Violent and non-violent death tolls for the Gaza conflict: new primary evidence from a population-representative field survey.

Abstract

BACKGROUND High-quality mortality estimates are crucial for understanding the human cost of conflict. The Gaza Ministry of Health (MoH) has provided regular updates to their violent death toll for the Gaza Strip following Oct 7, 2023, but these reports have attracted both criticism and support. Independent estimates of both violent and non-violent deaths were needed. METHODS We conducted a population-representative household survey, the Gaza Mortality Survey, between Dec 30, 2024, and Jan 5, 2025. We surveyed 2000 households across 200 primary sampling units, documenting the vital status of 9729 household members as of Oct 6, 2023, plus newborns. The sample was stratified by dwelling type and Governorate of origin. We used raking procedures to adjust for demographic characteristics and calculated confidence intervals using Taylor series linearisation. Sampling occurred in accessible areas, with displaced populations representing inaccessible Governorates. FINDINGS We estimated 75 200 violent deaths (95% CI 63 600-86 800) between Oct 7, 2023, and Jan 5, 2025, representing approximately 3·4% of the Gaza Strip's pre-conflict population. Women, children (ie, younger than 18 years), and older people (ie, older than 64 years) comprised 56·2% (95% CI 50·4-61·9) of violent deaths, totalling 42 200 deaths (95% CI 33 100-51 300). We also estimated 16 300 non-violent deaths (12 300-20 200), of which 8540 (4540-12 500) represent excess deaths above pre-conflict projections. The MoH figure for this period (49 090 violent deaths) was 34·7% below our central estimate. INTERPRETATION This first independent population survey of mortality in the Gaza Strip shows that violent deaths have substantially exceeded official figures whereas the demographic composition of casualties aligns with MoH reporting. Non-violent excess deaths, although substantial, are lower than some projections have suggested. These findings show the feasibility of mortality surveillance in active conflict zones and provide crucial empirical foundations for assessing the true human cost of the conflict. FUNDING European Research Council Grant 101055176, ANTICIPATE, and the Center for Research on the Epidemiology of Disaster at Université Catholique de Louvain. TRANSLATION For the Arabic translation of the abstract see Supplementary Materials section.