Deaths from bombs and other traumatic injuries during the first nine months of the war in the Gaza Strip may have been underestimated by more than 40%, according to a new analysis published in The Lancet.

The peer-reviewed statistical analysis, led by public health researchers at the London School of Hygiene and Tropical Medicine, used modeling in an effort to provide an objective third-party estimate of casualties. The United Nations has relied on the figure from the Hamas-led Health Ministry, which it says has been largely accurate but which Israel criticizes as inflated.

But the new analysis suggests the Health Ministry tally is a significant undercount. The researchers concluded that the death toll from Israel’s aerial bombardment and military ground operation in Gaza between October 2023 and the end of June 2024 was about 64,300, rather than the 37,900 reported by the Palestinian Ministry of Health.

The estimate in the analysis corresponds to 2.9% of Gaza’s prewar population having been killed by traumatic injury, or 1 in 35 inhabitants. The analysis did not account for other war-related casualties such as deaths from malnutrition, waterborne illness or the breakdown of the health system as the conflict progressed.

The study found that 59% of the dead were women, children and people over the age of 65. It did not establish what share of the reported dead were combatants.

Mike Spagat, an expert on calculating casualties of war who was not involved in this research, said the new analysis convinced him that Gaza casualties were underestimated.

“This is a good piece of evidence that the real number is higher, probably substantially higher, than the Ministry of Health’s official numbers, higher than I had been thinking over the last few months,” said Spagat, who is a professor at Royal Holloway College at the University of London.

The researchers said their estimate of 64,260 deaths from traumatic injury has a “confidence interval” between 55,298 and 78,525, which means the actual number of casualties is likely in that range.

If the estimated level of underreporting of deaths through June 2024 is extrapolated out to October 2024, the total Gaza casualty figure in the first year of the war would exceed 70,000.