Gaza death tolls: How the Health Ministry arrives at the numbers, and why they're criticized

With Israel besieging and bombing Gaza at a scale never seen before, arriving at a precise number of thosekilled has proven challenging.

The Gaza-based Ministry of Health an agency in the Hamas-controlled government continues to tally casualty numbers amid spotty cell service and electricity, as well as the destruction within the city that hampers rescue efforts.

On Thursday, the ministry released a 212-page report listing every Palestinian killed in the war so far, including names, ID numbers, ages and gender. A copy of the report shared with the Associated Press names 6,747 Palestinians and says an additional 281 bodies have not yet been identified. The list did not provide a breakdown by location.

The list was produced as U.S. President Joe Biden said Thursday he had "no confidence" in the accuracy of the ministry's reporting, while Lt. Col. Richard Hecht, Israeli military spokesman, said in a briefing that the ministry's numbers should be "taken with a pinch of salt."

A controversy over the death toll from an Oct. 17 explosion al-Ahli Arab Hospital, and who caused the blast, brought the issue to the fore even as the United Nations and other international institutions and experts say the Gaza ministry has long made a good-faith effort to account for the dead under the most difficult conditions.

"The numbers may not be perfectly accurate on a minute-to-minute basis," said Michael Ryan, of the World Health Organization's Health Emergencies Program. "But they largely reflect the level of death and injury."

Here's a look at how Gaza's Health Ministry has generated death tolls since the war started.

Who works in the ministry

The Palestinian Authority, which controlled Gaza before Hamas overran the area in 2007, retains power over health and education services in Gaza, even though it's based in the occupied West Bank. The ministry is a mix of recent Hamas hires and older civil servants affiliated with the secular nationalist Fatah party, officials say.

Employees of the Health Ministry insist Hamas doesn't dictate casualty figures.

"Hamas is one of the factions. Some of us are aligned with Fatah, some are independent," said Ahmed al-Kahlot, director of Kamal Adwan Hospital in northern Gaza. "More than anything, we are medical professionals."

How numbers get tallied

Hospital administrators say they keep records of every wounded person occupying a bed and every dead body arriving at a morgue.

"Every person entering our hospital is recorded," said Atef Alkahlout, director of Gaza's Indonesian Hospital. "That's a priority."

They enter this data into a computerized system shared with Health Ministry spokesperson Ashraf al-Qidraat an office at Shifa Hospital in Gaza City, as well as some of his colleagues. According to screenshots hospital directors sent to the Associated Press, the system looks like a colour-coded spreadsheet divided into categories: name, ID number, date of hospital entry, type of injury, condition.

Names aren't always available, al-Qidra said. He and colleagues face disruptions because of spotty connectivity but say they call to double-check the numbers.

Ministry stands by hospital toll

Less than an hour after images of the explosion surfaced on social media, the ministry reported that 200 to 300 people had been killed at al-Ahli Hospital. A half-hour later, the ministry put that toll at a staggering 500. The next day, it revised the number down to 471, without releasing details.

Western intelligence agencies said they believed the toll was considerably lower. Israel says the ministry inflated the toll. American intelligence agencies estimate 100 to 300 people killed, but haven't said how they arrived at the numbers.

WATCH l 'Best evidence' suggests Israel not responsible: Trudeau:

Israel was not responsible for Al-Ahli Hospital blast in Gaza, Trudeau says

11 months ago

Duration 1:21

Conservative Party Leader Pierre Poilievre pressed the prime minister on who was responsible for the hospital blast in Gaza last week. Prime Minister Justin Trudeau said that, based on information obtained by the Canadian government, the rocket did not come from Israel.

Gaza's Health Ministry stands by the 471 figure. When asked about conflicting accounts, authorities emphasize the difficulties of their work and vigorously deny any fabrication.

"We had a uniquely hard time because the bodies were so dismembered, body parts were everywhere," Health Ministry official Mehdat Abbas said.

There were conflicting accusations of who was responsible, with Hamas officials blaming an Israeli airstrike and Israel saying it was caused by a an errant rocket launched by Palestinian militants.

An Associated Press analysis of video, photos and satellite imagery, as well as consultation with experts, showed the cause was likely a rocket launched from Palestinian territory that misfired and crashed. However, a definitive conclusion couldn't be reached.

Other criticisms

Omar Shakir, Human Rights Watch's Israel and Palestine director, defends the ministry's overall approach but said he was "cognizant of different blind spots and weaknesses" such as the fact the ministry totals do not distinguish between civilians and combatants in the death tolls.

That lack of transparency has drawn criticism.

The Health Ministry also doesn't report how Palestinians were killed, whether from Israeli airstrikes and artillery barrages or other means, like errant Palestinian rocket fire.

It describes all casualties as victims of "Israeli aggression."

The historical record

Throughout four wars and numerous bloody skirmishes between Israel and Hamas, UN agencies have cited the Health Ministry's death tolls in regular reports. The International Committee of the Red Cross and Palestinian Red Crescent also use the numbers, and the U.S. government's annual human rights assessments from the region frequently cite the Gaza ministry.

UN counts have largely been consistent with the Gaza Health Ministry's in the past, with small discrepancies.

• 2008 war: The ministry reported 1,440 Palestinians killed; the UN reported 1,385.
• 2014 war: The ministry reported 2,310 Palestinians killed; the UN reported 2,251.
• 2021 war: The ministry reported 260 Palestinians killed; the UN reported 256.

Israel's accounts of Palestinian casualties have sometimes come close to the Gaza ministry's. For instance, Israel's Foreign Affairs Ministry said the 2014 war killed 2,125 Palestinians.

"These figures are professionally done and have proven to be reliable," Shakir said.