The death toll from Israel's war on Gaza could be as high as 186,000, medical experts have concluded, a figure 150,000 higher than current estimates.
The analysis by the medical journal The Lancet could give a deeper understanding of the devastation reaped in Gaza, where 2.2 million Palestinians live, in what aid groups say was a "heartbreaking and harrowing, but not necessarily surprising" new figure.
Authors of the article Rasha Khatib, Martin McKee and Salim Yusuf estimated this figure by taking the number of direct deaths reported by Gaza's health authorities at the time, 37,396 people, and applying an estimate of four indirect deaths to every one direct death, a calculation that comes from the 'Global Burden of Armed Violence' report by the Geneva Declaration.
This was published in 2008 where several conflicts were analysed to attain the estimate that for every one direct death in the wars analysed in the report, four people were killed indirectly due to the "worsening of social, economic, and health conditions in conflict-affected areas".
Gaza's health ministry's most recent update on the casualty figure of Israel's war on Gaza puts the number of killed at 38,193, with a further 87,903 wounded.
According to a 10 June report from the World Health Organization as of 26 May, there were 865,157 cases of acute respiratory infections, 485,315 cases of diarrhoea, 93,690 cases of scabies and lice, 57,887 cases of scabies and lice 8,538 cases of chicken pox and 81,795 cases of acute jaundice syndrome.
On Monday, Al Jazeera reported that a medical source in Gaza said that 436 cancer patients had died since the outbreak of the war due to lack of treatment.
The Lancet report also determined that the estimated figure of 186,000 killed represents 7.9 percent of Gaza's pre-war population estimate of 2,375,259 people, and noted that it is difficult to determine an accurate death toll on the ground due to a number of factors.
This includes undercounting by Gaza's health authorities due to the destruction of the health service, with health authorities relying on reliable media sources and first responders to estimate the death toll.
Likewise, Gaza's official statistics don't account for bodies that are buried under the rubble, which is currently estimated at 10,000 people. At least 35 percent of Gaza's buildings have been destroyed.
"Documenting the true scale is crucial for ensuring historical accountability and acknowledging the full cost of the war," the report said.
The Lancet has previously published articles on Gaza's death toll, with one arguing that there was no inflation of mortality in the reporting by Gaza's health ministry after accusations of falsified figures by some pro-Israel media and figures.
The medical journal famously estimated that 655,000 Iraqis had died following the 2003 US-led invasion of Iraq.
The Lancet's Gaza report has prompted stark reactions from aid groups, with Aseel Baidoun, Senior Advocacy and Campaigns Manager at Medical Aid for Palestinians (MAP) telling °®Âþµº that the estimate "is heartbreaking and harrowing but not necessarily surprising".
This is due to Israel's "total and unrelenting siege and bombardment" of Gaza, which she said has enabled a "public health disaster of starvation, dehydration and infectious diseases - from which many people have and will continue to be killed".
Baidoun cautioned that "even after a ceasefire, we know that many will die from the long-term impacts of malnutrition, untreated medical conditions, and neglected chronic disease".
"What is happening in Gaza should put the world to shame," Baidoun added.
The report also garnered a response from Labour MP Zarah Sultana, who : "I repeat my longstanding call for the UK government to immediately end all arms sales to Israel."
The UK's Foreign, Commonwealth and Development Office (FCDO) told °®Âþµº that the situation in Gaza was "distressing" and the death toll was "intolerable".
"Clearly, many people across our country are distressed at the images that we have been seeing from Gaza over many, many months," the FCDO said in its statement.
"All of us want to see an immediate ceasefire. [...] We also want the hostages out. And we want unfettered aid to get into Gaza. And in the end, we must work towards that two-state solution and have a clear path to progress."