Horror Beyond Comprehension: Gaza Death Toll Realistically Assessed At 186,000, But Could Be As High As 600,000

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Many thanks to three medical experts, research scientist Rasha Khatib, Professor Martin McKee and Professor Salim Yusuf, who have finally broken the global medical establishment’s silence regarding the true death toll of Israel’s genocidal assault on the Gaza Strip, now in its tenth month, pointing out, in correspondence printed in The Lancet, one of the world’s most respected academic medical journals, that, at a conservative estimate, the total death toll is likely to be at least 186,000, and maybe much higher.

The experts’ assessment is based on multiplying the known, direct deaths of Israel’s unprecedentedly brutal assault on the nearly 2.4 million inhabitants of the Gaza Strip (2,375,259, as of 2022), which is widely understood to be around 37,000 (37,396, as of June 19, according to the Gaza Health Ministry), by a factor of five, to include the indirect deaths that, as established through detailed research into armed conflict since the 1990s, always exceed direct deaths many times over.

The experts’ main source for indirect deaths in wartime appears to be the Geneva Declaration Secretariat’s ‘Global Burden of Armed Violence’ report, published in 2008 after the Geneva Declaration on Armed Violence and Development was adopted by 42 states at the conclusion of a ministerial summit in June 2007, which “recogniz[ed] that the fight against the global scourge of armed violence and the prospects for sustainable development are closely linked.”

As the report stated (p. 32), “The lethal impact of modern war extends far beyond the number of soldiers and civilians who die violently in armed combat or clashes … Armed conflict generates a series of lethal but indirect impacts on communities beyond the number of people killed in battle or combat. In the short term, indirect victims of armed conflict die from a variety of specific causes, usually from easily preventable diseases such as dysentery or measles, or from hunger and malnutrition. These deaths are a result of the loss of access to basic health care, adequate food and shelter, clean water, or other necessities of life … These indirect victims of war do not die violently. But, from a human, moral, and political point of view, the distinction between a violent and non- violent death is irrelevant. All that matters is that a number of people died who would otherwise have lived if armed violence had not ravaged their communities.”

In a crucial passage, the report stated, “In the majority of conflicts since the early 1990s for which good data is available, the burden of indirect deaths was between three and 15 times the number of direct deaths.”

Using these multipliers in connection with Gaza, the experts chose to adopt a relatively low estimate of the indirect deaths — four times the number of direct deaths, making 186,000 in total (7.9% of the total population). If they had taken the most extreme example, however, of 15 times the number of direct deaths, the total would be nearly 600,000 (almost a quarter of the population).

As the experts note in their letter, “The total death toll is expected to be large given the intensity of this conflict; destroyed health-care infrastructure; severe shortages of food, water, and shelter; the population’s inability to flee to safe places; and the loss of funding to UNRWA [the UN Relief and Works Agency], one of the very few humanitarian organisations still active in the Gaza Strip.”

Noticeably, too, most of these deaths are expected to be civilians. Of the direct deaths recorded to date, the Geneva-based Euro-Med Human Rights Monitor, which has been including those buried under the rubble in its figures, estimates that 90% of those killed were civilians, a more realistic estimate than Israeli claims, made in February, that it had, at that point, killed 10,000 Hamas fighters. As the BBC reported at the time, there were “concerns” about whether Israel was “able to separate fighters from ordinary civilians.”

Citing experts who were “concerned that the IDF might be counting some non-combatants as fighters merely because they are part of the Hamas-run territory’s administration”, the BBC quoted Andreas Krieg, a senior lecturer in security studies at Kings College London, who stated that “Israel takes a very broad approach to ‘Hamas membership’, which includes any affiliation with the organisation, including civil servants or administrators.”

Obviously, there is no way of knowing the exact number of deaths until Israel stops its genocide, and the horrific work of locating the uncounted dead begins, but the significance of the experts’ letter cannot be overestimated. Although the US political analyst Ralph Nader first proposed a death toll of “at least 200,000 Palestinians” in March, few commentators picked up on it, and, as noted at the start of this article, the three experts who wrote this letter to The Lancet (and The Lancet’s editors, who recognized its significance) are to be commended for seeking to broaden the scope of our understanding of the unforgivably colossal scope of Israel’s genocide by factoring in the indirect deaths.

This is particularly so given the scale of Israel’s destruction of Gaza, which in so many ways represents the very deliberate and maximum infliction of the “hunger and malnutrition” and “easily preventable diseases” identified by the Geneva Declaration Secretariat, as “a result of the loss of access to basic health care, adequate food and shelter, clean water, or other necessities of life.”

In Gaza, “the loss of access to basic health care” has been accomplished to maximum destructive effect via the almost complete destruction of all of its hospitals and healthcare facilities, while adequate shelter has been almost entirely eradicated not only through the destruction of housing on an unprecedented scale, but through the subsequent forced evacuation orders which have required almost the entire population to leave their neighbourhoods, and to live in makeshift tents in so-called “safe zones” that have turned out not to be safe at all, and where, of course, no sanitation or sewage facilities are available.

Regarding food and water, both have been severely restricted, to the point of starvation and of widespread illness contracted through having to drink contaminated water, by the “complete siege” that the Israeli defense minister Yoav Gallant imposed shortly after the attacks on Israel by Hamas and other militants on October 7. Just this week, UN experts issued a press release stating that they were in “no doubt that famine has spread across the entire Gaza strip.”

The “complete siege” has remained in place to a startling extent ever since, and, via Israel’s ban on medical supplies and fuel, has also consigned almost everyone with any kind of pre-existing health condition to an uncertain future, if not certain death. Alarmingly, even after so many months of grotesque and unprecedented live-streamed slaughter, Israel’s noose on Gaza has tightened even more significantly over the last few months, since the Rafah Crossing with Egypt was closed, preventing the delivery of almost any supplies whatsoever, and also preventing aid agencies from arranging for seriously ill babies, children and adults to be evacuated to healthcare facilities in other countries.

As a result of all the above, it seems reasonable to assume that the experts’ estimate of indirect deaths is on the low side, and that we should expect the true total to be in the many hundreds of thousands.

Western indifference, even to the messianic genocidal intent of Israel’s far-right settlers

Shamefully, the western media have barely seen fit to comment on the letter in The Lancet, with only MSNBC deigning to report it, in a decent assessment by “breaking/trending news blogger” Clarissa-Jan Lim.

This lack of interest follows a pattern established in the first few months of Israel’s genocide, when, as Lim reported, “Israeli government agencies … accused the Gaza Health Ministry, which is run by Hamas, of inflating the death toll. President Joe Biden similarly suggested at one point that those numbers are not to be believed. However, human rights groups, news organizations and even Israeli intelligence services have previously considered the health ministry’s numbers to be largely accurate.”

In their letter, the experts also addressed Israeli claims of inflated figures, noting that, although contested by Israel, “they have been accepted as accurate by Israeli intelligence services, the UN, and WHO. These data are supported by independent analyses, comparing changes in the number of deaths of UN Relief and Works Agency (UNRWA) staff with those reported by the Ministry, which found claims of data fabrication implausible.”

While much of Israel’s black propaganda has evaporated as the genocide has ground on, those paying close attention to the conflict have long been aware that even the direct death toll hasn’t been accurate for many many months, because it was largely based on the health ministry matching existing records with hospital admissions, and was impossible to continue with any accuracy after administrative offices and hospitals were so mercilessly targeted and destroyed. At the end of February, for example, the health ministry’s estimate was 30,035, but it is frankly inconceivable that just 7,000 people have been killed in the four months of carnage since.

As Israel’s atrocities continue — it recently attacked four schools sheltering displaced people, with no possible claim of military necessity, and yesterday ordered the entire surviving population of Gaza City to evacuate their homes — it is imperative that the medical experts’ extremely reasonable and fundamentally unarguable assessment of the death toll is not ignored — or, even worse, insulted and demeaned as it has been throughout the Israeli media, with, to cite just one example, the Jerusalem Post screaming that it is a “blood libel”, and calling the figure of 186,000 “libellous.”

Do the Israelis — and, by extension, their still resolute supporters and facilitators in the west — somehow think that they can hide the scale of their war crimes and their crimes against humanity forever? Do they somehow think that they can endlessly defer the day of reckoning, when the killing eventually stops, and the international community will secure access to the ruins of the Gaza Strip, to finally uncover the extent of their lies, and the extent of their genocide?

As the medical experts state at the conclusion of their letter, “An immediate and urgent ceasefire in the Gaza Strip is essential, accompanied by measures to enable the distribution of medical supplies, food, clean water, and other resources for basic human needs. At the same time, there is a need to record the scale and nature of suffering in this conflict. Documenting the true scale is crucial for ensuring historical accountability and acknowledging the full cost of the war.”

As they add, “It is also a legal requirement. The interim measures set out by the International Court of Justice in January, 2024, require Israel to “take effective measures to prevent the destruction and ensure the preservation of evidence related to allegations of acts within the scope of … the Genocide Convention.” The Gaza Health Ministry is the only organisation counting the dead. Furthermore, these data will be crucial for post-war recovery, restoring infrastructure, and planning humanitarian aid.”

Like Auschwitz and other Nazi death camps, the truth about the colossal death camp that Israel has created in the Gaza Strip must eventually emerge. The only other option — if Israel is intent on hiding its genocide forever — is that it fulfils the dreams of its most deranged genocide supporters, the far-right settlers who include two government ministers, Itamar Ben-Gvir and Bezalel Smotrich, and the fanatical settler leader Daniella Weiss, by cutting itself off completely from the rest of the world, and exterminating not only the entire Palestinian population of the Gaza Strip, but also the entire Palestinian population of the West Bank and East Jerusalem.

Israel’s most messianic and unhinged mass murderers don’t say this out loud — generally talking of “voluntary migration” for western audiences, even though no country is prepared to accept an influx of Palestinian refugees — but it is what they want, and what they talk about when they are unmonitored, and if, in some dark future in which the west continues to fail to curb the worst impulses of the Israeli far-right, still sending them weapons even as their economy collapses and they are treated as a pariah state by the rest of the world, these people, amongst the most evil to have ever walked the earth, will continue to pursue their blood-soaked dream to its logical conclusion: the erasure of 5.3 million Palestinian people, which would finally confirm them as rivalling Hitler in their genocidal intent.

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Andy Worthington is a freelance investigative journalist, activist, author, photographer (of an ongoing photo-journalism project, ‘The State of London’), film-maker and singer-songwriter (the lead singer and main songwriter for the London-based band The Four Fathers, whose music is available via Bandcamp). He is the co-founder of the Close Guantánamo campaign (see the ongoing photo campaign here) and the successful We Stand With Shaker campaign of 2014-15, and the author of The Guantánamo Files: The Stories of the 774 Detainees in America’s Illegal Prison and of two other books: Stonehenge: Celebration and Subversion and The Battle of the Beanfield. He is also the co-director (with Polly Nash) of the documentary film, “Outside the Law: Stories from Guantánamo” (available on DVD here, or you can watch it online here, via the production company Spectacle, for £2.50).

In 2017, Andy became very involved in housing issues. He is the narrator of the documentary film, ‘Concrete Soldiers UK’, about the destruction of council estates, and the inspiring resistance of residents, he wrote a song ‘Grenfell’, in the aftermath of the entirely preventable fire in June 2017 that killed over 70 people, and, in 2018, he was part of the occupation of the Old Tidemill Wildlife Garden in Deptford, to try to prevent its destruction — and that of 16 structurally sound council flats next door — by Lewisham Council and Peabody.

Since 2019, Andy has become increasingly involved in environmental activism, recognizing that climate change poses an unprecedented threat to life on earth, and that the window for change — requiring a severe reduction in the emission of all greenhouse gases, and the dismantling of our suicidal global capitalist system — is rapidly shrinking, as tipping points are reached that are occurring much quicker than even pessimistic climate scientists expected. You can read his articles about the climate crisis here.

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