From Ali Sawafta and Maggie Feek

Ramallah (West Bank)/Beirut, December 6 (Reuters) - Israeli forces launched an air and ground campaign against the Islamic Resistance Movement (Hamas) in Gaza after the movement’s October 7 attack on southern Israel. Figures from the Ministry of Health in Gaza indicate that the Israeli attack claimed the lives of at least 16,015 Palestinians, while Israeli statistics estimate that 1,200 people died in a Hamas attack inside Israel.

Relief agencies warn that the humanitarian catastrophe in Gaza is worsening by the hour, with most of the Strip's 2.3 million people displaced and trapped in a narrow coastal enclave with little food, water, medical care, fuel and safe shelter.

There is growing concern about the possibility of the health authorities in Gaza being unable to continue an accurate count of the dead, with the destruction of basic infrastructure, repeated disruptions to telephone and Internet services, and the death or disappearance of a number of those responsible for this operation.

* How have the results been collected so far?

In the first six weeks of the war, hospital morgues across Gaza sent numbers to the Hamas-run Health Ministry's main statistics center at Shifa Hospital. The officials used an Excel program to record the names, ages, and ID numbers of the dead and transferred this to the Palestinian Ministry of Health in Ramallah.

But Omar Hussein Ali, director of the ministry's emergency operations center in Ramallah, said that of the four officials running the Shifa data center, one of them died in an air strike that hit the hospital while the fate of the other three is unknown when Israeli forces seized the building under the pretext that it was a Hamas hideout. .

“The kind of casualty registration required to understand what is going on has become more difficult,” said Hamit Dardogan, founder and director of the Iraq War Victims Project, which was established during the US invasion and occupation of Iraq. “The information infrastructure and health systems are being systematically destroyed.”

With the collapse of the one-week truce on December 1, the toll update that was generally issued daily became irregular. The latest addition to data from the Ministry of Health in Gaza came on Monday via its spokesman, Ashraf Al-Qudra, raising the death toll to 15,899.

Al-Qudra did not hold his usual press conference yesterday, Tuesday, and Reuters has not been able to contact him since. Only two partial reports were issued by the ministry updating the death toll, based on the number of bodies that arrived at two hospitals, with 43 bodies yesterday, Tuesday, and 73 bodies today, Wednesday.

Palestinian Health Minister Mai Al-Kaila said yesterday, Tuesday, that health services in Gaza are in a deplorable state, after Israeli forces killed more than 250 employees and arrested at least 30.

*Are the announced casualty figures comprehensive?

The experts' answer to Reuters to this question was negative.

A spokesman for a United Nations human rights agency said, “Our monitoring indicates that the numbers provided by the Ministry of Health may be an underestimate because they do not include the dead who did not reach hospitals or those who may be under the rubble.”

“It is a reasonable assumption that the recorded numbers are underestimates and low,” said Nathaniel Raymond, executive director of the Human Research Laboratory at Yale University School of Public Health, who has worked on counting deaths from armed conflicts and natural disasters for more than 20 years.

A Palestinian Authority report issued on October 26 said at least 1,000 bodies could not be recovered or transported to morgues, citing families interviewed by PA staff, a clear example of the impact of war “on data collection and reporting,” the report said. For The Lancet.

Minister Mai Al-Kaila said yesterday, Tuesday, that the number of bodies feared to be buried under the rubble now reaches thousands, and that a large part of the drilling equipment belonging to the Gaza Civil Defense Forces was destroyed in Israeli air strikes.

* How reliable are the human casualty figures so far?

Public health experts told Reuters that pre-war Gaza had good population statistics, from the 2017 census, more recent UN surveys, and smoother, better health information systems than most Middle Eastern countries.

Oona Campbell, a professor at the London School of Hygiene and Tropical Medicine, said that Palestinian health authorities have well-established credibility in their methods for maintaining basic statistics and tracking deaths in general, and not just in times of war. United Nations agencies depend on it.

"Palestinian data collection capabilities are professional, and many of the ministry's employees were trained in the United States. They work hard to ensure statistical accuracy," said Yale University's Raymond.

On October 26, the Palestinian Ministry of Health published a 212-page report that included the names, ages, and identity numbers of 7,028 Palestinians it registered as dead as a result of Israeli air strikes, after US President Joe Biden cast doubt on the death toll.

Campbell and two other academics analyzed the data in the November 26 Lancet medical journal report and concluded that there was no clear reason to doubt its validity. “We find it implausible that these patterns (of death rates) are derived from fabricated data,” the researchers wrote.

The Palestinian Authority Ministry of Health has not issued a similar detailed report since then, a manifestation of weak communications with Gaza.

*What does Israel say?

A senior Israeli official told reporters on Monday that about a third of those killed in Gaza so far were what he described as enemy fighters, estimating their number at less than ten thousand but more than five thousand, without providing details of the justifications for his estimate. The official said that the total number of deaths announced by the Palestinian authorities, which as of Monday amounted to about 15,000 dead, without division between civilians and combatants, is correct “in one way or another.”

Human rights groups and researchers say the high civilian death toll is due to the use of heavy weapons, including so-called “bunker buster” bombs aimed at destroying Hamas’ strategic tunnel network and air strikes on residential areas where Israel says Hamas has hidden bases for its fighters, rocket launchers and weapons inside residential buildings and hospitals. And below it.

* What is the percentage of children among the dead?

The United Nations, Israeli and Palestinian law define a child as someone under the age of 18, although some Hamas fighters are believed to be in this age group.

The Palestinian Authority Ministry of Health said on Tuesday that about 70 percent of the dead in Gaza were women and those under 18 years of age, but it had not published any breakdown of age groups since its report issued on October 26.

The Lancet medical journal report stated that data from the Palestinian Ministry’s report showed that 11.5 percent of the deaths it recorded in the period from October 7 to 26 were of children no more than four years old, and that 11.5 percent were between five and nine years of age, and 10.7 percent. Percent are between 10 and 14 years old, and 9.1 percent are between 15 and 19 years old.

The report stated, “There is a clear increase among men between the ages of 30 and 34 years, which may represent combatants or civilian exposure (such as medics at bombing sites, journalists, and people who go out to bring water and food for their families).”

* Can counting the dead become a casualty of war now?

The World Health Organization's envoy to Gaza, Richard Peppercorn, said on Tuesday that the new phase of the Israeli offensive, which extends to the southern half of Gaza starting on December 1, has further diminished the ability to collect reliable data on the death toll.

He added, "As we all know, we usually get (data) from the Ministry of Health, and a few days ago the matter relied more on estimates, and it became more difficult."

Another horrific indicator of the war's toll is that it has become almost impossible for a previously competent group of health technocrats to operate, experts said.

“It's a terrible sign when we get to a point, like in Sudan, where there's not even a record of deaths,” said Yale University's Raymond. “That in itself seems to us as aid workers the worst possibility.”

(Additional reporting by James MacKenzie in Jerusalem, Jana Choucair in Dubai, Emma Farge in Geneva, Helen Reed in London, and Adam Makari in Cairo - Prepared by Muhammad Harfouche for the Arab Bulletin - Ali Khafaji)