A leading medical journal called the Lancet says that the “indirect deaths” of Palestinians in Gaza from Israel’s destruction of civilian infrastructure would far exceed those killed directly by the bombing and war efforts. The Lancet claimed that Indirect deaths due to the war could be anywhere between 149,000 and 598,000 Palestinian deaths if the war were to end immediately.

The medical journal published a research correspondence between physicians and public health experts on 5 July on the difficulty of accounting for the number of those killed by Israel’s war on Gaza, highlighting that both direct and indirect deaths should be considered. The Gaza Health Ministry has reported over 38,000 Palestinians killed since the beginning of the war.

The ministry traditionally relies on data from hospital officials in the besieged enclave, who receive the injured and bodies of the dead. However, Israeli bombing has destroyed many of Gaza’s hospitals and brought its entire health system to the brink of collapse.

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“Even if the conflict ends immediately, there will continue to be many indirect deaths in the coming months and years” due to disease, destroyed healthcare infrastructure, and severe shortages of food and water, the authors write.

According to a report by The Cradle, the United Nations estimated that as of February 29th, Israeli bombings had destroyed 35 percent of buildings in the Gaza Strip, with an estimated 10,000 bodies buried under the rubble, including many that were never found.

“Children in Gaza have been dying from starvation-related complications since the Israeli government began using starvation as a weapon of war,” Human Rights Watch noted in April.

“In recent conflicts, such indirect deaths range from three to 15 times the number of direct deaths. Applying a conservative estimate of four indirect deaths per one direct death to the 37,396 deaths reported, it is not implausible to estimate that up to 186,000 or even more deaths could be attributable to the current conflict in Gaza,” the authors concluded.