What estimates exist for indirect deaths (disease, malnutrition, lack of medical care) in Gaza since October 2023?
Executive summary
Estimates of indirect deaths in Gaza since October 7, 2023 vary enormously: peer-reviewed and population-health modelling papers point to thousands of excess non‑violent deaths (roughly 8,000–8,540 through early January 2025), while advocacy letters and some extrapolations put tens of thousands — and a small set of extrapolations using large multipliers project totals as high as ~186,000 when indirect deaths are added to direct fatalities [1] [2] [3] [4]. The divergence stems from differing methods, incomplete access, and contested assumptions about what counts as war‑related indirect mortality [5] [6].
1. A crowded map of estimates: the short list
Independent household surveys and modelling studies published or reported through 2025 produce a range: a capture–recapture and related peer‑reviewed work primarily quantified traumatic (direct) deaths but noted the potential for large indirect tolls if conservative multipliers are applied (The Lancet commentary that referenced up to 186,000 total deaths used a 4:1 indirect-to-direct ratio) [6] [4]. Field‑based survey work led by Michael Spagat estimated about 8,540 non‑violent, war‑related (indirect) deaths through Jan 5, 2025 in addition to violent deaths [2]. A Brown University Costs of War synthesis aggregates multiple sources and highlights a widely cited October 2024 letter from 99 US clinicians that estimated at least 62,413 deaths from starvation plus at least 5,000 from lack of chronic care; those clinical estimates are incorporated in Costs of War discussions of indirect deaths [7] [3] [5]. More recent large modelling and household‑survey efforts reported much higher direct death totals, and some commentators applying historical multipliers have produced upper‑bound indirect projections [8] [9] [4].
2. Where the high numbers come from
Two sources drive the high-end indirect estimates. First, clinician‑led letters that combine Integrated Food Security Phase Classification outputs with field observations estimated catastrophic numbers of starvation deaths (the October 2, 2024 letter claimed >62,000 starvation deaths and >5,000 chronic‑care deaths) and were cited by Costs of War as part of an indirect‑death dataset [3] [7]. Second, conservative multiplier rules of thumb—such as the “four indirect deaths per direct death” used in a Lancet commentary—transform direct‑death tallies into very large totals (the 4:1 ratio applied to mid‑2024 direct counts produced a possible aggregate near 186,000) [4].
3. Why some studies report far fewer indirect deaths
Field surveys and capture approaches that try to separate violent from non‑violent war‑related deaths yield much lower short‑term indirect estimates: the independent household‑survey reported roughly 8,540 non‑violent excess deaths through Jan 5, 2025, and a later population‑health methods paper summarized similar order‑of‑magnitude short‑term excess non‑violent deaths (~8,000) for the same period [2] [1]. Those teams emphasize direct field ascertainment, conservative attribution rules (excluding deaths likely to have occurred regardless of the war), and bounded time frames, producing more modest counts than long‑run multiplier models [2] [1].
4. Methodological fault lines that explain the spread
Differences in definition (what counts as an indirect death), time window, data sources (household surveys, hospital records, obituaries, clinician reports), and whether models borrow multipliers from other conflicts drive the spread in estimates; capture–recapture methods focus on traumatic deaths while IPC‑based food‑security extrapolations or borrowed multipliers inflate long‑term projections [6] [5] [4]. Access constraints, damaged civil‑registration systems, large numbers of unidentified or buried bodies, and displacement further complicate counting and force researchers into divergent assumptions [6] [10] [11].
5. Synthesis: what counts as the best current evidence?
Peer‑reviewed and field‑survey work to early 2025 converge on thousands of excess non‑violent deaths (on the order of ~8,000–8,540 through Jan 5, 2025), while clinician letters and multiplier‑based scenarios argue for tens of thousands or more indirect fatalities if prolonged deprivation and collapsed services are fully counted over time [1] [2] [3] [4]. All sources and the Costs of War synthesis agree that indirect mortality will continue to rise as infrastructure, displacement, and health‑system collapse persist, but the precise toll depends on contested attribution rules, continued access for epidemiological work, and whether broad multipliers are judged appropriate for Gaza’s specific pre‑war health profile [11] [5] [4].