The study finds factors like diseases will lead to many more indirect deaths in the long run even if the war stops now.

The accumulative effects of Israel’s war on Gaza could mean the true death toll could reach more than 186,000 people, according to a study published in the journal Lancet.

According to Gaza’s Ministry of Health, more than 38,000 Palestinians have been killed since Israel launched its military offensive on October 7 in the wake of deadly Hamas attacks.

The study pointed out that the death toll is higher because the official toll 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.

Conflicts have indirect health implications beyond the direct harm from violence, the study said, and even if the Gaza war ends immediately, it will continue to cause many indirect deaths in the coming months and years through things like diseases.

The study said the death toll is expected to be far larger given that much of Gaza’s infrastructure has been destroyed; there are shortages of food, water and shelter; and the United Nations Relief and Works Agency for Palestine Refugees has seen its funding cut.

“In recent conflicts, such indirect deaths range from three to 15 times the number of direct deaths,” it said.

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.

Such a number would represent almost 8 percent of Gaza’s pre-war population of 2.3 million.

The Lancet study noted that Israeli intelligence services, the UN and the World Health Organization all agree that claims of data fabrication levelled against the Palestinian authorities in Gaza over its death toll are “implausible”.

It pointed out that the toll is likely much higher because the destruction of infrastructure in Gaza has made it extremely difficult to maintain a count that is not lower than the actual death toll.

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

The study pointed out that the International Court of Justice said in interim rulings in January in a genocide case brought against Israel that it needs to “take effective measures to prevent the destruction and ensure the preservation of evidence related to allegations of acts” under the Genocide Convention.