What the ‘Gaza Polytrauma Syndrome’ reveals about the conduct of the war

When Gaza’s bloody conflict ends remains to be seen, despite current hopes. And whether tranquillity follows across Palestine and Israel depends on many complex factors. One of them is acknowledging the truths of how the Gaza war has been fought.

That lesson comes from the Second World War and numerous subsequent conflicts. When war-torn societies in Western Europe, Cambodia and Rwanda settled past narratives, they were freed to move forward. When the story is contested as in Bosnia Hercegovina or Haiti, confused as in Sudan and Ukraine, or denied as in Ethiopia and Myanmar, sustainable peace remains uncertain.

Another lesson is that the quality and resilience of a newly forged peace is related to the nature of brutalities experienced during the preceding war. Perpetrators and victims take time to heal and come to terms with history. That takes a generation or two as West Africans and Latin Americans have discovered after earlier wars.

Palestine and Israel are not exempt from universal experience, and peace-seekers must meticulously establish all gruesome details around the conduct of the Gaza war. That includes the vicious Hamas-led assault and hostage-taking on October 7, 2023 and the furious Israeli response.

Achieving an accurate narrative is hindered by Israeli restrictions on independent reporting from Gaza and the information warfare waged by all sides to manipulate or deceive public and political opinion. That truth is the first casualty is normal in today’s multi-dimensional conflicts.

What truths can we glean from Gaza’s war statistics? Hamas authorities indicate that about 67,000 people have died so far. Although the reliability of that is disputed, it is an under-estimate because unknown numbers lie under three-quarters of the Gaza infrastructures that has been razed.

The World Health Organisation suggests that more than 167,000 have been injured. Going with the published numbers indicates a ratio of two to three injured for every killed person. That appears within the wide range of injury-mortality ratios in modern wars where highly skilled and protected militaries may lose only one combatant for every 10-20 injured while inferior forces may suffer three or more wounded for every fatality.

How many of Gaza’s dead are civilians? That is very difficult to ascertain. Israel claims that it targets militants and minimises civilian casualties. Meanwhile, 70 per cent of casualties are women and children, roughly in line with Gaza’s pre-war demographics.

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That implies no quarter being given to women and children which, Israel’s critics argue, shows that it considers all Gazans as military opponents. But that assumes – unverifiably – that Hamas or other militia do not coerce some women and older children into military service. Meanwhile, the world average of civilian-to-military casualties in recent decades hovers around 50 per cent. But the highly urbanised Gaza theatre is not comparable to other wars.

The indirect casualties of the Gaza war – from malnutrition and disease – must also be considered. Elsewhere, indirect mortality is often three or four times the recorded deaths. How that ratio is applied in Gaza depends on whether the assessor has pro-Israel or pro-Palestine sympathies.

In short, raw statistics cannot provide definitive unbiased answers to questions around Israel’s war conduct. But could fuller truths be inferred from collateral data?

An authoritative analysis is provided by a peer-reviewed study in the British Medical Journal. Despite the problems of researching active war zones, this is the largest-ever study of its kind. It is an extraordinary collaboration of 23 medical experts from 15 reputable institutions in UK, US, Palestine and Saudi Arabia who rent the fog of war with an impressive observational and epidemiological methodology.

The researchers faced the problem of destroyed medical records after Israeli attacks that have touched all of Gaza’s 36 hospitals. So they asked 78 experienced health workers to use structured memory recall aided by personal logbooks and records to detail the injuries they managed between August 2024 and February 2025. The informants reported about 24,000 traumatic injuries mostly from gunshot and shrapnel. This included more than 4,300 burns, largely of the most severe forms, and nearly 7,000 penetrating, blunt and crush injuries, and fractures. The traumas involved the head, neck, chest, limbs and all organ systems, and included lethal haemorrhaging and breathing problems. Miscarriage and sepsis were suffered by many pregnant injured women.

Mapping these numbers revealed a sinister pattern. Many casualties suffered multiple injuries across different parts of the body, and a quarter of the victims suffered life-changing effects. Gaza also has the highest rate of amputations in the world, and a large proportion of the injured appear to be part of mass-casualty incidents.

The pattern of injuries is dubbed the “Gaza polytrauma syndrome”, consistent with the extensive use of high-energy explosives and firearms in cramped urban corridors that people cannot flee easily. The magnitude of injuries resembles soldier-to-soldier fighting seen, for example, in the Vietnam and Iraq wars. That is suggestive of the deliberate targeting of Gazans as combatants.

Thus, Israel’s claim to minimise civilian harm is not reflected by evidence. That opens Israel to accusations of breaking international humanitarian law and systematically committing war crimes and crimes against humanity. These charges have been levelled by the International Criminal Court against Israeli Prime Minister Benjamin Netanyahu and former defence minister Yoav Gallant.

But although the research data are suggestive, they remain circumstantial. And, with no universally agreed benchmarks, it is disputable when the level of collateral civilian harm inflicted by Israel as part of legitimate self-defence against the equally brutal Hamas, enters criminal territory.

Meanwhile, the court of global public opinion and influential opinion formers have already decided that Israel is committing genocide in Gaza while the International Court of Justice has opined that this is a plausible risk. The medical data quoted here do not, by themselves, prove the point one way or other.

Numbers require context for interpretation. Hence it is crucial to go beyond anecdotes to systematically collect the testimonies of patients and health staff. But that is risky as those who speak up may be targeted because they are witnesses in possible future prosecutions. Besides, the dilemma is that space for the health mission will be further reduced if its neutrality is compromised by medics documenting what they see. More than 1,200 health workers have already been killed and 300 detained by Israel, which argues that Gaza hospitals have provided cover for Hamas operations.

Another potential information source is the forensic examination of bodies under the rubble. Their retrieval is important not only for the dignity of victims and closure for their relatives but for determining accurately how they died. That is crucial for assessing alleged war crimes in Gaza, just as forensics provided vital insights for the Rwanda, Srebrenica and Cambodia genocides.

But with an understandable rush to advance the 20-point peace plan including the reconstruction of Gaza, some political actors may prefer to bury the truths of war even deeper under the foundations of the territory’s proposed gleaming skyscrapers.

That would be a mistake. The region’s own history shows that burying unpalatable truths seeds future conflict. But first, the full truths must be found and collated through all and every technical means. The durability of the peace that Palestinians and Israelis desperately seek depends on that.