It noted that “this would translate to 7.9% of the total population in the Gaza Strip.”

According to the piece, the latest available count of Palestinians killed – 37,396 – is far too low, based on the fact that it is still unknown how many more lie under the rubble, how many are missing but not accounted for among the dead, and how many will perish due to starvation, dehydration, or diseases.

“Even if the conflict ends immediately, there will continue to be many indirect deaths in the coming months and years from causes such as reproductive, communicable, and non-communicable diseases,” it noted.

However, even this Lancet estimate of nearly 200,000 dead might be only half the actual number of Palestinians killed, according to some counts.

Norwegian Dr. Mads Gilbert, who has worked extensively from Gaza over the years – notably during times when Israel was waging wars on the Palestinian enclave – recently outlined the manifold preventable conditions which contribute to such “indirect” deaths, estimating the number dead or soon to die could be over 500,000.

As causes of indirect deaths, he details “the lack of food entering Gaza and the destruction the agriculture, the fisheries, the poultry, the dairy farms, and so on. The lack of water, which leads to dehydration and infections.”

The third component of the “triangle of death” is common diseases, Gilbert notes. “There are maybe as many as 10,000 or more cancer patients in Gaza. The Israeli army bombed the Rantisi hospital for children with cancer and they bombed the Turkish friendship hospital for adult cancer patients. They do not allow cancer drugs to come in.”

More than 1.2 million people, he says, are getting infected because of the bad hygiene conditions.

Gilbert points out that in the high temperatures in Gaza now, the uncollected garbage, destroyed sewage pumps and resulting flooding of streets with raw sewage, “it makes a hell of parasites that can spread diseases.”

Then, there are the pregnant women giving birth in unsanitary conditions, their bodies weakened from starvation. He estimates that more than 50,000 children have been born in Gaza since October 7, 2023, adding that “all these women need clean water and good food in order to take care of their children. There is massive over mortality among pregnant women who have difficult deliveries, who need cesarean sections.”

The nearly 40,000 dead is already an appalling number, but these recent estimates are absolutely horrifying.

Planned starvation and diseases

Having lived three years in Gaza (over the period of late 2008 to early 2013), I saw (and lived) the brutality of the Israeli siege, the severe power outages (16-22 hours a day when I lived there) after Israel destroyed the only power plant and how those power outages impacted hospitals (dialysis and emergency room function; incubators; refrigeration for medicine, etc.).

The power outages impacted the ability to treat sewage, or at the least pump it into the sea. When sewage over-accumulates, it overflows into the streets (including at least one horrific case where five civilians drowned in a northern Gaza village when sewage overflowed).

The Israel lockdown itself severely restricts what is allowed into Gaza, including medicine, cooking gas, fuel, food products, livestock, seeds, fertilizers, and much more. Likewise, it severely limits exports, contributing to the killing of economy.

As I wrote a few years ago, the power outages, fuel and cooking gas shortages, dramatic food insecurity, stunted growth in children, 50% unemployment, and 96% undrinkable water have been Gaza’s reality for years.

In fact, already back in 2008, I wrote (from Gaza) about the dearth of food aid allowed into the enclave:

“UN figures reveal an average of less than five truckloads a day have been allowed in, compared to 123 in October and 475 in May last year. On 27 November, the UN announced that it had run out of food supplies and essentials in Gaza.”

Back then, there was already a drastic shortage of “300 different kinds of medicines, 95 of which (including cancer medicines) are no longer available in Gaza.” 220 machines used for dialysis and other vital procedures, like CT scans, were not serviceable.

Likewise, the relentless Israeli attacks on Palestinian farmers and fishers, killed and maimed with bullets and shells, abductions of fishers and theft of their boats, have been going on for over a decade and a half, meaning a severe impact on Palestinians ability to grow or catch their own food.

Other Israeli army tactics include burning Palestinian crops, cutting down or otherwise destroying olive trees, and demolishing farms throughout the border regions. The Israeli government went as far as to calculate the minimum number of calories needed to keep Palestinians not quite fully starving.

In 2010, I wrote about Israel’s systematic destruction of wells and cisterns from the southeast to the north, visiting farmers and witnessing the destruction. Many resorted to trying to irrigate their land via donkey cart with jugs of water. For over a decade, 95% of water from the Gaza’s sole aquifer has been unfit for human consumption.

Add numerous Israeli wars on Gaza to the unrelenting siege, and you can see how Israel long ago set the stage for chronic disease, stunted growth, anemia, and so many more diseases and afflictions – long before October 7, 2023.

Remember, in October, Israeli Defense Minister Yoav Gallant declared, “I have ordered a complete siege on the Gaza Strip. There will be no electricity, no food, no fuel, everything is closed. We are fighting human animals, and we are acting accordingly.”

Remember, also, how Israeli forces have repeatedly fired on starving Palestinians lined up for what meagre food aid did enter Gaza, the worst such massacre in February, killing at least 115 civilians and wounding over 750.

Some months before the Lancet’s warning, back in March, Ralph Nader likewise questioned what he believed was a severe undercounting of the Palestinians killed in Gaza, writing, “From accounts of people on the ground, videos and photographs of deadly episode after episode, plus the resultant mortalities from blocking or smashing the crucial necessities of life, a more likely estimate, in my appraisal, is that at least 200,000 Palestinians must have perished by now and the toll is accelerating by the hour.”

More recently, Dr. Ahmad Yousaf, a doctor with Med Global who is working in Deir al-Balah, central Gaza, said in an interview:

“This ICU is full of diabetic patients who get a very treatable disease but they are dying of the most simple thing: because the insulin is unavailable, because they’re not allowed to bring it in, and refrigeration is gone. As many amputees from the trauma, there are amputees of diabetes uncontrolled. 

“The numbers are vastly higher, I would say four, five, six times higher easily. Let alone the ones who will die in the decades coming from both the psychiatric trauma and the physical disabilities associated with what’s happened in the last nine months.”

‘Safe zones’ are not safe

Palestinians tortured to death in Israeli prisons should also be included in the “indirect” death count, as Israel has abducted over 4,000 Palestinians from Gaza, including children, journalists, doctors, women (this is in addition to the nearly 10,000 non-Gaza Palestinians in Israeli detention).

Virtually no coverage in Canadian legacy media, scant coverage in the US. In fact, the New York Times’ heading unsurprisingly removes Israel as the reason behind the deaths, with its, “Fighting Isn’t the Only Killer of Gazans Amid the War, Researchers Say,” and otherwise writes Israel out of responsibility for the starvation it deliberately has caused in Gaza.

It is always worth it to point out the hypocrisy of Western press and talking heads’ reactions when it is Israel committing atrocities, compared to when the West claims Syria, Russia or another state allegedly did something similar. Meanwhile, Israel continues to massacre Palestinians in what were supposed to be “safe zones,” notably the recent repeated bombing of al-Masawi refugee camp (with least 1.5 million displaced Palestinians), killing at least 71 civilians and injuring nearly 300 more. Then, Israel re-bombed that same camp just days later.

It is mind-boggling that this slaughter of Palestinian civilians continues, with some hand wringing and mild condemnations. As Ralph Nader wrote, “It matters greatly whether the aggregate toll so far, and counting, is three, four, five, six times more. It matters for elevating the urgency for a permanent ceasefire.”

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Eva Bartlett is a Canadian independent journalist and activist. She has spent years on the ground covering conflict zones in the Middle East, especially in Syria and Palestine (where she lived for nearly four years). Her writings can be found on her blog, In Gaza. Email: evakbartlett2017@gmail.com

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