whose stated demand is a US arms embargo. Its appendix builds the total from four parts:

• the ministry’s count of 41,495 killed as of 25 September 2024;
• about 10,000 people under rubble;
• 62,413 deaths from “starvation and its compilations [sic]”;
• 5,000 deaths among patients with chronic disease.

The 62,413 is not a count. The appendix derives it by multiplying population estimates for the two most severe food-insecurity phases by the threshold death rates that define those phases in the Integrated Food Security Phase Classification (IPC), the international system for grading hunger. Alex de Waal of the World Peace Foundation, whom the appendix itself quotes, wrote in December 2024 of this method that “The IPC discourages this.”

In the record, deaths from hunger and disease appear in estimates labelled as such, one a preprint and one an advocacy derivation. They do not appear as a column on the ministry’s lists.

Methodology and limitations

This report draws on four types of source. The primary records are the Gaza Ministry of Health’s four name-by-name lists (to 29 March, 30 April, 30 June and 31 August 2024), its daily statistical reports and its own statements, read directly on 10 September 2026. The lists were read from a public mirror of the files the ministry posted to its media office channel and checked against the ministry’s own stated record counts and column sets. The Palestinian Central Bureau of Statistics supplied the population projections. These are official records of bodies that are parties to the events, and none of their figures is independently verified. The IDF figure is likewise a party’s own count.

The peer-reviewed measurement is Jamaluddine and colleagues (2025), a three-list capture-recapture estimate whose two main inputs are the ministry’s own strata. Huynh, Chin and Spiegel (2024) is a Lancet correspondence letter, editorially reviewed but not peer-reviewed, and is cited here only for a relayed civil-registration figure. Crawford (2025) is a university project report that compiles other bodies’ counts. The indirect-death range is from a preprint. The open letter of 2 October 2024 is an advocacy document. The Jerusalem Center, Henry Jackson Society and Washington Institute figures are those organizations’ own estimates and assessments. The BBC interview is press reporting of an official’s account.

The central limitation is in the record. No ministry list carries a cause-of-death or date-of-death field, and no body publishes a cause-coded count of the ministry’s records or a count of records removed on cause-of-death grounds. Every natural-death figure above is therefore an estimate or a derivation, and each is labelled as such where it appears. Derivations made here, such as pro-rating the 4,884 annual average or inverting the 14.0 rate ratio, are marked in the sentence that carries them.

Conclusion

Are natural deaths included in the ministry’s casualty figures? On the published record, the lists cannot show either way, because no column records how anyone died. These are the Gaza Ministry of Health’s own lists, published by a party to the war and not independently verified.

What the record does show is consistent across sources. The lists record name, identity, birth date, sex, age and provenance. The ministry’s five stated exclusions all turn on identification, not cause. A relatives’ channel holding 5,817 of 28,185 records by June 2024 is the route by which an unexamined death can enter. The ministry’s approval committee publishes its additions, 280 in one batch, and no removal count appears in its own statements. Against that, the Bureau’s 4,884 registered deaths a year and a peer-reviewed injury rate 14.0 times all of Gaza’s 2022 mortality set the scale. Even if ordinary deaths were present in full, they would be small beside the injury toll. The deaths from hunger and disease that the question often implies sit in separate estimates, one a preprint and one an advocacy derivation.

The open question is less whether ordinary deaths reach a wartime list than what a reader can do with a list that has no column in which the answer could appear. A record that names every person and is silent on how each one died will be read by every side according to its prior expectations. How much would one field change, if a cause of death were printed beside each name?

Frequently Asked Questions

Does the Gaza Ministry of Health separate combatants from civilians?

No. Crawford (2025) records that the ministry publishes no combatant and noncombatant breakdown at all, and none of its four lists read here carries such a field. Combatant figures in circulation come from other parties, such as the IDF’s own February 2024 count.

Why do the lists carry a date of birth but not a date of death?

The ministry’s statement of 29 July 2024 says the date of death was registered on the family’s report or on the date the body reached hospital, and that a committee was formed to audit it. The published lists print date of birth in three of the four rounds, and none prints a date of death.

Are people still under rubble included in the total?

Not on the ministry’s own terms. Its statement of 7 January 2024 excludes the missing and bodies under rubble. Its daily report of 10 September 2026 records 831 bodies recovered from the rubble since the ceasefire; this is the ministry’s own count, not independently verified.

How did the ministry’s count compare with other bodies’ counts in earlier wars?

Huynh, Chin and Spiegel (2024) give discrepancies of 1.5% to 3.8% in previous conflicts. The sentence that states the range carries no citation in the letter, and the letter’s own measurement covers only 7 October to 10 November 2023. No peer-reviewed study comparing pre-2023 ministry counts with another body’s count was located.

What is the ministry’s most recent cumulative total?

The ministry’s daily report of 10 September 2026 records 73,670 cumulative deaths and 174,682 injuries, its own figures and not independently verified. The total includes records added by committee approval as well as newly reported deaths.

Does the ministry publish deaths by age and sex group?

Its Health Annual Report, Palestine 2025 gives children 30%, women 16%, elderly 7% and men 47% of deaths from 2023 to 2025, against a stated total of 71,271. These are the ministry’s own shares, read from a graph and not independently verified.

Sources

• American Medical Professionals Who Served in Gaza, 2024. Open Letter to President Biden and Vice President Harris, and Appendix. Self-published. https://www.gazahealthcareletters.org/s/Appendix-20241002.pdf. Advocacy open letter.
• BBC, 2025. Gaza health ministry denies manipulating death toll figures. BBC News. https://www.bbc.com/news/articles/cx25x35476yo. International press.
• Crawford, Neta C., 2025. The Human Toll of the Gaza War: Direct and Indirect Death from 7 October 2023 to 3 October 2025. Costs of War project, Watson School of International and Public Affairs, Brown University. https://costsofwar.watson.brown.edu/paper/HumanTollGaza. University research report, not peer-reviewed.
• de Waal, Alex, 2024. How many people have died of starvation in Gaza? World Peace Foundation. https://worldpeacefoundation.org/blog/how-many-people-have-died-of-starvation-in-gaza/. Research institute commentary.
• Henry Jackson Society, 2024. Questionable Counting. Henry Jackson Society. https://henryjacksonsociety.org/publications/questionable-counting/. Think tank report.
• Huynh, Benjamin Q., Chin, Elizabeth T. and Spiegel, Paul B., 2024. No evidence of inflated mortality reporting from the Gaza Ministry of Health. The Lancet, 403(10421), 23 to 24. DOI 10.1016/S0140-6736(23)02713-7. Correspondence, editorially reviewed, not peer-reviewed.
• Israel Defense Forces, 2024. Press Briefing by IDF Spokesperson, Rear Admiral Daniel Hagari, February 29th, 2024. https://www.idf.il/en/mini-sites/israel-at-war/briefings-by-idf-spokesperson-bg-effie-defrin/february-24-press-briefings/press-briefing-by-idf-spokesperson-rear-admiral-daniel-hagari-february-29th-2024/. Official record, a party’s own count.
• Jamaluddine, Zeina, Abukmail, Hanan, Aly, Sarah, Campbell, Oona M. R. and Checchi, Francesco, 2025. Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture-recapture analysis. The Lancet, 405(10477), 469 to 477. DOI 10.1016/S0140-6736(24)02678-3. Peer-reviewed.
• Jerusalem Center for Security and Foreign Affairs, 2025. The Death of Genocide. https://jcfa.org/the-death-of-genocide/. Research institute.
• Ministry of Health, Gaza, 2024 to 2026. Published martyr lists, daily statistical reports and statements; Health Annual Report, Palestine 2024 and 2025. https://t.me/MOHMediaGaza and https://site.moh.ps/index/Books/BookType/2/Language/ar. Official record, a party’s own count, not independently verified.
• Palestinian Central Bureau of Statistics, 2023. Child Day and World Population Day releases, mid-2023 population estimates. https://www.pcbs.gov.ps/portals/_pcbs/PressRelease/Press_En_IntPopulationDy2023E.pdf. Official record.
• Spagat, Michael, Pedersen, Jon, Shikaki, Khalil, Robbins, Michael, Bendavid, Eran, Hegre, Håvard and Guha-Sapir, Debarati. Gaza mortality estimates, as relayed in Crawford (2025). medRxiv. Preprint.
• Washington Institute for Near East Policy, 2025. Assessing the Gaza Death Toll After Eighteen Months of War. Policy Note 158. https://www.washingtoninstitute.org/sites/default/files/pdf/PolicyNote158Epsteinv3.pdf. Think tank policy note.