The Ministry of Health in Gaza has been struggling to update casualty figures as Israeli forces have increasingly targeted hospitals and allied services in the besieged enclave.
The United Nations has confirmed that the “collapse of services and communications” at hospitals in northern Gaza is seriously hampering health officials.
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So, when was the last time we got an update, how has the ministry managed its figures so far, and how dire is the situation of hospitals in Gaza?
When was the last update?
On Sunday, the government media office in Gaza updated the casualty figures after a gap of two days. It raised the death toll to 11,100, including more than 8,000 children and women. The last official update came on November 10 at 2pm (12:00 GMT).
“Due to the targeting of hospitals and the prevention of entry of any of the bodies or wounded, the Ministry of Health was unable, on Saturday, to issue accurate statistics for the numbers of dead and injured during the past hours,” the media office said in a statement.
The Health Ministry in Gaza has been providing daily updates since the war started following the surprise Hamas attack inside Israel killed about 1,200 people.
Last week, Barbara Leaf, assistant US secretary of state for Near Eastern affairs, told a House panel that the number of those killed in Gaza – home to 2.3 million people – is likely “higher than is being cited”.
The UN relief agency confirmed in its latest update on Saturday that a communications breakdown has prevented new figures from coming in.
Nearly 3,000 Palestinians remain missing and may be trapped or dead under the rubble while another 27,490 Palestinians have reportedly been injured, the Health Ministry said on Friday.
How does the system work?
The Health Ministry had previously explained its methodology for compiling data on Palestinian casualties.
Once a victim who arrives at the emergency department of a government hospital is identified, their data, including ID number and personal information, along with the time of arrival, are recorded in the hospital’s computerised information system.
Each hospital also records the cases of death for the wounded who spent a period in the hospital before their death.
The daily information about the killed Palestinians is transferred from the decentralised hospital system to the central database of a government registry.
Non-governmental hospitals use their own forms to record data about the victim as soon as they arrive. Then, these forms are sent to the Health Information Centre at the Ministry of Health within 24 hours for entry into the central database.
The ministry processes the data, verifies its completeness, and ensures there are no duplicates or errors after the transfer is completed.
The ministry’s information centre prepares daily reports, which are sent to the government-run Health Emergency Operations Centre for approval and dissemination.
How bad are hospitals in Gaza having it?
Israeli air raids have struck areas in and surrounding hospitals and medical centres across Gaza to devastating effect since the start of the war based on a claim disputed by Palestinians as well as international medical NGOs that Hamas is operating in those areas. Israel has not provided any proof for its claims.
But as Israel’s ground offensive has progressed in northern Gaza, its forces have also increasingly focused on hospitals, and the past few days have marked a sharp increase in their targeting.
Israeli tanks have now surrounded al-Shifa Hospital, the largest facility in Gaza, and snipers and drones positioned all around are shooting at people.
A surgeon at the hospital told Al Jazeera on Sunday that an engineer who tried to fix a blackout at the hospital was shot and left paralysed by a drone. He said he witnessed a family being shot at and injured while trying to leave through an exit that the Israeli military had said civilians could take.
“We can hardly treat the patients within the hospital and are in the middle of the warzone. There are continuous air strikes, and the drones are hovering within the hospital area,” Dr Ahmad Mokhallalati said.
The facility’s director, Mohammed Abu Salmiya, told Al Jazeera on Saturday that two premature babies have died after an electricity failure at the neonatal intensive care unit, and 37 more babies are at risk of imminent death.
There are reports that some of those who fled the hospital have been shot at, wounded, or killed.
— Tedros Adhanom Ghebreyesus (@DrTedros) November 12, 2023
On Sunday, the Palestine Red Crescent Society said Al-Quds Hospital was no longer operational due to a shortage of fuel and a power outage.
The World Health Organization (WHO) said early on Sunday that it had lost communication with its contacts at the hospital and confirmed receiving reports of people being killed while trying to flee.
Is anywhere safe?
For weeks, the UN and international rights groups have warned that Palestinians in Gaza, especially the most vulnerable, have no place safe to turn to.
@PalestineRCS announces Al-Quds Hospital out of service and no longer operational.
🚨✋The cessation of services is due to the depletion of available fuel and power outage.
🛑 PRCS holds the international community and signatories of the Fourth Geneva Convention accountable… pic.twitter.com/SPg69Zv7GH
— PRCS (@PalestineRCS) November 12, 2023
UN shelters have not been spared either, and the organisation has said as of Friday, 66 internally displaced people have been killed and 588 have been injured while staying in UN shelters.
“Hundreds of thousands of people who remain in the north are struggling to get the essentials for their survival. Consumption of water from unsafe sources raises serious concerns about dehydration and waterborne diseases,” the UN said.
It noted that hospitals are explicitly entitled to specific protection under international humanitarian law.