Since the start of Israel’s war in Gaza, global observers and organizations on the ground have warned of the true extent of the devastation. However, counting the dead has been increasingly difficult.

While the Gaza Ministry of Health had said that more than 38,000 Palestinians had been killed by Israeli shelling, a new study shows a much more frightening figure.

Nearly 200,000 people reportedly died in Gaza

A new study published in the journal Lancet found out the actual death toll in Gaza could reach more than 186,000 people. The main victims are women and children.

The new analysis explains that, due to circumstances on the ground, it is difficult to accurately document the death toll of the conflict. The researchers noted that the number of “indirect” deaths ranges from three to 15 times the number of direct deaths.

“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,” they wrote.

It is a cumulative effect

The new study points out that the death toll in Gaza is higher because the official figure does not take into account “thousands of dead buried under rubble and indirect deaths due to destruction of health facilities, food distribution systems, and other public infrastructure,” Aljazeera reported.

To make matters worse, the report asserts that Israel’s invasion will continue to cause many more deaths in the coming months and years from causes such as disease. These could become endemic due to a lack of food, water, and shelter.

“In recent conflicts, such indirect deaths range from three to 15 times the number of direct deaths,” the study explains

After applying a “conservative estimate” of four indirect deaths per one direct death, “it is not implausible to estimate that up to 186,000 or even more deaths could be attributable” to the Gaza war, the study found.

That number would represent almost 8% of Gaza’s pre-war population of 2.3 million.

“Documenting the true scale is crucial for ensuring historical accountability and acknowledging the full cost of the war. It is also a legal requirement,” the report concluded.