For six months, the Gaza Ministry of Health presented its data as the authoritative source of information about the number of lives lost in Gaza since October 7. Then, in April, it quietly acknowledged that its records for more than 10,000 of the war’s fatalities include “incomplete data.”

A spokesman for the organization portrayed the admission as proof of the ministry’s commitment to transparency. Yet the ministry has said little about how much information is missing from its incomplete records or how it collected that information in the first place. What’s more, the ministry has continued to make sudden and unexplained revisions to the data.

Foreign media and UN agencies routinely cite the ministry’s data and confidently defend its collection methods. In his most recent State of the Union address, President Joe Biden presented as fact, without noting the source of the information, the ministry’s claim that 30,000 Palestinians have died.

Until early May, when the UN quietly halved its own casualty numbers for women and children, few noticed the Gazan avowal of flaws in the data. It remains to be seen whether the State Department will take notice. Also in early May, in a report on the Israeli military, the State Department defended the Ministry of Health’s numbers, which, it said, “international organizations generally deem credible.” The slow response to the news out of Gaza is not exactly surprising—the ministry hardly trumpeted its failure. Its admission appeared in a statistical digest published only in Arabic and distributed via the social-media app Telegram. Yet this channel is far from a secret—it has more than 19,000 subscribers.

A closer look at the ministry’s statistical digests and related information shows that signs of major defects in the casualty data have been visible since December.

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The credibility of the ministry’s data has been the subject of heated debate since the first days of the war. On the night of October 16, an explosion rocked al-Ahli hospital in northern Gaza. Within an hour, the ministry told reporters an Israeli air strike had killed nearly 500 people, soon putting the number of fatalities at precisely 471. Yet once the sun rose the next morning, the limited size and depth of the crater on hospital grounds made clear that an errant Palestinian rocket had caused the explosion. Gaza police reportedly cleansed the impact site shortly after the incident, preventing an independent investigation. U.S. intelligence estimated an actual death toll of 100 to 300. The ministry admitted no error.

Against this backdrop, Biden declared that he had “no confidence” in the ministry’s statistics. The ministry responded by releasing a list with the names, ages, and ID numbers of nearly 7,000 of the dead, to show there was solid evidence behind its claims. The U.S. media came down firmly on the ministry’s side, citing two principal arguments in its favor. First, as the Washington Post noted, “The Gaza Health Ministry has had a pretty good track record with its death estimates over the years, notwithstanding that it is part of the Hamas-run government.” Second, the ministry has direct access to data from the hospitals that handle the bodies. “Hospital administrators say they keep records of every wounded person occupying a bed and every dead body arriving at a morgue,” the Associated Press reported. Biden offered no further criticism of the ministry’s data, which became a fixture in media across the globe.

The entry of Israeli forces into Gaza in late October disrupted the ministry’s system for collecting data. Moving from north to south, the Israelis flushed Hamas fighters out of hospitals in the coastal strip, disrupting their communications with the ministry, which had to find new sources of data. It turned to what it would describe as “reliable media sources.”

On December 12, the ministry released the first of its statistical digests; it has been publishing them with growing frequency since then. The reports include information on subjects ranging from hospital-bed-occupancy rates to the number of operations Gaza doctors have performed. The ministry distributes the documents via its official account on Telegram.

The first of the ministry’s digests put the death toll at 18,412 but divided that figure into two parts. The first consisted of individuals “registered through the central information system,” meaning that hospitals recorded their deaths. But 4,143 deaths (or 22.7 percent) were attributed to information from “reliable media sources.” The report did not indicate which sources these were or how the ministry determined the accuracy of such information amid the fog of war.

Gabriel Epstein, an analyst at the Washington Institute for Near East Policy, noticed some striking differences in the demographic make-up of the two categories of deaths. Looking at the ministry’s digest for December 31, Epstein saw that men over 18 were  39.7 percent of the fatalities that hospitals recorded, but less than 1 percent of data collected from media sources. Of 6,629 deaths attributed to media information, the deceased included just 10 men, 1,941 women, and 4,678 children.

Toward the end of March, Epstein updated his initial findings. There continued to be a sharp imbalance in the age and gender composition of fatalities attributed to media sources. Only 8.4 percent were adult males, while 28.7 were female and 62.9 children. Moreover, media accounted for a rapidly growing share of the ministry’s data, serving as the documentation for 8,441 deaths—or 77.7 percent of all reported fatalities in the first three months of 2024.

It remains unclear whether the information derived from media sources identifies specific deceased individuals or is just a running total of numbers men-tioned in news coverage. One of the few reporters to inquire about the ministry’s methods wrote that health officials use “estimates from media reports to assess deaths in the north of Gaza, where Israeli forces control access.”

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After months of attributing much of its information to media sources, the ministry suddenly pivoted to a different approach. In its April 1 digest, the ministry acknowledged that roughly a third of its death records had “incomplete data,” while the remainder were complete. Initially, the exact number of incomplete records was 12,263. A few days later, it was down to 11,371, then up to 12,205 before falling again to 11,400 and eventually to 10,174. The statistical digests provide no explanation for these shifts. Nor is it clear how much information is missing from the incomplete records. Dr. Ashraf al-Qudra, the ministry’s longtime spokesperson, told a British correspondent that the figure for incomplete deaths “is included as an estimate.”

The ministry also released a 454-page list of the more than 21,000 individuals whose records it considers complete. Yet a closer examination shows that the list includes hundreds of duplicates, hundreds of individuals without ID numbers, and thousands of individuals with invalid ID numbers. Even some of the ministry’s most vocal defenders in the West concur with this finding. Michael Spagat, a Harvard-trained economist, teaches at the University of London and works with Action on Armed Violence, a British NGO that “records, investigates, and disseminates evidence of armed violence against civilians worldwide.” When Joe Biden expressed a lack of confidence in the ministry’s data last October, Spagat published a rebuttal that concluded the ministry is a “reputable source of information” and there is “no reason to doubt” its assertions. In February, he condemned what he described as Israeli attacks on hospitals, “attacks that have severely disrupted what was previously a well-functioning and rigorous casualty recording system.” (An alternate view is that Hamas committed deliberate and pervasive violations of the laws of war by turning hospitals and patients into civilian shields.)

On April 17, Spagat released his analysis of the ministry’s new list of fatalities. He found 440 duplicate records, 470 records with no ID number, 792 records with ID numbers that have too few digits, and 1,486 records with ID numbers that had the correct number of digits but were invalid for other reasons. Another 219 entries provided no age for the deceased. In all, Spagat found 3,407 flawed entries, or 15.7 percent of the total. (Epstein has not yet published his analysis of the list but told me his numbers are nearly identical.)

Spagat also had some sharp words regarding the ministry’s lack of transparency. Of the incomplete records, he writes there are “roughly 13,000 deaths that have, apparently, been entered into an unavailable database using an unknown methodology.” Spagat also noted, “The oft-cited claim that 70 percent of the Gazans killed in the conflict are women and children seems increasingly untenable.” In the ministry’s list of fatalities, women, children, and the elderly are 61 percent of the total. If one looks only at individuals with valid ID numbers, the figure drops to 53.3 percent.

The ministry itself seems to understand that it has a problem. Whereas it routinely included the 70 percent claim in statistical digests published through March 23, it has been absent from the dozen editions published in the past month. In an unusual instance in which a journalist asked the head of the ministry’s data unit to explain the origin of the 70 percent claim, the unit chief responded that the figure was only a “media estimate,” as if the ministry itself had not originated and widely publicized the claim.

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Many of the ministry’s advocates in the West defend its figures by arguing that they are, if anything, an undercount. “Doctors say Gaza death toll could be higher than reported,” reads the title of a Washington Post video from earlier this month. An NPR headline from February reported that the death toll had passed 30,000, but “it’s an incomplete count.” Last November, the head of the State Department’s Middle East bureau said the same thing. The common thread in all these arguments is that there are likely numerous bodies trapped under the rubble in Gaza. While it’s impossible to know how many, when the ministry made its admission regarding incomplete data, it also shared information that provides significant insight into the number of missing people.

Gaza’s Government Media Office, which is separate from the Ministry of Health, has consistently reported since late November that there are 7,000 residents of Gaza “missing under the rubble,” of whom nearly 70 percent are women and children. The Media Office has never identified the basis for this estimate, nor has it explained why the number has remained constant for so long. Meanwhile, in January, the ministry introduced a system that enables residents to report the death of their relatives in cases where the body “remained under the rubble or was buried without reaching a hospital.” Relatives can file the reports in person or online.

Initially, the ministry’s statistical digests presented the number of reports filed by relatives as a category of fatalities separate from the main death toll. But on April 1, the ministry revealed that reports filed by relatives are part of the main toll. In effect, the ministry has already adjusted its total to account for missing persons. Spagat writes, “We should dismiss the common claim that, because many of the dead are trapped under rubble or are missing for other reasons, the announced totals are undercounts.” Whereas the Media Office continues to claim 7,000 are missing, relatives have filed 3,160 reports as of April 24. Of those reports, 1,762, or 55.8 percent, are for men ages 18–59, a figure at odds with the contention that nearly 70 percent are women and children.

Another potential adjustment to the ministry’s numbers concerns the number of Palestinian lives lost to rocket fire by Hamas and its allies. The ministry consistently describes its figure as “the cumulative number of martyrs since the beginning of the [Israeli] aggression,” language that could either include or exclude the victims of Palestinian munitions. From the incident at al-Ahli Hospital, we know that one errant rocket can claim scores or even hundreds of lives, even if the ministry exaggerated the number. In November, the IDF estimated that Palestinians had fired 9,500 rockets at Israel during the first month of the war, of which 12 percent, or more than 1,100, “failed and fell short, inside the Gaza Strip”—a rate comparable to that of previous conflicts.

Finally, there is the question of underage fighters, which Hamas has employed in the past. Among casualties under age 18, there is a disproportionate number of males, suggesting involvement in combat. For example, if one sorts the entries from the health ministry’s list of fatalities, there are 225 17-year-old males, compared with 132 females of that age. Among 16-year-olds, there are 226 males to 127 females. The imbalance becomes progressively smaller as age diminishes, with more girls than boys in some age brackets—an outcome consistent with the expectation that teenagers may fight, but younger children rarely will. All together, these data suggest there may be a few hundred underage fighters among the dead, which is enough to raise concerns about the exploitation of children but not enough to have a significant impact on the overall demographics of the casualties.

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In mid-December, as the war in Gaza entered its third month, Joe Biden first levelled the charge that Israel had engaged in “indiscriminate bombing.” Vice President Kamala Harris said, “Too many innocent Palestinians have been killed.” Data from the Gaza Ministry of Health never distinguish between fighters and civilians, yet its claim that 70 percent of the dead are women and children immediately suggests a lack of discrimination. But the picture begins to look very different if one considers that a third or more of the records have incomplete data and that this third consists overwhelmingly of women and children. Meanwhile, thousands more records that the ministry has labeled as complete are actually missing data.

If one examines only records from Gaza hospitals that the ministry considers complete, the data show that the pace of violence has decelerated sharply since the beginning of 2024. From October 7 through the end of the calendar year, Gaza hospitals recorded 15,349 deaths, or more than 5,000 per month. From January 1 through March 31, hospitals recorded an additional 2,426 fatalities, or 800 per month, and 60 percent of those were adult males. Yet the rapid addition of incomplete records obscured these trends—if one counts them, too, the monthly toll rises to more than 3,600 for January through March and the percentage of women and children is in the mid-seventies.

The Gaza Ministry of Health has proven itself to be an unreliable source of information. While posing as a neutral arbiter of facts, the ministry retails a narrative whose purpose is to blacken Israel’s reputation. Its statistical sleight-of-hand is meant to draw attention away from Hamas’s criminal conduct of the war, built around the exploitation of hospitals, schools, mosques, and UN buildings as military assets. The terror group is glad to sacrifice as many Palestinian civilians as necessary while assigning Israel the blame. In contrast, Israeli forces have engaged in persistent efforts to shepherd civilians away from the battlefield while providing extensive warning of coming operations. There is no question that prosecuting this war to the end will impose additional costs on civilians, but if Hamas survives to rebuild its forces and replenish its arsenal, then the countdown to the next war will begin.

Photo: AP Photo/Fatima Shbair

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