Revisiting Gaza mortality estimates: adjusted for non-sampling zero-survivor households

Revisiting Gaza mortality estimates: adjusted for non-sampling zero-survivor households | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Revisiting Gaza mortality estimates: adjusted for non-sampling zero-survivor households Ron Roberts , Joel Vos doi: https://doi.org/10.1101/2025.08.06.25333116 Ron Roberts 1 Kingston University PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: r.roberts{at}kingston.ac.uk Joel Vos 2 Metanoia Institute , Ealing, London, United Kingdom PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Current Gaza mortality estimates systematically undercount deaths by failing to account for zero-survivor households. We argue that adjusting for this factor and multi-family cohabitation yields significantly higher figures than previously reported. If we assume 3% zero-survivor households with 75% multi-family cohabitation, mortality estimates increase to 152,395-179,555 direct and indirect deaths (6.92-8.16% of pre-war population). Introduction Mortality estimates from the Gaza war beginning October 7, 2023, face systematic underestimation across all methodologies (see Table 1 ). The Gaza Ministry of Health (GMoH) relies primarily on hospital records, but 654 documented attacks on healthcare facilities have severely compromised record-keeping capacity. 1 Bodies may remain unreported due to inaccessible hospitals or cultural burial practices. 2 Airwars reports substantial undercounting in GMoH’s named casualty lists. 3 Additionally, zero-survivor households may result in bodies remaining unrecovered, unidentified, and unreported when buried in mass graves or rubble. View this table: View inline View popup Download powerpoint Table 1: Data Collection Methods by Source Online data collection methods face limitations from Gaza’s damaged communications infrastructure, with 70% of networks destroyed and frequent blackouts precisely when mortality reporting would occur. 4 The London School of Hygiene & Tropical Medicine’s capture-recapture analysis explicitly excluded missing persons potentially deceased under rubble. 5 The Gaza Mortality Survey (GMS) by Spagat et al. attempted to overcome these limitations through face-to-face interviews yet acknowledged “downward bias” from non-sampling households with zero survivors or no surviving adults. 6 This critical bias remains unaddressed in all current estimates. Gaza’s exceptionally high population density (6,024 people/km 2 average, reaching 161,532 people/km 2 in Beach Camp) dramatically increases vulnerability compared to other conflict zones (20-300 people/km 2 in Rwanda, Syria, Bosnia, Darfur, Iraq, and Yemen). 7 This density exacerbates full-family casualties from single strikes. The UN reports 35% of Gaza buildings destroyed by February 2024, suggesting substantial numbers remain buried. 8 Additionally, multi-family cohabitation—prevalent at 50-75% pre-war and likely higher post-displacement 9 —further complicates mortality accounting. The documented 2,200 zero-survivor households as of May 2025 10 likely underestimates the true figure and doesn’t account for the 1.41 multiplier for individuals missing under rubble. 11 Table 1 outlines major mortality estimation methodologies. Table 2 presents our adjusted confidence intervals incorporating zero-survivor households and multi-family cohabitation levels applied to the Gaza Household Survey figures 6 , with equivalent findings to the capture-recapture study based on morgue records, online surveys, and social media reports 5 . While our data assume the same ratio of direct to indirect deaths as the Gaza Mortality Survey, it is probable that there remains a significant undercount of indirect deaths, for instance due to starvation, non-communicable diseases, endemic infectious disease, epidemics and neonatal health complications 12 , 13 , 14 ; these may be higher due to the unique population density and household composition in Gaza, which may lead to a quicker spread of diseases and increased vulnerability of humanitarian transport routes in densely populated areas. View this table: View inline View popup Download powerpoint Table.2: Adjusted Confidence Intervals by Household Loss x Multi-Family Cohabitation (95% CI) Mortality figures during conflicts typically undergo substantial upward revision post-conflict (by factors of 0.7-23.3). 15 , 16 , 17 , 18 Given Gaza’s unprecedented population density and documented destruction scale, current estimates therefore likely represent significant undercounts. While it is impossible to make a precise estimation of the multiplier factors for zero-survivor households and indirect deaths, our calculations indicate the importance of adjusting the figures for the non-sampling of zero-survivor households and household composition. As the authors of the Gaza Mortality Survey noted in their conclusions, the ratio of non-violent deaths to violent deaths may well have grown since the period of data collection. Therefore, our own figures are still likely to be conservative and to seriously under-estimate the present death toll. Accurately recording the complete magnitude of destruction serves dual purposes: preserving historical truth while honouring all victims’ suffering and fulfilling essential legal obligations under international humanitarian law. Data Availability All data produced in the present work are contained in the manuscript https://www.medrxiv.org/content/10.1101/2025.06.19.25329797v3 Declaration of interests No Funding Received No Competing Interests References 1. ↵ World Health Organization . Health Cluster Bulletin: Gaza Strip. Regular situation reports citing Gaza MoH data, 2023-2025 . 2. ↵ Stamatopoulou-Robbins S. The Human Toll: Indirect Deaths from War in Gaza and the West Bank, October 7 , 2023 Forward. Watson Institute for International and Public Affairs. The Human Toll: Indirect Deaths from War in Gaza and the West Bank, October 7, 2023 Forward | Costs of War . 3. ↵ Airwars . Gaza Casualty Assessment: Methodological Review of Gaza Ministry of Health Figures . Airwars Report , May 2025 . 4. ↵ United Nations Office for the Coordination of Humanitarian Affairs (OCHA ). Humanitarian Situation Update #297 | Gaza Strip . June 18, 2025 . https://www.ochaopt.org/content/humanitarian-situation-update-297-gaza-strip ; 5. ↵ Jamaluddine Z , Abukmail H , Aly S , Campbell OMR , Checchi F. Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture-recapture analysis . The Lancet . 2025 ; 405 ( 10477 ): 469 – 477 . doi: 10.1016/S0140-6736(24)02678-3 . OpenUrl CrossRef PubMed 6. ↵ Spagat M , Guha-Sapir D , Abu-Raddad LJ , et al. The Gaza Mortality Survey: A population-based assessment of mortality in the Gaza Strip, October 7, 2023 - January 5, 2025 . medRxiv 2025 ; doi: 10.1101/2025.06.19.25329797 [Preprint]. OpenUrl Abstract / FREE Full Text 7. ↵ Palestinian Central Bureau of Statistics (PCBS ). Population Density Report: Gaza Strip 2023 . PCBS Statistical Yearbook, 2023 . 8. ↵ United Nations Satellite Centre (UNOSAT ). Damage assessment of the Gaza Strip. February 2024 . 9. ↵ United Nations Relief and Works Agency (UNRWA ). Occupied Palestinian territory. 2015 Emergency Appeal . Annual Report . 2015 . https://www.unrwa.org/sites/default/files/content/resources/2015_opt_emergency_appeal_annual_report.pdf 10. ↵ New Arab . ‘They want to erase us’: Israel wipes out over 2,200 Palestinian families in Gaza . May 26, 2025 . https://www.newarab.com/news/israel-wipes-out-over-2200-palestinian-families-gaza 11. ↵ UN Office of the High Commissioner for Human Rights (OHCHR ). Update Report on the Situation in Gaza . May 6, 2024 . https://www.ohchr.org/sites/default/files/documents/countries/opt/20241106-Gaza-Update-Report-OPT.pdf 12. ↵ Khatib R , McKee M , Yusuf S. Counting the dead in Gaza: difficult but essential . The Lancet . 2024 ; 404 ( 10449 ): 237 – 238 . OpenUrl 13. ↵ Sah S. Infectious diseases are being allowed to run rampant in Gaza . BMJ 2024 ; 387 : q2186 . OpenUrl FREE Full Text 14. ↵ Jamaluddine Z , Chen Z , Abukmail H , et al. Crisis in Gaza: scenario-based health impact projections . Report one: Feb 7 to Aug 6, 2024 . https://gaza-projections.org/gaza_projections_report.pdf x(accessed Oct 10, 2024 ). 15. ↵ Hagopian A , Flaxman AD , Takaro TK , et al. Mortality in Iraq associated with the 2003-2011 war and occupation: findings from a national cluster sample survey by the University Collaborative Iraq Mortality Study . PLoS Med . 2013 ; 10 ( 10 ): e1001533 . OpenUrl CrossRef PubMed 16. ↵ Verpoorten , M. ‘How many died in Rwanda?’ , Journal of Genocide Research , 2020 , 22 ( 1 ), pp. 94 – 114 . OpenUrl 17. ↵ World Bank , The Toll of War: Economic and Social Consequences of the Conflict in Syria , 2022 , Washington, DC. World Bank . 18. ↵ United Nations Development Programme (UNDP) Assessing the Impact of War on Development in Yemen , 2021 . New York. UNDP . View the discussion thread. Back to top Previous Next Posted August 08, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Revisiting Gaza mortality estimates: adjusted for non-sampling zero-survivor households Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. 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