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Notes -
It's a judgment call. I'm actually kind of surprised that the IDF estimates are in the same order of magnitude. I could say that you could split the difference, but that's a ratchet.
One way to get numbers would be to look at population before and after. Another would be to try to work back from satellite imagery (just checked and google earth doesn't have images from the last year yet, and commercial providers crashed my tab). Another would be to notice that by the time you get vaccine-derived polio, the population has to be pretty weakened. Another hint is the recent declaration of a famine by FEWS (since withdrawn because of USAID pressure, which funds FEWS). Israel destroying one of the last Northern Gaza hospitals also seems pretty concerning.
Idk man, take the 17K estimated by the IDF, say they only catch 75% direct deaths, and that direct deaths are 65% of total deaths, that's already 34.87K.
Then on top of this you could say, well, are these deaths justified. I have some sympathy for that, and I can see the argument where if your enemy is taking refuge in a hospital, then destroy the hospital—I wouldn't make the argument, but maybe that's just, like, me being weak, man. But I think this is separate from the magnitude of the death and destruction, where 40K is just not very far off.
Gaza gets more than enough aid to feed the people there. Of course, the distribution is challenging, with Hamas still being on the ground, still being very interested in presenting the picture of mass starvation, and also of course the whole process is grotesquely corrupt, with the aid which is supposed to be free being sold, etc. But even given that, there's no mass starvation is Gaza. There might be some nutritional imbalances and food quality issues, I mean living for an extended time on basic foods probably not a lot of fun, but that's a different picture.
But that's not what happens. I mean, "if" here is redundant - every single hospital in Gaza is used by Hamas as a base, it is a fact. There's absolutely no question about it, and the same of course is true for every school, mosque and other building with lower probability of IDF just blowing it out from the sky. But hospitals are not just destroyed with everybody in it. What is done about it is the hospital is surrounded, and then evacuated, and then it is searched (with multiple Hamas tunnels, weapons caches and often explosive traps inevitable discovered). Of course, this does not always goes smoothly - Hamas operatives sitting inside the hospital sometimes get ideas that shooting at IDF may be fun, and get the return fire, and so on. That stage is usually when civilians get hurt, but it doesn't usually take long to eliminate all active resistance. During the evacuation, of course Hamas operatives will pretend to be the sickest patients in urgent need to be in another hospital - e.g., in Kamal Adwan the first evacuating ambulance had 21 people inside, out of which 13 were completely healthy Hamas operatives (IDF has pretty good face recognition and by now very extensive lists of Hamas members, so it's not as easy as saying "I'm a sick civilian, please let me go"). The civilians that aren't identified as Hamas are provided with tents, generators, food and field medical facilities. Do civilians get hurt in the process? Yes, they do, but it's not like the whole thing is destroyed and everybody inside is instantly dead (though this is exactly the story that was told when Islamic Jihad hit another hospital with it's rocket and they tried to sell it as IDF attack - they counted 500 or so casualties within minutes, they're good like that, and nobody in the press cared to doubt it). Does replacing proper hospital facilities with whatever field medicine can be provided lead to some additional casualties? It probably does, but I don't think anyone has any accurate count of it.
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