BBC | At al-Shifa Hospital in Gaza City, Alam Hirzallah resigns himself to a grim task: registering the deaths of the wife and two children of his grieving cousin.
His family brought the bodies here on an electric rickshaw or tuk-tuk. They found them in their house in eastern Gaza City after Israeli shelling hit the family home. Asma Hirzallah, Mayar, 5, and Abdullah, 3, were killed.
"The hospital asked for their full names and ID numbers," explains Alam, referring to the numbers all Palestinians are given in a population registry administered by Israel.
"They gave us a paper to confirm they were martyred and told us to come back for the death certificate. Now we don't know where to go to bury them as the cemeteries are in areas under Israeli control."
At least 51,266 people have been killed in the 18 months since the Gaza war began, according to the Hamas-run Ministry of Health, with nearly a third of the dead aged under 18.
Israel has repeatedly challenged the accuracy of the Palestinian fatalities list - in terms of overall numbers, and in particular, the demographic breakdown - claiming it is used as Hamas propaganda. The figures are cited with attribution, by UN agencies and widely in the media.
The list does not distinguish between civilians and members of Palestinian armed groups who are killed in the war, and Israel has accused Hamas of inflating the percentages of women and children.
Recently, several media reports have raised questions about the reliability of the statistics by highlighting anomalies between the August and October 2024 and March 2025 lists of fatalities. The reports focus on how some 3,000 names of people originally identified as fatalities were removed from later revised lists.
A Gazan health official, Zaher al-Wahidi, denied to the BBC that victims had vanished or that there was a lack of transparency, insisting: "The health ministry works towards having accurate data with high credibility.
"In every list that gets shared, there is a greater verification and revision of the list. We cannot say that the health ministry removes names. It's not a removal process, rather it is a revision and verification process."
Verifying data
So how are the statistics gathered and how accurate are they?
Until the first months of this war, the number of people killed in Gaza was calculated from counting bodies that arrived in hospitals - like those of Asma Hirzallah and her children.
Medics could log data for all deaths into a centralised computer system, which was based at a Ministry of Health office at al-Shifa hospital, with a back-up at al-Rantissi hospital.
However, as conditions became more chaotic and medical sites repeatedly came under attack, this method became less reliable. During the war, Israel says it has targeted hospitals – which have protected status under international law – because Hamas has used them to hide its fighters and infrastructure – something the armed group denies.
From the start of 2024, Gazan health officials introduced online forms which relatives could use to report their loved ones dead or missing.
According to Mr Wahidi, the head of statistics at the health ministry, most of the names which were recently removed from the official list as part of a new checking process had originally been submitted using these forms. He says that names which are taken off may later be added back
"A judicial committee was set up and it looks into all of the cases received," Mr Wahidi says. "To ensure credibility we verify the data so that it will be accurate."
During investigations by the judicial committee, some people were found to have died of natural causes – not directly because of the war. When Gazans die from lack of medical treatment, malnutrition or hyperthermia, Mr Wahidi clarifies "these cases are indirect and do not get added to the lists."
Other individuals were wrongly listed as dead but then found to have been among thousands of Gazans imprisoned by Israel.
Mr Wahidi confirms that in August and then October, a total of more than 3,000 names were removed from the list, saying this was a precautionary measure pending full checks.
For some pro-Israel groups, such as media watchdog HonestReporting, this was strong indication of "deliberate manipulation, not honest error"