What is Gaza's Ministry of Health and how does it calculate the conflict's death toll?

The Health Ministry is the only official source for Gaza casualties. Credit: AP

Hospitals in Gaza are rundown, medics are working under torchlight and people are struggling without internet connection - but still the Hamas-run Ministry of Health has compiled an injury and death toll.

The ministry is the only official source for Gaza casualties and over four weeks has reported that more than 10,000 Palestinians have died.

International institutions, the United Nations (UN) and rival Palestinian authorities in the West Bank say the Gaza ministry has long made a good-faith effort to account for the dead under the most difficult conditions.

In previous wars, the ministry's counts have held up to UN scrutiny, independent investigations and even Israel's tallies.

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

Israeli ground forces push deeper into Gaza City as millions forced from homes
Criticisms have been made, including by the US, over the ministry's transparency. Credit: AP

How does the ministry determine the death toll?

Gaza’s most widely quoted source on casualties is Health Ministry spokesperson Ashraf al-Qidra.

From an office at Shifa Hospital, in Gaza City, al-Qidra receives a constant flow of data from every hospital in the strip, the Associated Press (AP) reports.

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

They enter this data into a computer system, shared with al-Qidra and colleagues.

According to screenshots that hospital directors sent to AP, the system looks like a colour-coded spreadsheet divided into the following categories: name, ID number, date of hospital entry, type of injury, condition.

The ministry releases casualty updates every few hours, providing the number of dead and wounded with a breakdown for men, women and minors. 

Surgeons have been forced to perform operations by torchlight due to electricity blackouts. Credit: AP

Is this accurate?

Criticisms have been made, including by the US, over the ministry's transparency. It generally doesn't provide names, ages or locations of those killed.

Names aren't always available, al-Qidra said, as he and colleagues face disruptions because of spotty connectivity. But he says they call to double-check the numbers.

However on October 27, in response to US doubts over its figures, the ministry released a 212-page report, listing every Palestinian killed in the war so far, including their names, ID numbers, ages and gender.

A copy of the report shared with AP named 6,747 Palestinians and said an additional 281 bodies have not yet been identified. The list did not provide a breakdown by location.

The ministry’s credibility also came into question after confusion over the death toll, from an explosion at al-Ahli Hospital, in Gaza City, in mid-October.

Within an hour, Gaza's ministry reported 500 Palestinians had been killed, then lowered that to 471 the next day. Israel says the ministry inflated the toll.

American intelligence agencies estimate 100 to 300 people were killed, but have not said how they arrived at the numbers.

“When the Hamas health agency comes out with the numbers, take it with a pinch of salt,” Lieutenant Colonel Richard Hecht, Israeli military spokesman, said in a briefing. But he repeatedly declined to offer any alternative number of Palestinian casualties.

Israel says more than 1,400 civilians and soldiers were killed and over 200 hostages seized when Hamas invaded Israel.

What's the track record from previous wars?

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.

In the aftermath of war, the UN humanitarian office has published final death tolls based on its own research into medical records, which are mostly consistent with the Gaza Health Ministry's.

  • 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.

“These figures are professionally done and have proven to be reliable,” said Omar Shakir, Human Rights Watch’s Israel and Palestine director, adding he remained “cognizant of different blind spots and weaknesses” - such as the failure to distinguish between civilians and combatants.

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