The rest of Gaza was listed at crisis and/or catastrophic levels of malnutrition. The hospital care system had almost completely broken down. Treating this situation as if they definitely had a total count when half the Strip is still inaccessible to rescue workers is just plain denial.

Urban warfare is hell. But almost none of the modern urban wars have involved this level of siege warfare and systematic targeting of the healthcare system.

Pretending we know for certain a complete count when that is fundamentally impossible at this stage is completely irresponsible. No one knows the actual death toll. Not you, not the UN, not the Gaza health ministry. No one has conducted a survey to determine excess deaths. No one has even recovered the dead. We do not know how many people have died as a result of the siege. We only know how many were reported and certified. Certified deaths are not the same as a complete record of deaths.

You're misreading the Lancet article. It says 75k violent deaths, plus 8.5k non-violent deaths based on the immediate members in the ~2000 households surveyed. That's 83k deaths so far that had someone left in their household to be surveyed. Jan 2025 was also before the months of total siege that ended in May of the same year. Nothing in that article offers a full estimate of indirect deaths or an accounting of excess mortality. The study fully admits that they have no access to the 20-25% of the population still trapped in the North.

This is that part that gets me: "This approach implicitly assumes similar mortality rates between displaced and non-displaced households from the same Governorate of origin." Even in UN sponsored refugee camps, mortality among young children is about 3x higher than non-displaced people. At the same time, many of the non-displaced people in Gaza have been cut off from all support in an area where the military has openly declared than every person remaining will be presumed a combatant regardless of sex, age or ability. Estimating a low rate of indirect death by surveying intact families who are in the safest possible place under the circumstances is an odd methodology.

That study method is incapable of accounting for the families that were completely wiped out and all of the orphans left behind with no surviving adults in their extended family. 2700 entire bloodlines wiped out, 8000 extended families with one surviving member, 25000 orphans whose families can't be accounted for because of the survey method.