Gaza Health Ministry

The Gaza Health Ministry (GHM), officially the Palestinian Ministry of Health - Gaza, is responsible for managing healthcare and medical services in the Gaza Strip. It operates under the jurisdiction of the territory's Hamas government, which is independent of the Palestinian National Authority, and was headquartered in Gaza City before the outbreak of the Israel–Hamas war in October 2023.

The health ministry's casualty reports have received significant attention during the course of the Gaza–Israel conflict. Its numbers have historically been considered reliable by the United Nations, the World Health Organization, and Human Rights Watch. In relation to the Israel-Hamas war, two papers published in The Lancet journal did not find evidence of inflation or fabrication.

History
The Palestinian territories (the West Bank and the Gaza Strip) used to be served by a single government ministry of health. Following Hamas' takeover of Gaza in 2007, the Hamas government in the Gaza Strip has appointed its own alternate health ministers than those in the West Bank.

Following the 2007 Hamas takeover of Gaza, a month-long doctors' strike ensued due to political disputes. The new Gaza government, with Basem Naim as Health Minister, replaced Fatah-affiliated hospital directors and staff with Hamas loyalists. Jomaa Alsaqqa, a 20-year surgeon at al-Shifa Hospital, lost his job due to his Fatah support and faced arrests and assaults since the Hamas takeover. In response, Naim stated "the hospital managers weren't fired for political reasons: they were fired because of managerial, financial, and moral corruption in the hospitals."

The current director-general of the Gaza Health Ministry is Medhat Abbas.

On November 17, 2023, amid the Israeli invasion of the Gaza Strip, the head of Médecins Sans Frontières in Palestine stated the Gaza Health Ministry had been "decimated", and Gaza's health sector had been "systematically destroyed".

Casualty reports
As of 26 October 2023, the Gaza Health Ministry (GHM) was the sole official source of data on Palestinian casualties in Gaza during the 2023 Israel-Hamas war, although these numbers are also published by the West Bank-based Palestinian health ministry, which confirms them with its Gaza-based staff. The health ministry's numbers have historically been considered reliable by the United Nations, the World Health Organization, Human Rights Watch. The United States Department of State cited its numbers in a public report in March 2023.

The casualty figures provided by the ministry do not distinguish the difference between civilians and combatants or provide the cause of death. The percentage of civilian deaths is only calculated post-conflict by the UN and various rights groups.

Methodology
The GHM released a full list of the people killed at the time since October 7, a 200-page document with 6,747 identified individuals listing their names, ages, and ID number as well as 281 unidentified victims. Omar Shakir, Israel and Palestine director at Human Rights Watch, said "the numbers coming out of the ministry are not beyond reason", and noted a grey area in differentiating combatants from civilians among the dead, as well as emphasized that immediately released figures may often be different from those ultimately based on recorded data.

Palestinian political analyst Nour Odeh has asserted the process of issuing death certificates is not done by political figures, but by health professionals, insisting "this process enables families to deal with issues such as inheritance and custody of children whose parents have died." Director of Kamal Adwan Hospital, Ahmed al-Kahlot, denied that the GHM was unduly influenced by Hamas' control, stating that "Hamas is one of the factions. Some of us are aligned with Fatah, some are independent." and "More than anything, we are medical professionals."

As of February 29th, the Gaza Health Ministry stated that its daily tallies now rely upon "a combination of accurate death counts from hospitals that are still partially operating, and on estimates from media reports to assess deaths in the north of Gaza", but did not "cite or say which sources those are." On March 31st, it stated that 15,070 fatalities (45.8% of the then total) had been compiled via "reliable media sources" instead of direct reporting. The Ministry further clarified in reports made on April 1st and April 4th that it had “incomplete data” for 12,263 (later reduced 11,371) of its 33,091 reported fatalities.

The methodology for the counts was explained in more detail by Zaher al Wahaid in an article in April. Only three of the eight hospitals responsible for collating deaths were still contributing data. Reports from journalists and first responders contributed to the number of unidentified bodies in the count of recorded deaths. A new system enables Palestinians to report a death using a computer form or the phone, these are counted as identified bodies; they are subtracted from the number of unidentified bodies and do not contribute to the total recorded deaths. Most of those (55%) identified by the forms are men, Mr al Wahaidi said this is because it is mainly used by widows, who must register the deaths to receive government assistance.

Papers
Two papers published in The Lancet found that the GHM numbers were plausible and credible: the first was authored by scholars at the London School of Hygiene and Tropical Medicine, and the second by scholars at Johns Hopkins University. The Johns Hopkins University paper verified GHM reported deaths by looking at the UNRWA's reported deaths of its staff members. The UNRWA reported deaths are also publicly available, and independent of the GHM casualty reports. The authors found that the GHM reported death rate (5.3 deaths per 1000) was consistent with data reported by UNRWA (7.8 deaths per 1000, as of Nov 10, 2023). It also found temporal consistency between the two independent reports.

The London School of Hygiene and Tropical Medicine conducted several analyses on the data and concluded it was "implausible" that GHM engaged in data fabrication. The authors found that GHM's reported crude mortality rate in the age bracket of 20-59 years was broadly similar to the mortality rate of UNRWA employees and the mortality rate of Gaza's health-care workers (reported by the World Health Organization). The authors also found that the number of buildings reported damaged by the Hamas-run Gaza Ministry of Public Works was consistent with satellite imagery-based estimates conducted by Sky News (both arrived at the figure of 7%). The authors looked at 7,028 reported deaths (Oct 7 to Oct 26), and found only one case of a duplicated identification number and one case of implausible age.

Other analysis
Columbia professor Les Roberts argued that GHM numbers were accurate, citing the two Lancet papers and other data. Professor Michael Spagat stated that GHM provides very detailed and real-time information about casualties in the war, that far exceeds the quality of reporting from conflicts such as Ukraine. He did note that this quality has declined over time, due to Israeli attacks on hospitals, and thus the GHM is relying on first responders and media sources. Writing in April 2024, Spagat also noted the deteriorating quality of data with hundreds of duplicate, missing or invalid IDs, accounting for roughly 1/7 of the total.

According to AP, the ministry's public statements regarding the share of women and children continuing to be the majority part of casualties in April 2024 is contradicted by its own detailed data, which suggested a decline in women and children casualties as a share of casualties.

American and Israeli governments
Historically, the US State Department has relied on the GHM data for its annual human rights reports. For example, it cited GHM numbers in a public report in March 2023. On 26 October, 2023, US President Joe Biden stated he had "no confidence" in the casualty numbers being reported. Subsequently, National Security Council spokesperson John Kirby asserted that the death toll cannot be taken "at face value". However, the US Assistant Secretary of State for Near Eastern Affairs said that actual death toll could be "even higher" than what the GHM reported. On 10 November 2023, the Wall Street Journal reported that the US intelligence community has growing confidence that death toll reports from the Gaza Health Ministry are roughly accurate. The article also reported that despite US officials had growing confidence, they did not have enough information to confirm for sure.

In January 2024, Israeli news magazine Mekomit reported that Israeli intelligence officials had concluded that Health Ministry casualty reports are generally reliable and are used in briefings to senior officials. In follow-up reporting, an unnamed official told Vice News, "The numbers are heavily relied up for official briefings on civilian casualties because with the exception of strikes on high-value targets, where senior officials are briefed on collateral damage, no civilian casualty figures or estimates are collected [by the Israeli military]."

In June 2024, the U.S. House of Representatives passed an amendment to the annual U.S. State Department appropriations bill that would bar the department from citing casualty figures from the Gaza Health Ministry, which is criticized by the Israeli government for inflating the numbers. Gaza Health Ministry's numbers are likely to be an undercount, as thousands of bodies remain trapped in rubble and are accounted for, according to The Intercept, which called it an attempt to conceal Gaza's death toll. The bill has been called by one Democratic staff as evidence of anti-Palestinian racism in the House, and by US representative Rashida Tlaib as an example of genocide denial.