THE SET-UP: Is there an upper limit on the number of children Israel can acceptably kill in Gaza? It’s a question I asked repeatedly during the first 10 months of the war. At that point, it looked like I had my answer … no, there is no upper limit … at least as far as the United States government and the majority of its people are concerned.
You certainly won’t find any objections to almost daily reports of children being killed in bunches … not from the Pro-Life Christians at the Christian Broadcasting Network or from Pro-Life Evangelicals in Congress like Speaker Mike Johnson. Nor will you find objections lodged on so-called “legacy media” … not from commentators or anchors or from politicians not named Bernie Sanders.
Nor are you likely to see much said about The Lancet’s new study of the war’s true death toll. They claim that the Ministry Of Health’s number is “under-reported” by 41%. That stands in stark contrast to the constant criticism of the Ministry Of Health’s number as inherently inflated and unreliable because they are “Hamas.” That’s why you’ll always hear a US newsreader say “Hamas” or “Hamas-run” before “Ministry Of Health” when they recite the number.
On the other hand, a pair of studies by the Costs of War Project at Brown University released last October estimated the war’s “cost to US taxpayers at over $17.9 billion” and the “likely number of people killed at well over 100,000.” Taken together, both the Costs of War Project and The Lancet point to the Ministry Of Health’s numbers as being somewhat conservative, particularly given the acres upon acres of collapsed buildings and the unrecovered bodies they likely house.
The New York Times’s recent exposé of the IDF’s “loosened” rules of engagement hints at the scale of the task that awaits excavators when the bombing eventually stops:
The risk to civilians was also heightened by the Israeli military’s widespread use of 1,000- and 2,000-pound bombs, many of them American-made, which constituted 90 percent of the munitions Israel dropped in the first two weeks of the war. By November, two officers said, the air force had dropped so many one-ton bombs that it was running low on the guidance kits that transform unguided weapons, or “dumb bombs,” into precision-guided munitions.
…and…
The air force used the one-ton bomb to destroy whole office towers, two senior Israeli military officials said, even when a target could have been killed by a smaller munition.
No doubt, it’s a practice replicated many times over. And it lends credence to The Lancet’s findings. It also rings true when you read on and see how the IDF rang-in the New Year. It’s a stark reminder that the United States is aiding and abetting a war without limits. - jp
TITLE: Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture–recapture analysis
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02678-3/fulltext
EXCERPTS: Our analysis suggests high mortality rates and substantial under-reporting of mortality due to traumatic injury in the Gaza Strip during the first 9 months of the Israeli military operation. We estimated around 64 000 deaths due to traumatic injuries from Oct 7, 2023, to June 30, 2024, implying 41% under-reporting in the MoH estimate over the same period and corresponding to approximately 2·9% of Gaza's projected pre-war population (2 227 000), or approximately one in 35 inhabitants. Although we only analysed data up to June, 2024, the official MoH estimate from Oct 7, 2023, to Oct 6, 2024, was 41 909. Assuming that the level of under-reporting of 41% continued from July to October, 2024, it is plausible that the true figure now exceeds 70 000. Our study demonstrates the utility of integrating existing data from alternative sources, rather than relying on any single figure, to compose an estimate of both reported and unreported deaths in contexts affected by armed conflict and extreme violence. Our use of scraped social media data extends previous efforts by Airwars, a casualty tracking organisation, who found that during the first 3 weeks of the Israeli military operation, 75% of publicly reported decedents also appeared on the MoH list5 (by contrast, we found an overlap of 54% or 1721 of 3190 during the entire study period).
The estimated annualised mortality from traumatic injury of 39·3 per 1000 people is exceptionally high, surpassing rates seen during earlier conflicts in the Gaza Strip.8,29 Although daily traumatic injury mortality decreased since December, 2023, both the scale and age–sex patterns of traumatic injury deaths raise grave concerns about the conduct of the military operation in Gaza despite Israel stating that it is acting to minimise civilian casualties. The majority of deaths (59·1%) occurred among women, children, and older people, groups considered particularly vulnerable in conflict-affected settings and less likely to be combatants. The age–sex pattern of mortality during violent conflicts might help investigate the motivations of combatants, albeit only within a much broader evidentiary context. A lack of discrimination in killings by age and sex would manifest itself numerically as a relatively flat age–sex risk—eg, as described by the UN Inter-Agency Group for Child Mortality Estimation during the 1994 Rwandan genocide.30 Our estimates for deaths among women and girls broadly exhibit such a pattern. Among men and boys, we cautiously propose that two processes might be at work: a level of mostly non-discriminant killing across age and sex, with higher risk among young men explained by targeting of combatants (or those presumed to be) plus greater exposures to risk among this stratum—eg, because adult men are more often outdoors procuring supplies, working, or being first responders.
Our findings underestimate the full impact of the military operation in Gaza, as they do not account for non-trauma-related deaths resulting from health service disruption, food insecurity, and inadequate water and sanitation. A recent commentary suggests a potential excess all-cause death toll of 186 000,14 but it applied multiplication factors from other conflicts (Burundi, 1993–2003; Timor-Leste, 1974–99)14 to estimate indirect deaths in the Gaza Strip, which might be inappropriate due to obvious differences in the pre-war burden of disease (compared with Burundi and Timor-Leste, the Gaza Strip featured a high burden of non-communicable disease and a very low burden of undernutrition and infectious disease, although infections have become an increasing challenge since October, 2023).31 Projections we previously coauthored suggested that in an escalation scenario, Gaza would have experienced 2680 excess deaths from non-communicable diseases, 2720 from endemic infectious diseases, 11 460 from potential epidemics, and 330 from maternal and neonatal health complications during the period from February to August, 2024.32 However, accurately measuring indirect mortality during an ongoing war is fraught with challenges and limitations. Although a ground survey could yield robust estimates, the highly unsafe conditions for humanitarian and health workers inside Gaza and access constraints currently make it unfeasible.
Limitations of our study include challenges in data cleaning and standardisation, particularly in reconciling variations in name spellings and translations. The exclusion of individuals identified only by familial relationships might have resulted in overestimation or underestimation depending on the probability of those individuals matching across lists, relative to other decedents. Generally, although key identifier variables for record linkage were consistently available, any misclassification of match status would result in some bias.
The omission of covariates not available in the datasets might have biased model estimates to an unknown extent by insufficiently accounting for heterogeneity in individual capture probabilities. Although three-list analysis with model averaging and stratification generally relaxes the assumption of list independence, some residual dependence among lists might not have been reflected in the estimates due to model misspecification and the theoretical limits of any candidate modelling approach. Additionally, we assumed that MoH hospital and survey lists captured only deaths due to traumatic injury. The survey specifically asked respondents to enter details of those martyred, a term commonly understood to signify victims of war. However, some non-trauma deaths might have been included, potentially resulting in an overestimation of deaths due to traumatic injury. This would not affect estimates of all-cause mortality.
Conversely, we excluded people reported as missing because we were unable to discern if they were detained and imprisoned or potentially deceased but unrecovered under rubble. If these missing people were included in the analysis, the overall estimate would increase. Last, we were unable to stratify estimates by geography because location variables included in the lists were frequently missing or reflected the place of reporting or of morgues rather than the exact place of death. ACLED, using a combination of MoH reports and media sources, documented 10 400 geo-located conflict events in the Gaza Strip over our study period,12 of which 4260 (40·9%) had known casualty numbers, summing to 39 276 deaths. Although ACLED-reported deaths also decreased progressively from October, 2023 onwards, the relative share of mortality shifted towards central and southern governorates over time (Khan Yunis and Deir el Balah first, and later Rafah; appendix p 2). This geographical progression mirrors the pattern of destruction across the Gaza Strip, initially concentrated in Gaza City and North Gaza and expanding southward over time (appendix p 2).
Our analysis supports the accuracy of the MoH-reported mortality figures but suggests that these are to be treated as a minimum estimate subject to considerable under-reporting. Once the military assault ends, reconstructing Gaza's health information system emerges as an essential priority for accurately assessing impacts and supporting future public health efforts. A robust health information system is crucial for accurate mortality reporting, early disease outbreak detection, efficient resource allocation, and informed long-term health planning.
Our findings highlight the urgent need for expanded humanitarian access to all of the Gaza Strip and protection of health-care personnel, ambulances, and static health facilities so that people with traumatic injuries can access timely and appropriate care, thereby reducing case-fatality. More fundamentally, our findings warrant immediate diplomatic initiatives to achieve an immediate and sustained cessation of hostilities and a lasting deal that includes the release of Israeli hostages and thousands of Palestinian civilians imprisoned by Israel.10 Just as in other settings, active investigation of potential war crimes committed seems important to affirm justice principles and hold perpetrators from all sides accountable. Quantitative analyses similar to ours have previously informed these investigations.16 We thus encourage the scientific community to supplement and improve on our work, while also extending it to other settings.
TITLE: Humanitarian Crisis in Gaza: Over 74 Children Killed in First Week of 2025 Amid Ongoing Violence
https://www.devdiscourse.com/article/headlines/3219930-humanitarian-crisis-in-gaza-over-74-children-killed-in-first-week-of-2025-amid-ongoing-violence
EXCERPTS: The Gaza Strip has witnessed a devastating start to 2025, with at least 74 children reportedly killed in the first seven days of the year due to relentless violence. Children have died in mass casualty events across Gaza City, Khan Younis, and Al Mawasi, a designated "safe zone" in the south, where a recent attack claimed the lives of five children.
Winter conditions, combined with inadequate shelter, have further endangered Gaza’s children. Over a million children are living in makeshift tents, with many families displaced for over 15 months. Since December 26, eight infants and newborns have reportedly succumbed to hypothermia, a severe risk for young children unable to regulate body temperature.
UNICEF has warned that the lack of access to proper shelter, food, healthcare, and sanitation, exacerbated by the cold weather, poses life-threatening challenges. Children with medical conditions and newborns are particularly vulnerable.
The humanitarian situation has spiraled out of control, with aid deliveries falling far short of meeting even the most basic needs. Civil order in Gaza has disintegrated, with reports of looting of humanitarian goods.
Healthcare infrastructure is on the brink of collapse. Kamal Adwan Hospital, the last operational pediatric facility in northern Gaza, was rendered nonfunctional after a raid in late December. The destruction of civilian infrastructure has left families without access to essential supplies, including food, clean water, and sanitation. The remaining operational hospitals are overwhelmed, leaving critically ill children and newborns without care.
UNICEF has renewed its call for all parties to adhere to international humanitarian law, urging them to cease attacks on civilians, humanitarian workers, and infrastructure. The organization emphasized the need for rapid, safe, and unimpeded humanitarian access to deliver life-saving supplies.
TITLE: Thabat Salim, Palestinian OBGYN Who Told Jezebel About Horror in Gaza, Killed in Israeli Airstrike
https://www.jezebel.com/dr-thabat-salim-obituary
EXCERPTS: On Sunday, Israel killed Dr. Thabat Salim, an OBGYN who worked for the Palestine Family Planning and Protection Association (PFPPA), in an airstrike on a residential building, part of Israel’s continued, brutal war on Palestinian health workers in Gaza.
In a press release shared with Jezebel, PFPPA, which is a member organization of International Planned Parenthood (IPPF), said that Salim, 30, was killed in a house in the Al-Nuseirat refugee camp. She died “just hours after providing care to women and children,” the organization said. In November, the United Nations reported that 80% of victims in Gaza are killed by Israeli strikes on residential buildings and 70% of fatalities are women and children.
Last month, Salim told Jezebel in an email that there’s been a “sharp rise” in miscarriages, maternal deaths, and “high-risk pregnancies” during Israel’s war on Gaza, and said that the few remaining hospitals in the region are “operating at over 250% capacity.” She also warned of “critical shortages of antibiotics, incubators, and basic hygiene supplies are endangering lives”—particularly vulnerable newborns and postpartum women, who face heightened risk of sepsis.
“The conflict has created generational trauma and worsened poverty and malnutrition, with no resolution in sight,” Salim wrote. “Healthcare infrastructure is nearing complete collapse, and the ongoing violence threatens to deepen the crisis further.”
As of this week, Gaza’s health ministry counts about 47,000 people killed by Israeli forces since October 2023. The Costs of War Project at Brown University recently estimated that the actual death toll is likely well over 100,000, thanks to the total collapse of Gaza’s health system.
Israel’s war on Gaza has brought disparate harm to pregnant women and children. Gaza has seen a 300% increase in miscarriages. There’s nowhere safe to give birth; C-sections without anesthetic and fatal infections are rampant; and, as Salim noted, maternal and infant mortality have surged, too. In an October article in The Lancet, doctors warned that Israel’s attacks on reproductive healthcare in Gaza are “not merely collateral damage,” but “a violation of international law, a grim reminder of the structural violence imposed on this population.” Nonetheless, doctors like Salim have been risking their lives to provide any care they can to their pregnant patients and children.