Explainer-Gaza death toll: how many Palestinians has Israel's campaign killed?

By Emma Farge and Nidal al-Mughrabi

(Reuters) - Palestinian health authorities say Israel's ground and air campaign in Gaza killed more than 46,600 people, with just over half of identified victims being women, children or older people.

Israel and Hamas agreed to a deal to halt the fighting in Gaza and exchange Israeli hostages for Palestinian prisoners, an official briefed on the deal told Reuters on Wednesday, opening the way to a possible end to a 15-month war that has inflamed the Middle East.

The latest round of Israeli-Palestinian conflict began on Oct. 7, 2023 when Hamas militants stormed across the border into Israeli communities. Israel says the militants killed more than 1,200 people, mostly civilians, and took some 250 people into captivity in Gaza. 

The official Palestinian Health Ministry count of more than 46,600 Palestinian dead amounts to more than 10 times its count of losses in all previous Gaza conflicts since 2008, according to a Reuters calculation. 

This explainer examines how the Palestinian toll is calculated, how reliable it is, the breakdown of civilians and fighters killed and what each side says.     

HOW DO GAZA HEALTH AUTHORITIES CALCULATE THE DEATH TOLL?

In the first months of the war, death tolls were calculated entirely from counting bodies that arrived in hospitals and data included names and identity numbers for most of those killed. 

As the conflict ground on and fewer hospitals and morgues continued to operate, the authorities adopted other methods too.

From early May 2024, the ministry updated its breakdown of fatalities to include unidentified bodies which accounted for nearly a third of the overall toll. 

Since then, health authorities have been working to identify them and that portion has shrunk to less than 3%.

Zaher Al-Waheidi, Director of the Information Unit at the Gaza Health Ministry, attributed progress in identifying bodies to the restoration of a central database from Shifa Hospital and a new system allowing families to provide input on victims, which is then verified by medics and police. 

Of the identified dead, about 55% are estimated to be women, children or elderly, according to a Reuters calculation based on Palestinian data released in January.

IS THE GAZA DEATH TOLL COMPREHENSIVE?

The numbers do not necessarily reflect all victims, as many are still under rubble, the Palestinian Health Ministry says. It estimates some 10,000 bodies were uncounted in this way.

Official Palestinian tallies of direct deaths in the Gaza war likely undercounted the number of casualties by around 40% in the first nine months of the war as Gaza's healthcare infrastructure unravelled, according to a peer-reviewed study published in The Lancet journal this month.

The U.N. human rights office also says the Palestinian authorities' figure is probably an undercount. In past Gaza wars, the U.N. tally sometimes exceeded the Palestinian count.

The office confirmed to Reuters that the deaths it has verified so far show that the majority are women and children.

HOW CREDIBLE IS THE GAZA DEATH TOLL?

Pre-war Gaza had robust population statistics and better health information systems than in most Middle East countries, public health experts told Reuters.

A study of open sources by the UK-based Airwars non-profit found a correlation of at least 75% between its lists and those of Gazan authorities for thousands killed early in the war.

The U.N. often cites the ministry's death figures and the World Health Organization has voiced full confidence in them.  

Questions remain over the inclusion of 471 people said to have been killed in an Oct. 17, 2023 blast at Gaza's al-Ahli al-Arab hospital. The toll was "at the low end of the 100 to 300 spectrum", an unclassified U.S. intelligence report estimated. 

DOES HAMAS CONTROL THE FIGURES? 

While Hamas has run Gaza since 2007, the enclave's Health Ministry also answers to the overall Palestinian Authority ministry in Ramallah in the West Bank. 

Gaza's Hamas-run government has paid the salaries of all those hired in public departments since 2007, including in the Health Ministry. The Palestinian Authority still pays the salaries of those hired before then. 

The extent of Hamas control in Gaza now is hard to assess with Israel occupying most of the territory.

WHAT DOES ISRAEL SAY?

Israeli officials have said the figures are suspect because of Hamas' control over government in Gaza. Foreign Ministry spokesperson Oren Mamorstein said the numbers were manipulated and "do not reflect the reality on the ground".

However, Israel's military has also accepted in briefings that the overall Gaza casualty numbers are broadly reliable.

The Israeli military says 405 of its soldiers were killed in combat since its Gaza ground operation began on Oct. 27, 2023. 

The Israeli military says it goes to great lengths to avoid civilian casualties. It says Hamas uses Gaza's civilians as human shields by operating within densely populated areas, humanitarian zones, schools and hospitals, which Hamas denies.

HOW MANY OF THE DEAD ARE FIGHTERS?

The Palestinian Health Ministry figures do not differentiate between civilians and Hamas combatants, who do not wear formal uniform or carry separate identification. 

Israel periodically estimates the number of Hamas fighters killed. Last year it put that figure at 17,000-18,000. Recent assessments put the number of Palestinian militant dead at 20,000. It says about one civilian was killed for every fighter, a ratio it blames on Hamas for using civilian facilities. 

Israeli officials say such estimates are reached through a combination of counting bodies on the battlefield, intercepts of Hamas communications and intelligence assessments of personnel in targets that were destroyed. 

Hamas has said Israeli estimates of its losses are exaggerated, without saying how many of its fighters have been killed. The Health Ministry's Waheidi said men of fighting age represent only a fraction of all identified victims.     

(Compiled by Emma Farge, Nidal al-Mughrabi, Ali Sawafta, James MacKenzie and Angus McDowall, Editing by William Maclean)