Correspondence published in the peer reviewed medical journal The Lancet has said that it is "not implausible" that the death toll in Gaza could be as high as 186,000 people.

The Lancet is a weekly peer-reviewed medical journal, and one oldest academic journals of its kind. The journal also publishes correspondence as a reflection on content published in The Lancet.

In a correspondence it published last week, titled ‘Counting the death in Gaza: difficult but essential’, it highlighted the challenges  the Gaza Health Ministry faces in collecting data.

The health ministry is currently the only organisation counting the dead in the region.

While the Ministry's figures have been contested by the Israeli authorities, they have been accepted as accurate by Israeli intelligence services, the UN, and WHO according to the correspondence.

However, the correspondence highlighted that the mass destruction of the infrastructure in Gaza made it more difficult to accurately count the death toll and that the current reported figure of 38,153 people killed in Gaza since October 7 could be much lower than the reality.

“The Ministry has had to augment its usual reporting, based on people dying in its hospitals or brought in dead, with information from reliable media sources and first responders,” said the report in The Lancet.

The authors said this change has “degraded the detailed data previously recorded” and that the number of reported deaths is “likely an underestimate”.

For example, Airwars, a not-for-profit that tracks and assesses civilian casualties from war, has noted that the names of unidentified victims are often not included in the list of the deceased from the Gaza health ministry.

Meanwhile, the UN warned in May that more than 10,000 people could be under the rubble in Gaza and that it could take up to three years to retrieve their bodies.

As of the end of February, 35% of buildings in the Gaza Strip had been destroyed, which the authors said meant "the number of bodies still buried in the rubble is likely substantial, with estimates of more than 100,00".

The correspondence also pointed to “indirect health implications beyond the direct harm from violence”.

The authors stated that even if the conflict in Gaza were to end immediately, there would continue to be many indirect deaths in the coming years.

“The total death toll is expected to be large given the intensity of this conflict; destroyed health-care infrastructure; severe shortages of food, water, and shelter; the population’s inability to flee to safe places; and the loss of funding to UNRWA, one of the very few humanitarian organisations still active in the Gaza Strip,” the journal read.

The article stated that in recent conflicts, “indirect deaths” are three to 15 times greater than the number of direct deaths.

By applying what the authors describe as a “conservative estimate of four indirect deaths per one direct death” to these figures as of 19 June, they said it is “not implausible to estimate that up to 186,000 or even more deaths could be attributable to the current conflict in Gaza”.

This would equate to 7.9% of the Gaza Strip population, according to the 2022 census estimate.

The authors said an immediate and urgent ceasefire is essential, alongside measures to enable medical supplies, food, and water into the region.

They add that providing a true count of the death toll in Gaza is vital for ensuring “historical accountability and acknowledging the full cost of the war”.

Concluding the authors said: "These data will be crucial for post-war recovery, restoring infrastructure, and planning humanitarian aid".