What is the scope and scale of Israel’s U.S.-backed genocidal slaughter in Gaza? Official numbers gathered from hospital logs and media coverage have not been able to provide a real picture of that. But people need to know and confront the enormity of the death toll in Gaza.

A letter from three experts published on July 5 in the prestigious medical journal The Lancet is titled “Counting the dead in Gaza: difficult but essential.” It takes up the essential challenge of putting a number on the catastrophe. The result is stunning. The letter makes a case that “it is not implausible [far-fetched] to estimate that up to186,000 or even more deaths could be attributable to the current conflict in Gaza.” And that “this would translate to 7.9% of the total population in the Gaza Strip.”

If the United States suffered a death rate of 7.9% from bombs, missiles, and disease, the toll would be 26 million people! More than the entire population of Florida.

This figure of 186,000 includes deaths so far plus deaths that are projected over “the coming months and years” as a result of Israel’s assault on Gaza. And this is a projected death toll “even if the conflict ends immediately.”

The hellish mosaic of death includes hundreds of bodies discovered dumped into mass graves at Nasser and Al Shifa hospitals after long, bloody sieges by Israel. The toll includes babies who will not survive without nutrition, and women too starved, exhausted, and diseased to survive giving birth. It includes tens of thousands of people wounded by Israeli bombs and missiles who are so weakened by Israeli blockades of food that their bodies cannot recover, even with stitches or surgery. It includes thousands buried in rubble. And it includes people suffering from what should be treatable diseases—like diabetes and heart conditions—diseases that are fatal sooner rather than later in Gaza under Israeli siege.

Behind the Projection of 186,000 Deaths

The term “difficult” in the title of the letter to The Lancet refers in part to the challenge of really counting the humans already killed by Israel in Gaza. But beyond that and even worse, it refers to the much greater death in store. 

The letter writers draw on expertise in the fields of public health, medicine, and epidemiology (the study of the spread and impact of disease). Based on methods developed in those fields, they look ahead at the expected impact of what is being done to the Palestinian people in Gaza. They calculate the impact of “destroyed health-care infrastructure.” They factor in the short- and longer-term impact of “severe shortages of food, water, and shelter” created overwhelmingly by Israel blocking entry and distribution of aid. 

And their projected death toll takes into account “the population’s inability to flee to safe places.” Only days after the letter was published, Israel bombed the supposed “safe space” in the packed desert of Al Mawasi on the west coast of Gaza, killing at least 90 people. 

The Cruel Impact of Reproductive Disease

The letter cites reproductive diseases as a source of current and projected deaths. Relief agencies Christian Aid and the British Palestinian Centre for Human Rights report women miscarrying due to intense fear and fatigue as they flee bombing or after being exposed to Israel’s white phosphorus bombs (the use of which against people is a war crime). And that women miscarrying or losing a child during or immediately after birth “is a horror being experienced daily by women across Gaza.” 

In July, ReliefWeb  reported that compared to already terrible rates of miscarriage and death in childbirth in Gaza before October 7, women in Gaza are now three times more likely to miscarry and three times more likely to die in childbirth.

In an interview on The RNL—Revolution, Nothing Less!—Show, Dr. Majed Jaber described trying to treat infants brought to the European Gaza Hospital, where he was on duty, who were so starved and emaciated that they could not be revived except with special formula, which Israel did not allow into Gaza. 

These horrors will have lasting impact on women’s ability to bear children in Gaza. And on the physical and mental health of women who have watched their babies die in their arms because of a genocidal slaughter and choking off of medicines that are backed up in thousands of trucks denied entry into Gaza by Israel.

Death by Preventable and Treatable Diseases

The Lancet letter warns of death by communicable and noncommunicable diseases. Communicable diseases spread rapidly from one person to another in the refugee camps people are packed into in Gaza without access to medical care, sanitation, waste disposal, food, or water. Medical workers report spreading meningitis, chicken pox and other diseases that, if left untreated, can be dangerous in the short and longer term to people whose immune resistance has been broken down by starvation, injury, and trauma. Diarrhea spreads among people suffering from extreme dehydration, causing kidney failure in some cases.

Dr. Mohamad Abdelfattah, an American doctor who spent time recently at the European Gaza Hospital, told The RNL Show that at the hospital, without ability to sanitize equipment, “when someone needs a ventilator, what you’ll notice after a few days is that you’re dealing with a really aggressive pneumonia because the ventilators are contaminated with this bacteria. So it’s a horrific scene.”

Noncommunicable diseases, like cancer, diabetes, and heart disease, are almost completely untreated in Gaza now. Even cases that would be addressed elsewhere with medication, or operations, go completely untreated. The toll that will take on human lives in months and years to come is part of the picture illustrated by the projection of 186,000 deaths.

Biden Responds with 500-Pound Bombs

In projecting 186,000 deaths as “not implausible” (not unlikely), The Lancet letter points to “the intensity of this conflict.” The intensity of the conflict in large part is due to the incredible level of U.S.-supplied bombs, including the massive and massively criminal 2,000-pound and 500-pound bombs. These bombs have reduced every city in Gaza to uninhabitable, disease-spreading, ruin. And bombs continue to rain down even on those sheltering among the ruins. 

The impact of these bombs is no secret to Biden. Neither are the projections in the letter to The Lancet, which Biden’s State Department has to be aware of. So how did Biden respond? Five days after the letter appeared in The Lancet, which was covered in the mainstream news in the U.S. and around the world, Biden released a temporary hold he had placed on shipping 500-pound bombs to Israel! 

Days later, Israel unleashed ferocious bombing on survivors sheltering in the ruins and wreckage of Gaza City, killing dozens. And the bombing has escalated since.

Biden Covers for Israel’s Choking Off Aid

The “severe shortages of food, water, and shelter” that the letter to The Lancet identifies as long-term killers are due to Israel blocking food, water, and other aid. That is not an accusation, it is a fact. This crime against humanity was openly ordered by high-ranking officials in the Israeli government, one of whom said that as long as Hamas holds hostages, “no electrical switch will be turned on, no water hydrant will be opened and no fuel truck will enter [Gaza].” 

Israel further choked off aid trickling into Gaza when, on May 7, Israeli tanks shut down the Rafah Crossing from Egypt. It had been most reliable way aid was trickling in.

At his July 11 press conference, Biden dismissed all that as Israel “occasionally [being] less than cooperative” with aid delivery! That is like saying a serial killer was “occasionally less than cooperative” with laws against murder. Except multiply that crime by hundreds of thousands of times.

Biden Defunds UN Relief Agency in Gaza

The letter to The Lancet points to “the loss of funding to UNRWA [the main UN agency providing aid in Gaza], one of the very few humanitarian organizations still active in the Gaza Strip,” as a critical factor in the death toll projections it makes.

In January, Israel accused less than a dozen of the 13,000 UNRWA employees of having been associated with the Hamas attack on Israel on October 7 that included war crimes of killing civilians and taking civilian hostages. Before any evidence was presented (and while Israel was torturing suspects to force confessions), Biden’s Secretary of State Blinken told reporters that Israel’s undocumented allegations were “highly, highly credible.”

Genocide Joe managed to move decisively and immediately on something: He cut U.S. funding to UNRWA. And he pressured U.S. allies to do the same. That not only crippled the most effective aid distribution network in Gaza, but it also signaled a green light to Israel to target UN workers in Gaza, more than 190 of whom have been killed in Israel’s genocidal slaughter, and many more attacked while acting on UN business in clearly marked UN uniforms and vehicles.

Biden temporarily resumed funding for UNRWA in April, but shortly after that, and in a climate fostered by Biden’s ban and State Department promotion of Israel’s false accusations, Congress banned U.S. aid for UNRWA for a year. Only a couple dozen Democrats opposed the bill containing the ban, and Biden signed it into law.

Blood on the Hands of Genocide Joe: Needed, MORE Resistance

The incredible number of deaths already in Gaza, and the even worse coming catastrophic death toll calculated in the letter to The Lancet, are directly a product of U.S. military, economic, and diplomatic (excuses, apologies, coverups) “aid” to Israel. 

In REVOLUTION 44: Israel’s continuing genocide against Palestinians—and Joe Biden’s continuing support for this genocide, revolutionary leader Bob Avakian (BA) makes the damning case that “Biden has always been a bloodthirsty supporter of Israel, going back to his time as a Senator decades ago, and right up to now.” And BA poses a challenge that is all the more urgent, really existentially critical in light of the documented projections in the letter published in The Lancet:

The resistance against this U.S.-Israeli genocidal slaughter of Palestinians needs to become even broader, stronger and more determined.