This week, researchers from the Johns Hopkins University Center for Humanitarian Health and the London School of Hygiene and Tropical Medicine released a report that attempts to project how many people will die in Gaza in the next six months. The authors estimated what are called excess deaths, which includes deaths owing to Israel’s war campaign directly and also those caused indirectly, owing to factors such as disease and a lack of access to medical care. They modelled for three possibilities: if the next six months of the war are similar to the first three months, if the war escalates, or if there’s a ceasefire. If the war stays its course without escalation until early August—with Israel bombing densely populated areas, and blockading food and medicine—the researchers project somewhere between 58,260 and 66,720 excess deaths in addition to the more than twenty-eight thousand deaths that the Gaza Ministry of Health reported in mid-February. (That number is currently more than twenty-nine thousand.) If the war escalates, the authors project that that death toll could rise to between 74,290 and 85,750 excess deaths over the next six months. (Their escalation scenario makes projections based on the highest single month of casualties.) Even if a ceasefire begins immediately, the researchers project between 6,550 and 11,580 more people will still die over the next six months, than if there had been no war. (For each scenario, the higher number includes deaths from possible epidemics.)
“For now, this looks like a serious attempt to quantify the important issue of deaths and especially nonviolent deaths in Gaza,” Michael Spagat, an economics professor at Royal Holloway, University of London, and an expert on civilian death tolls, told me. (The study has not yet been peer-reviewed because of time constraints.) To talk about how the report was compiled, and the dire humanitarian situation in Gaza, I recently spoke by phone with Paul B. Spiegel, one of the report’s authors and the director of the Center of Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health. During our conversation, which has been edited for length and clarity, we discussed the different factors that shaped the authors’ projections, why even a ceasefire scenario could see more than ten thousand additional excess deaths, and what makes Gaza unique among humanitarian tragedies.
How did you decide to focus on three scenarios, and can you talk about what those scenarios consist of?
We wanted to look at the potential extremes as well as the current situation, so because of that, and from that, we developed three scenarios to give the range. These are not predictions; they’re projections. And there is a difference. Predictions have much more confidence. Projections are what could happen. These scenarios are lasting over six months, beginning from February 7th. So the first-case scenario is a ceasefire, the middle scenario is what we call status quo, which is what is happening, and what continues to be happening, now. The worst-case scenario would be an escalation.
So when you say “best” case and “worst” case, do you mean in terms of casualties, or are you saying something beyond that?
That’s right. We are just talking about casualties. If you read the report very carefully, we are coming at it from an academic perspective. We are apolitical and we’re not even making any sort of causal inferences. What we’re really trying to do is document excess mortality according to these three different scenarios.
Can you talk about what projections are? Should we be thinking of this the way we think of polls, with a margin of error? Should we be thinking of this as sort of back-of-the envelope calculations—
They’re definitely not back-of-the-envelope; we wanted to do this in a much more rigorous way. It’s more like thinking about the various projections of climate change. Predictions are usually for shorter periods of time. These are longer-term projections, over a six-month period, and they’re scenario-based. So with climate change, people asked what would happen if you see a 1.5-degrees-Celsius rise, etc. It’s that sort of thinking that we want to get across.
Under the immediate-ceasefire scenario, you still see excess deaths ranging from 6,550 to 11,580. Can you explain why that would be the case? And, moreover, can you explain exactly what you mean by excess deaths?
Excess deaths are deaths that would not have occurred if there wasn’t this conflict. So these are deaths that would be projected to occur because of the current conflict. For example, there were no deaths due to trauma when there was not the conflict, before October 7th. The trauma deaths are all excess deaths, but other deaths are due to diabetes, etc. We’ve had to look at how the health system is functioning now, the access to services as well as the types of services. Then we made certain assumptions. For example, that there would be a limitation for people who have diabetes in terms of accessing insulin by a certain percentage, and therefore the deaths will increase. Similarly, we know that every year there are endemic infectious diseases. We know how many people died of COVID and how many people died of influenza in the past. We now increase those numbers due to the current situation of overcrowding, the lack of water and sanitation, and the lack of treatment.
In the ceasefire scenario, one of the most important points, and perhaps surprising to some, is that there still is going to be a lot of excess death over that six-month period. The reason for that is because the situation is so severe. The population itself is in a very poor state. There are a lot of traumatic injuries, and, while there may not be a lot of new trauma—although there may be some because of unexploded ordnance—there are going to be traumatic injuries of people that are infected, and who will die. On top of that, there are going to be continued infectious diseases that are going to occur, and potentially also some epidemics. And it’s not going to be immediate, necessarily. You have a population that is malnourished. You have a health system that is hardly functioning, and you’ve got roads and infrastructure that are destroyed. To be able to rebuild that quickly enough to even provide basic care is going to take some time.
Right now it doesn’t seem like a ceasefire is about to occur, but if one were to be negotiated, what would be the important things that would need to happen immediately to insure that the death toll remained as small as it could be?
There needs to be—and very, very quickly—a huge amount of water as well as sanitation facilities. So water, food, and fuel need to get in, in large amounts. And it’s not just going to be typical food. It has to be some nutritious foods, particularly for malnourished kids. So that’s No. 1.
No. 2 is there are many, many emergency medical teams that are waiting to be able to get in, and they are semi-autonomous or autonomous. They have surgeons, they have medical tents, and they need to be allowed in and to be able to be set up to support the existing system—not to replace it but to support it. » …
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