• Michel Guillot, Mohammed Draidi, Valeria Cetorelli, José H C Monteiro Da Silva, and Ismail Lubbad.
• Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA; French Institute for Demographic Studies, Aubervilliers, France. Electronic address: miguillo@sas.upenn.edu.
• Lancet. 2025 Feb 8; 405 (10477): 478485478-485.

BackgroundIn the context of the ongoing war in the Gaza Strip, the Gaza Health Ministry (GHM) has reported 45 936 fatalities and more than 10 000 individuals missing or under the rubble for the period Oct 7, 2023, to Jan 8, 2025. The scope of this death count is difficult to fully interpret because it does not account for the size and age distribution of the Gaza Strip population. Moreover, the quality of this death count has been questioned. In this study, we evaluated the quality of the GHM death count by comparing GHM data against register data, and we estimated life expectancy losses in the Gaza Strip for the period October, 2023, to September, 2024, ie, the first 12 months of the war.MethodsWe matched individuals included in the GHM nominative list of killed individuals for the period Oct 7, 2023, to Aug 30, 2024, with individuals included in the refugee register maintained by the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), which covers about 66% of the Gaza Strip population. We compared proportions of matched fatalities with proportions of registered refugees in the 2017 census. We then used census data, vital registration data, and GHM fatality information since Oct 7, 2023, to produce estimates of life expectancy losses in the Gaza Strip for the first 12 months of the war. We used three scenarios for these life expectancy estimates, based on the different types of counts provided by GHM. These scenarios did not account for the indirect effect of the war.Findings21 953 (63·9%) of 34 344 individuals in the GHM list of killed individuals (and 19 744 [64·4%] of 30 673 excluding those who were not yet born at the time of the 2017 census) were matched with individuals included in the UNRWA refugee register. This proportion is similar to the proportion of registered refugees in the 2017 census (65·7%), providing additional evidence regarding the reliability of the GHM data. In the central variant, life expectancy in the Gaza Strip decreased by 34·9 years during the first 12 months of the war, about half (-46·3%) the prewar level of 75·5 years. Life expectancy losses were larger for males (-38·0 years [-51·6%]) than for females, but nonetheless, females also suffered large losses (-29·9 years [-38·6%]). Losses between the low and high variants ranged between -31·1 years (-41·1%) and -39·4 years (-52·2%) for both sexes combined.InterpretationOur approach to estimating life expectancy losses in this study is conservative as it ignores the indirect effect of the war on mortality. Even ignoring this indirect effect, results show that the ongoing war in the Gaza Strip generated a life expectancy loss of more than 30 years during the first 12 months of the war, nearly halving prewar levels. Actual losses are likely to be higher.FundingNone.Copyright © 2025 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.

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