The health ministry in Gaza struggles with updating casualty figures, as a consequence of increased targeting of hospitals and allied services by Israeli forces in the besieged enclave.

Despite international humanitarian law specifically designating hospitals for protection, they have not been spared in the conflict.

The United Nations has confirmed a collapse of services and communications in hospitals in northern Gaza, which blocks the ability to provide accurate casualty figures. The last official update occurred on Sunday with the death toll reaching 11,100, including over 8,000 children and women.

Barbara Leaf, the assistant US secretary of state for Near Eastern affairs, suggested that the actual number of casualties in Gaza might surpass the official reports.

As of Friday, the health ministry reported nearly 3,000 Palestinians missing and potentially trapped or dead under the rubble, with an additional 27,490 Palestinians reported injured.

Government hospitals have a system in place to record victims’ data upon arrival, which is then transferred to a central database. Non-governmental hospitals follow a similar process, with forms sent to the Health Information Centre for entry into the central database.

Israeli air raids, under the claim that Hamas operates, have mostly targeted medical centres in Gaza. Al-Shifa Hospital, the largest facility in Gaza, is now surrounded by Israeli tanks, with reports of snipers and drones shooting at civilians. A surgeon reported an engineer being shot and paralysed while attempting to fix a blackout, and a family being injured while using an exit designated for civilians. The hospital director disclosed that two premature babies died due to an electricity failure, and 37 more babies are at risk of imminent death.

Al-Quds Hospital is no longer operational due to a shortage of fuel and a power outage.

The World Health Organization (WHO) stated on Sunday that it had lost communication with its contacts at Al-Shifa Hospital and received reports of people being killed while attempting to flee.

The UN shelters have also become targets. The United Nations reported that as of Friday, 66 internally displaced people have been killed, and 588 injured while seeking refuge in UN shelters.

The conflict has left hundreds of thousands of people in the north struggling to obtain essential resources for survival. The UN raised worries about dehydration and the increased risk of waterborne diseases among the affected population.