IIn August, a 10-month-old baby in Gaza was partially paralyzed by polio, the first confirmed case there in 25 years. The paralysis is likely to be permanent and there are no treatments for polio. We have a safe and effective vaccine to prevent serious illness, but the ongoing war in the region has halted vaccination campaigns. A polio outbreak seems inevitable as the disease spreads through dirty water and waste that surrounds people living in tents in camps.
Fortunately, a series of nine-hour pauses over consecutive days have been agreed to allow children to be vaccinated as part of a UN emergency aid campaign. The first of these three-day periods ended on Tuesday; the next will run until the end of the week. But whether the fighting will stop altogether is a major concern: Israeli forces have attacked hospitals, schools, aid trucks and UN workers in the past. UN agencies such as the World Food Programme have stopped sending staff into Gaza after Israeli forces opened fire on a marked World Food Programme truck – even after the vehicle had been given permission by Israeli authorities. It’s all very well to agree to a pause on paper; the real test will be whether it’s followed through in real life.
The discovery of polio in Gaza reminds us that it is increasingly difficult to estimate the true cost of the war. We have no idea how widespread disease and famine are – so-called “indirect deaths” – and we are in the dark about the total number of deaths. Data is usually collected in hospitals and morgues, which certify each death and inform the Ministry of Health. Yet these civil registration systems in Gaza are broken, meaning that there is no accurate data on the number of deaths. The Ministry of Health has tried to collect figures using media reports, which is not a reliable way to paint the full picture. The is estimated that there are still more than 10,000 bodies buried under the rubble (meaning they cannot be counted), and that the number of bodies that cannot be identified is growing.
It is important to have some sort of accepted and reliable process for remotely estimating the true number of deaths. For decades, methods have been developed to build datasets in situations where health and monitoring systems are poor or broken: the Global Burden of Disease study, funded by the Bill & Melinda Gates Foundation, is the gold standard here. The aim is to create a process for estimating deaths and then triangulate it across research groups and different methods to see if a robust, universally accepted number can be agreed upon. This is a process of peer review and discussion among scientists.
The medical journal The Lancet recently published an estimate of the number of deaths in Gaza from several respected scholars, who outline their estimation process (comparison with similar conflicts) and final numbers. They estimate that around 186,000 total deaths could be attributed to the current conflict in Gaza, which accounts for around 7.9% of the population, by mid-June 2024. This high number is despite several ceasefire agreements over the past six months. If the deaths continue at this rate – around 23,000 per month – there would be an additional 149,500 deaths by the end of the year, some six and a half months after the original mid-June estimate. Using this method, the total number of deaths since the beginning of the conflict would be estimated at around 335,500 in total.
Similarly, last winter I made a rough estimate by looking at other conflict situations and assessing how many people would die if the fighting continued without international intervention. By December 2023, my estimate was around half a million dead without a ceasefire. This is roughly in line with the Lancet estimates – they used a very conservative estimate, but allowed that the number could easily have been much higher. It also shows what could have happened if the international community had not acted and taken advantage of the short window of time available to deliver aid and medical care. Many have been saved by these various lulls in the fighting and humanitarian interventions, even if they were enforced piecemeal.
It’s easy to get lost in these numbers and forget the name and face behind each one. While the situation in Gaza may seem hopeless, it’s not. UN efforts to enter the Strip, like the one that resulted in humanitarian pauses for polio vaccinations, are saving lives. They’re making a difference for hundreds of thousands of families, even amid the horror of war. This isn’t a political argument or a debate: scientists working together to gather reliable facts and data are crucial to documenting what’s happening in the Gaza conflict—and will help those working on solutions to preserve human life and health.