Health
Death Toll in Gaza Likely 40 Percent Higher Than Reported, Researchers Say
Deaths from bombs and other traumatic injuries during the first nine months of the war in Gaza may have been underestimated by more than 40 percent, according to a new analysis published in The Lancet.
The peer-reviewed statistical analysis, led by epidemiologists at the London School of Hygiene and Tropical Medicine, used modeling in an effort to provide an objective third-party estimate of casualties. The United Nations has relied on the figure from the Hamas-led Ministry of Health, which it says has been largely accurate, but which Israel criticizes as inflated.
But the new analysis suggests the Hamas health ministry tally is a significant undercount. The researchers concluded that the death toll from Israel’s aerial bombardment and military ground operation in Gaza between October 2023 and the end of June 2024 was about 64,300, rather than the 37,900 reported by the Palestinian Ministry of Health.
The estimate in the analysis corresponds to 2.9 percent of Gaza’s prewar population having been killed by traumatic injury, or one in 35 inhabitants. The analysis did not account for other war-related casualties such as deaths from malnutrition, water-borne illness or the breakdown of the health system as the conflict progressed.
The study found that 59 percent of the dead were women, children and people over the age of 65. It did not establish what share of the reported dead were combatants.
Mike Spagat, an expert on calculating casualties of war who was not involved in this research, said the new analysis convinced him that Gaza casualties were underestimated.
“This is a good piece of evidence that the real number is higher, probably substantially higher, than the Ministry of Health’s official numbers, higher than I had been thinking over the last few months,” said Dr. Spagat, who is a professor at Royal Holloway College at the University of London.
But the presentation of precise figures, such as a 41 percent underreported mortality, is less useful, he said, since the analysis actually shows the real total could be less than, or substantially more. “Quantitatively, it’s a lot more uncertain than I think comes out in the paper,” Dr. Spagat said.
The researchers said their estimate of 64,260 deaths from traumatic injury has a “confidence interval” between 55,298 and 78,525, which means the actual number of casualties is likely in that range.
If the estimated level of underreporting of deaths through June 2024 is extrapolated out to October 2024, the total Gazan casualty figure in the first year of the war would exceed 70,000.
“There is an importance to war injury deaths, because it speaks to the question of whether the campaign is proportional, whether it is, in fact, the case that sufficient provisions are made to to avoid civilian casualties,” said Francesco Checchi, an epidemiologist with an expertise in conflict and humanitarian crises and a professor at the London School of Hygiene and Tropical Medicine who was an author on the study. “I do think memorializing is important. There is inherent value in just trying to come up with the right number.”
The analysis uses a statistical method called capture-recapture analysis, which has been used to estimate casualties in other conflicts, including civil wars in Colombia and Sudan.
For Gaza, the researchers drew on three lists: The first is a register maintained by the Palestinian Ministry of Health, which mainly comprises the dead in hospital morgues and estimates of the number of unrecovered people buried in rubble. The second is deaths reported by family or community members through an online survey form the ministry established on Jan. 1, 2024, when the prewar death registration system had broken down. It asked Palestinians inside and outside Gaza to provide names, ages, national ID number and location of death for casualties. The third source was obituaries of people who died from injuries that were published on social media, which may not include all of the same biographical details and which the researchers compiled by hand.
The researchers analyzed these sources to look for individuals who appear on multiple lists of those killed. A high level of overlap would have suggested that few deaths were uncounted; the low amount they found suggested the opposite. The researchers used models to calculate the probability of each individual appearing on any of the three lists.
“Models enable us to actually estimate the number of people who have not been listed at all,” Dr. Checchi said. That, combined with the listed number, gave the analysts their total.
Patrick Ball, director of research at the Human Rights Data Analysis Group, and a statistician who has conducted similar estimates of violent deaths in conflicts in other regions, said the study was strong and well reasoned. But he cautioned that the authors may have underestimated the amount of uncertainty caused by the ongoing conflict.
The authors used different variations of mathematical models in their calculations, but Dr. Ball said that rather than presenting a single figure — 64,260 deaths — as the estimate, it may have been more appropriate to present the number of deaths as a range from 47,457 to 88,332 deaths, a span that encompasses all of the estimates produced by modeling the overlap among the three lists.
“It’s really hard to do this kind of thing in the middle of a conflict,” Dr. Ball said. “It takes time, and it takes access. I think you could say the range is larger, and that would be plausible.”
While Gaza had a strong death registration process before the war, it now has only limited function after the destruction of much of the health system. Deaths are uncounted when whole families are killed simultaneously, leaving no one to report, or when an unknown number of people die in the collapse of a large building; Gazans are increasingly buried near their homes without passing through a morgue, Dr. Checchi said.
The authors of the study acknowledged that some of those assumed dead may in fact be missing, most likely taken as prisoners in Israel.
Roni Caryn Rabin and Lauren Leatherby contributed reporting.
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The simple act of noting how fast your heart is beating while you’re at rest may be the key to measuring your overall health.
Resting heart rate is defined by Mayo Clinic as the number of times your heart beats each minute while you’re awake, calm and not moving.
A normal resting heart rate ranges from 60 to 100 beats per minute for adults. A slower resting heart rate means the heart does not have the work as heard to pump blood through the body — something typical of someone who is more fit.
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Athletes who are very fit may have a resting heart rate closer to 40 beats per minute, according to Mayo Clinic.
Your resting heart rate can vary due to a variety of factors, including age, physical activity levels, sleep health, smoking, cardiovascular disease, high cholesterol, diabetes, stress, anxiety, hormones, body type and certain medications.
A normal resting heart rate ranges from 60 to 100 beats per minute for adults, according to medical experts. (iStock)
But a resting heart rate that’s often too high or too low may signal a health issue.
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A high resting heart rate, even if it’s slight, is usually a sign that something else may be going on in the body, such as anemia, an infection or a thyroid problem, according to Cleveland Clinic.
A high resting heart rate, even if it’s slight, is usually a sign that something else may be going on in the body. (iStock)
If your heart rate is regularly above 100 beats per minute, this is a sign to talk with your heart care provider.
The same advice applies if you are not a trained athlete and your resting heart rate is frequently below 60 beats per minute.
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Talk to your doctor if other symptoms such as fainting, dizziness or shortness of breath occur.
How to measure your heart rate
You can check your own heart rate by tracking your pulse on your wrist or neck. The best time of day to measure resting heart rate is first thing in the morning, says Mayo Clinic.
Place your index and middle fingers inside the wrist below the thumb, to feel the radial artery; or, do so on the side of the neck, to feel the carotid artery.
Place your index and middle fingers on the side of the neck, to feel the carotid artery — and count how many beats per minute. (iStock)
Count the number of times your pulse beats in 15 seconds, then multiply this number by four to calculate beats per minute.
Wearable devices can also detect and track resting heart rate, although this may not always be accurate.
How to lower your heart rate
If your resting heart rate is higher than normal, there are a few ways to work toward lowering it.
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Vigorous exercise is “the best way” to lower your resting heart rate and increase the heart’s aerobic capacity and max heart rate, according to Harvard.
For those who don’t exercise regularly, it’s important to work your way up in difficulty when following a new workout routine.
Vigorous exercise is “the best way” to lower your resting heart rate, Harvard Health says. But it’s vital to work your way up carefully. (iStock)
Some medications, such as beta blockers, can also lower heart rate. In the same way, managing stress through holistic methods such as meditation or yoga can also help.
Cleveland Clinic also recommends cutting back on harmful substances such as drugs and alcohol, which can dehydrate you and raise your heart rate.
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Adequate sleep can also help bring your heart rate down, in addition to maintaining a healthy weight.
Cardiologist Tamanna Singh, M.D., shared with Cleveland Clinic that lowering your heart rate takes time as various lifestyle changes kick in.
Managing stress through holistic methods such as meditation or yoga can help lower your resting heart rate,
“Just like building your biceps and triceps, it takes time for your heart to become stronger,” the doctor said.
Singh recommended focusing on heart rate patterns rather than dialing in on just the number.
Take note of how your heart rate changes after eating certain foods, when you’re dehydrated or after you’ve begun a new exercise or stress management routine.
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“If you notice that your heart rate is consistently over 100, mention it to your doctor, especially if you’ve tried making lifestyle changes and they don’t seem to be working,” she said.
“Your resting heart rate isn’t the be-all, end-all of your health, but it’s definitely a marker that you should pay attention to.”
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The health benefits of morning coffee may go beyond a wake-up call, according to a massive new study linking the beverage to a significantly lower risk of severe liver disease, liver cancer and liver-related death.
Published in the journal Clinical Gastroenterology and Hepatology, the research used data from 354,957 participants enrolled in the UK Biobank.
Researchers tracked individuals who had no history of cirrhosis or liver cancer at the start of the study for an average of 13 years, according to a press release.
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Participants who drank one to two cups of coffee daily showed a 20% lower risk of developing cirrhosis and a 31% lower risk of liver-related mortality compared to non-coffee drinkers.
The protective effects became even more noticeable at higher levels of consumption.
Data revealed that heavy coffee drinkers had significantly lower levels of liver fat and liver iron. (iStock)
Individuals who drank five or more cups of coffee per day experienced a 32% reduction in cirrhosis risk, a 42% lower risk of liver-related death and a 47% lower risk of developing hepatocellular carcinoma, the most common form of primary liver cancer.
While previous studies have hinted at coffee’s positive relationship with liver health, this study provides biological evidence to support the statistical trends, the researchers said.
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To better understand why coffee may protect the liver, the researchers conducted additional analyses using imaging data from a subgroup of nearly 29,000 participants and blood samples from approximately 50,000 individuals.
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The data showed that heavy coffee drinkers had significantly lower levels of liver fat and liver iron, as well as lower odds of developing fibroinflammation, which is the scarring and inflammation that often precedes permanent liver damage.
Participants who drank one to two cups of coffee daily showed a 20% lower risk of developing cirrhosis. (iStock)
The blood analysis linked coffee consumption with lower levels of some proteins known to trigger inflammation and tissue scarring, along with higher levels of proteins essential for healthy liver function.
Notably, the study found that the liver-protective benefits were similar for both caffeinated and decaffeinated coffee, suggesting that these benefits are driven by naturally occurring compounds not related to caffeine.
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While the benefits persisted regardless of whether the coffee was consumed black or with sweeteners, the researchers observed that adding sugar or artificial sweeteners slightly weakened the beneficial effects, particularly concerning markers of liver inflammation.
Researchers observed that adding sugar or artificial sweeteners slightly weakened the positive effects. (iStock)
While these findings suggest that coffee consumption is an accessible dietary habit for supporting liver health, the authors noted that it should serve as a complement rather than a replacement for standard preventative health practices.
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Because the research relied on self-reported dietary questionnaires from the UK Biobank, the findings could be susceptible to changes in participants’ coffee-drinking habits over the 13-year follow-up period.
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Additionally, as an observational study, it can only establish a strong correlation and cannot prove cause and effect, as other factors may influence the outcomes.
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