Comment
On the quantification of military violence in Gaza
James Smith, Duha Shellah, Zoé Samudzi
Lancet 2025; 405: 440-442
DOI: https://doi.org/10.1016/S0140-6736(25)00138-2
Against a history of protracted occupation,1 an unprecedented escalation in Israeli State violence occurred throughout Palestine in the wake of violent attacks in Israel on Oct 7, 2023.2 Concerning violence throughout Gaza, mortality statistics subsequently reported by the Palestinian Ministry of Health (MOH) have been repeatedly questioned by prominent Israeli and US politicians and right-wing think tanks,3, 4, 5, 6, 7 despite evidence that MOH reporting has not been inflated or any precedent of inflated mortality reporting during previous violent escalations by the Israeli military in Gaza.8, 9, 10 A failure to acknowledge more fully the impact of direct violence in Gaza by the Israeli military, as sanctioned by the State of Israel, has arguably delayed meaningful global efforts to prevent further death and destruction; this situation, in our opinion, has been to the dereliction of our collective responsibility to prevent what we believe to be genocide.11
In the context of attempts to deny Palestinian humanity and the suffering inflicted on Palestinians,12 the generation of robust evidence is imbued with heightened significance. Two studies in The Lancet exemplify the potential of health data sciences and epidemiology to more fully quantify the impact of violence as perpetrated by the Israeli military in Gaza. In their capture–recapture analysis, epidemiologist Zeina Jamaluddine and colleagues13 have studied the overlap between three data sources (MOH hospital lists, an MOH online survey, and social media obituaries) to estimate the true number of deaths due to traumatic injuries in Gaza from Oct 7, 2023 to June 30, 2024. Jamaluddine and colleagues estimate that the trauma-related death toll published by the MOH has under-reported the total number of Palestinians killed as a result of direct Israeli military violence by 41%, and extrapolate that 64 260 people (95% CI 55 298–78 525) had been killed due to traumatic injuries as of June 30, 2024. Where age and sex disaggregated data were available, women, children, and older people (aged >65 years) represented 59·1% of those killed.
In a second study, demographer Michel Guillot and colleagues14 estimated life expectancy losses throughout Gaza from October, 2023, to September, 2024. Guillot and colleagues matched MOH mortality data with the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) register and found that the proportion of refugees among individuals killed is similar to the proportion of refugees in the 2017 Gaza census, lending further weight to the reliability of the cumulative death toll as reported by the MOH. Additionally, the authors draw from multiple data sources to identify a precipitous decline of 34·9 years (–46·3%) in combined male and female life expectancy during the period October, 2023, to September, 2024.
Together, these studies function to counteract narratives that seek to downplay and render invisible the impact of violence by the State of Israel against Palestinians.15 Both studies also raise the question of what it means to quantify what several legal experts, genocide scholars, and human rights organisations have determined is genocide against the Palestinian people.16, 17, 18, 19, 20, 21 This question is particularly pertinent given that such violence was ongoing at the time the research was conducted. For example, Jamaluddine and colleagues refer to quantification for the purpose of memorialisation,13yet this typically motivates efforts to describe violence in the aftermath of genocide. The question of the value of quantification is well established in the field of genocide studies.22, 23 On one hand, accountability and justice cannot be achieved in full without recognition of the true scale of violence and its perpetrators. On the other hand, quantification alone has no bearing on the legal designation of a genocide; the crime of conspiracy to commit genocide does not require anyone to have been killed.24 Although no quantifiable threshold exists for genocidal violence, Jamaluddine and colleagues13 and Guillot and colleagues14 identify statistical patterns that are consistent with gender and age indiscriminate (and when coupled with evidence of intent,25, 26 arguably genocidal27) violence in Gaza: clear evidence of a sharp decline in life expectancy regardless of gender, and relatively flat age-disaggregated and sex-disaggregated risk of death.13, 14
Despite the importance of these contributions, both studies are limited by their inability to accurately estimate absolute all-cause mortality or all-cause life expectancy decline. The data required to make such estimations have remained largely unavailable as a consequence of widespread violence and inaccessibility throughout Gaza, and the systematic destruction of the health system.28, 29, 30 Non-trauma-related mortality resulting from the destruction of life-sustaining infrastructure, and what human rights organisations and legal experts have described as the intentional deprivation of water, food, medical care, and basic shelter,16, 19, 31 is as yet unclear and therefore under-reported.32 As such, the available evidence for direct trauma-related mortality should be interpreted as a conservative estimate of overall mortality within the Palestinian population in Gaza since October, 2023.
Beyond the incomplete nature of the mortality datasets used in these studies, the totalising violence of occupation and what we believe to be genocide simply cannot be reduced to numbers, which are wholly unable to capture the complete and cumulative effects of violence that manifest beyond the loss of life alone. Several Palestinian-led initiatives continue to meticulously narrate the lives of Palestinians in order to resist dehumanising political, media, and public health discourses.33 In Gaza, where both the biological and biographical character of lives have been obscured, quantification has come to offer an incomplete remedy to the statistical erasure of the Palestinian people, as emboldened by processes of dehumanisation and anti-Palestinian racism.34, 35
What does the evidence produced by these two latest Gaza mortality studies demand of us? In 2022, poet and academic Refaat Alareer (who was subsequently killed in an Israeli military air strike on his sister's home on Dec 6, 2023)36 reflected on the perceived futility of writing with the aim of provoking positive change for the Palestinian people and asked, “Does a single Palestinian life matter? Does it?”.37 Any attempt to redress the moral decay and political neglect that prompted Alareer to ask this question must ultimately take the form of reparative justice.38 More urgently, immediate and sustained action is required to safeguard the lives, dignity, and aspirations of Palestinians living in Gaza, throughout Palestine, and in situations of protracted displacement.
