How the Health Ministry in Gaza Counts the Dead

"Each of these individuals is more than just a number; each one carries a unique story, a profound tragedy, a home filled with memories, a family left grieving—don’t they deserve to be remembered?"

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Every day, the Palestinian Ministry of Health in Gaza publishes a bulletin of the number of people killed and wounded in Gaza over the previous 24 hours and updates the total number of casualties since October 7. Today’s report shows 24 Palestinians killed and 85 wounded, bringing the totals to 41,495 and 96,006, respectively.

The ministry also works to keep track of the names, ages, ID numbers, and other biographical data of those killed, periodically making its latest list public. The most recent published list includes biographical information for 34,344 Palestinians killed between October 7 and August 31—with the important caveat that there are over 6,000 more confirmed dead that the ministry had not been able to successfully identify.

The fact that the Health Ministry manages to gather, verify, and publish this data on a rolling basis is extraordinary. Michael Spagat, a Professor of Economics at the University of London whose research focuses on armed conflict and measurement of war deaths, told Drop Site News: “It’s very significant that [the Gaza health ministry] is making their data available and it’s highly unusual. As a consequence we understand the death toll in the Gaza war better than we do in almost all wars of the past few decades.”

The Health Ministry has persisted in documenting casualties despite the health care system in Gaza coming under a direct and sustained assault by the Israeli military, with multiple hospitals being bombed, besieged, and invaded by Israeli forces, doctors arrested and killed, and severe restrictions on medicine and medical supplies allowed into Gaza. Out of 35 public hospitals treating patients in Gaza before October 7, only 16 are partially functioning today.

To understand how it has managed to document tens of thousands of dead in Gaza to a high degree of accuracy, the processes it has used, and the philosophy behind it, Drop Site conducted an interview with Dr. Zaher al-Wahaidi, director of the information center at the Ministry of Health in Gaza who is based at Nasser hospital in Khan Younis.

Gaza ministry of health bulletin published September 25, 2024

This interview was translated from Arabic and has been lightly edited for clarity.

Drop Site News: How does the Ministry of Health document the number of Palestinians killed in Gaza and gather relevant information? What methods are used to collect and verify the data?

Dr. Zaher al-Wahaidi, director of the information center at the Ministry of Health in Gaza: The Ministry of Health relies on multiple sources to document data on martyrs. We use an electronic system and do not operate manually. We have a repository that collects data on martyrs and the injured, drawing from three sources. 

The first source is e-Hospital, a computerized program, which monitors all emergency departments in government hospitals. Any casualty brought to a government hospital is registered in the emergency department through the electronic system, and the information is automatically transferred to the repository.

The second source is an Excel file provided by field hospitals that offer emergency services and handle mass casualties, like the Red Cross hospital, the Kuwaiti field hospital and so forth. These hospitals document the casualties in the Excel sheet, which they supply to us; we then process this file and upload it to our system.

A third source was introduced in January – a link provided by the Ministry of Health for reporting martyrs who had not reached ministry hospitals, remained trapped under rubble, or who could not be identified. The Ministry of Health is committed to registering only those who reach its hospitals or other emergency medical care facilities in the Gaza Strip. Consequently, the number of martyrs announced by the ministry does not necessarily represent the total number of casualties but only those that have been officially documented.

DSN: So the number announced by the Ministry of Health, for example, around 41,000 martyrs, could potentially be higher, but this is the figure you were able to confirm?

Dr. Zaher al-Wahaidi: Correct. 41,266 martyrs [official ministry of health tally on September 16, 2024], as per the latest report. Bear in mind that the ministry releases multiple figures. The first figure of 41,266 martyrs represents the total number of martyrs who have reached the ministry's hospitals. The ministry also announces another number of martyrs for whom complete information is available—those for whom we have their full name, identification number, gender, date of birth, place of birth, and residence; we refer to this as "complete data cases." Currently, there are 6,200 martyrs for whom the ministry has not been able to gather complete data, which we call "incomplete data cases." For some of these martyrs, we only have partial information, such as their first and last names and an estimated age. Furthermore, there were bodies handed over by the occupying forces to hospitals like Nasser Hospital and Al-Najjar Hospital in multiple stages; these bodies were buried in mass graves and remain unidentified. There are also cases where the bodies of martyrs were received at the hospital in pieces, making identification impossible.

Many martyrs were not able to be documented due to the collapse of the health ministry’s systems following Israeli raids on November 10th and 11th. During this period, the Al-Shifa complex was raided, and both the central data center in Al-Shifa and a sub-data center at Al-Rantisi Hospital were attacked. This caused a complete breakdown of the health information system, cutting off communication with the database and the civil registry.

For example, entering a citizen's ID number would not yield any data. Registrars had to rely on sequential numbers or ID numbers, which might have been recorded incorrectly, along with information provided by family members regarding age and date of birth. This led to significant inaccuracies in documentation.

Additionally, hospitals such as Kamal Adwan Hospital, the Indonesian Hospital, and Al Ahli Arab Hospital were under siege, causing their systems to malfunction, so we had to resort to manual documentation On some days, particularly during massacres, we would receive over 300 martyrs in one hospital, while on other days some hospitals reported up to 700 martyrs in a single day during the peak of the events in the north. Given these circumstances, it was impossible to accurately document all 700 martyrs—we could only record a portion of them on paper, while others were simply noted as numbers in the morgue. 

The medical staff faced immense challenges in documenting the casualties due to threats and siege conditions, leading to a significant gap and an increase in the number of unidentified martyrs. At the beginning of the war, we had 12,000 martyrs who were unidentified with incomplete data. As systems began to recover, that number decreased to 11,000, then 9,000, and has now reached approximately 6,200.

The Ministry of Health began consolidating the information system and restoring the backup system. We rented cloud storage spaces to help recover essential systems, such as the main hospital system, the birth and death registration system, the human resources system, the healthcare system, and the infectious disease monitoring system. We started this process gradually to restore the documentation system.

In early May, we redeveloped the monitoring system, as we initially had at the beginning of the war before it collapsed. After the collapse, we switched to a paper-based documentation system. In the south, we used the local hospital systems that were functioning but on a local, unconnected database. Once the systems were restored, we were able to connect the southern hospitals to them.

We started developing a central data system with a simple cloud-based database. When hospitals in the north started returning to service, we connected them to the central database. Hospitals in the north, like Kamal Adwan Hospital and the Indonesian Hospital, began entering paper-based records retroactively, which were provided to us and integrated into the system.

We handled missing or incorrect ID numbers by creating algorithms and equations that link individuals with similar characteristics based on the event, location, and family ties. This allowed us to establish relationships between those affected by the same incident, complete their data, and link it to the civil registry.

At the beginning of May, there were at least 2,500 invalid ID numbers, and the number of incorrect estimated ages dropped to 1,300 in June and then further decreased to 313 in July. Currently, the number of records needing correction and processing is fewer than 100. A significant amount of incorrect data has been processed through the combined efforts of personnel and electronic processes and utilizing algorithms and equations we created to match the data. This collaboration has allowed us to create accurate records.

DSN: How do you obtain the names of the victims from the hospitals in Gaza?  Do they report to you daily?

Dr. Zaher al-Wahaidi: As I mentioned at the beginning of the interview, we have a computerized system, and the hospitals are connected to this system. Every morning, I review the number of martyrs from the previous 24 hours. We check if the data is complete, and we contact any hospitals facing issues with incomplete data, to process and transfer it automatically to our system accordingly.

DSN: How do the bodies reach the hospitals?

Dr. Zaher al-Wahaidi: There are two types: those that are directly targeted, which are delivered, identified, and registered, and the remains, bones, and skeletons, which are directed to the morgue. In the morgue, we have forensic evidence and forensic medicine experts who verify the distinctive markers and prominent features, such as documents like ID cards, shoes, and watches—any notable identifiers are recorded. Typically, during body recovery operations, family members come to search for and identify the bodies. For those that cannot be identified, all distinctive markers are documented, and photographs are taken, and they are given a serial number based on the location of the incident and the hospital. They are buried after several days, and if they remain unidentified, they remain recorded as unknown.

DSN: How do you track individuals who are reported missing?

Dr. Zaher al-Wahaidi: Missing persons are treated differently. The Ministry of Health registers the martyrs, and at the beginning of each month, we publish a list with the names of all the martyrs, excluding the missing persons. The status of missing persons is uncertain; their families report them through a dedicated link for martyrs and missing persons. There is the possibility that the reported missing person is detained, which is why we exclude their names from the list of martyrs and from the list that is presented to the judicial committee – we present a list of reported martyrs to a judicial committee composed of three judges from the Supreme Court, the Public Prosecution, and forensic evidence, including medical investigations and the Ministry of Health. We send a message to everyone who reported a martyr to appear before the committee to testify, along with two witnesses who are not first-degree relatives. The judge listens to their testimonies individually, and the prosecution investigates the incident, the family, the date, time, and location to ascertain whether the event actually occurred and whether the individual was martyred or not. As the Ministry of Health, we verify if this martyr had previously entered the hospitals. If so, their data should be recorded and available; however, if they entered with incomplete data or a serial number, they might not appear as martyrs in our records, or they could have entered for another medical reason unrelated to war-related affairs or injuries. This is because some report a patient as a martyr simply because they died during the war, but we strive for accuracy and discover that many of them were patients who died in the hospital and were recorded as natural deaths.

DSN: You mentioned that the number of martyrs has reached 41,266. What do you estimate the actual number to be, considering the individuals who have not been accounted for?

Dr. Zaher al-Wahaidi: The estimates from the Government Media Office indicate that the number of martyrs is 50,000, as at least 10,000 are still under the rubble. This is the declared number, and there are unreported figures as well. There are combat areas like Rafah with dozens or hundreds of bodies that we know nothing about. The estimates from the Civil Defense indicate that there are 50 or more residents in buildings from which no one has been recovered from under the rubble. In the areas of “contact,” like the Netzarim and Philadelphi corridors, there are dozens of bodies that have not been recovered, and we know nothing about them, and perhaps they have not even been reported.

DSN: What is the importance and significance of publishing the names of the martyrs?

Dr. Zaher al-Wahaidi: This is a message we are sending to the entire world, to all those skeptics who claim that the Gaza Strip and the Ministry of Health are exaggerating the numbers of our martyrs. Each of these individuals is more than just a number; each one carries a unique story, a profound tragedy, a home filled with memories, and a family left grieving—don’t they deserve to be remembered? Acknowledging their existence is a testament to their humanity and it means a lot to their families and loved ones. It is our duty to honor their names, to ensure that their sacrifices are not forgotten, and to share the painful truth that these remarkable souls were martyred, leaving behind loved ones who mourn their loss.

Additionally, it is important to counter the narrative of the occupation that we are exaggerating and that all those killed are combatants, and that they killed them by the thousands. On the contrary, we are publishing reports and infographics showing that 60% of those martyred are children, women, and the elderly. 

Even among male martyrs, the data shows that those aged 18 to 30 make up 17% percent of the total, while the percentage for those aged 35 to 40 is even lower. We have also published numbers for those aged 41 to 59. The Israeli army claims to have killed between 10,000 and 15,000 Hamas fighters. And the assumption that all the martyrs who fall within this age group are combatants is false to begin with.

DSN: Besides the number of martyrs, do you also document deaths caused by starvation and diseases?

Dr. Zaher al-Wahaidi: We do keep track of these cases, but the Ministry of Health has a policy of recording only direct casualties of war, such as those caused by missile strikes or war-related injuries. There are other deaths indirectly caused by the war, but we do not add them to the list of martyrs. For example, children who die due to malnutrition, lack of care, or because their mothers gave birth under difficult conditions and carried them in poor health, resulting in the birth of an underdeveloped infant who dies after a few days or lacked proper feeding, these cases are documented but not recorded as martyrs.

Similarly, cancer patients who pass away due to a lack of care, unavailability of treatment, or being denied travel for treatment are documented but not listed as martyrs. The same applies to kidney dialysis patients who used to receive treatment three times a week for three to four hours per session, but now receive it only once or twice a week with sessions reduced to less than two hours. This reduction in dialysis leads to poisoning and death. Additionally, patients who cannot get their medications due to shortages, chronic asthma patients, elderly patients, and heart disease patients who require catheterization or open-heart surgery are also affected. The Ministry of Health used to perform at least 5,000 catheterization procedures and no less than 500 open-heart surgeries [period was not mentioned], currently the number of open-heart surgeries is zero and most of these patients have now passed away.

Mohammed Rajab contributed reporting from Gaza. Translation by Zahra Sulaiman.