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The Ministry of Health in Gaza has been facing numerous challenges as it attempts to update casualty figures amid escalating attacks on hospitals and allied services by Israeli forces in the besieged enclave. The United Nations has confirmed that the "collapse of services and communications" at hospitals in northern Gaza is severely impeding the efforts of health officials to provide accurate statistics and assess the dire situation.

After a two-day gap, the government media office in Gaza recently provided an update on casualty figures, raising the death toll to 11,100, including over 8,000 children and women. The previous official update was issued on November 10 at 2 pm (12:00 GMT). The media office explained that due to the targeting of hospitals and the obstruction of entry for bodies and wounded individuals, the Ministry of Health was unable to provide accurate statistics on Saturday.

Providing daily updates since the start of the war, the Health Ministry in Gaza has been documenting the casualties caused by the surprise Hamas attack inside Israel, which resulted in the deaths of about 1,200 people. However, Barbara Leaf, assistant US secretary of state for Near Eastern affairs, suggested that the number of casualties in Gaza is likely higher than reported.

The United Nations relief agency has reported a communications breakdown preventing the flow of new figures. It is estimated that nearly 3,000 Palestinians are still missing and at risk of being trapped or dead beneath the rubble, while another 27,490 Palestinians have been reported injured, according to the Health Ministry's update on Friday.

The Health Ministry has detailed the methodology employed to compile data on Palestinian casualties. When a victim arrives at a government hospital's emergency department, their information, including ID number and personal details, is recorded in the hospital's computerized information system. Additionally, each hospital records deaths of those who spent time in their facility before succumbing to their injuries.

The daily information on killed Palestinians is centralized in the government registry's database through the transfer of data from decentralised hospital systems. Non-governmental hospitals also record data on victims using their own forms, which are then sent to the Health Information Centre at the Ministry of Health within 24 hours for inclusion in the central database. Daily reports, prepared by the ministry's information centre, are sent to the government-run Health Emergency Operations Centre for approval and dissemination.

Israeli air raids have targeted hospitals and medical centers across Gaza, causing significant damage and hampering medical services. Israel claims that Hamas is operating in those areas, but Palestinians and international medical NGOs dispute these claims without any provided proof. Moreover, as Israel's ground offensive has intensified in northern Gaza, hospitals have increasingly become targets. Al-Shifa Hospital, the largest facility in Gaza, is now surrounded by Israeli tanks, with snipers and drones shooting at people. A surgeon at the hospital reported that an engineer attempting to restore power was shot and paralyzed by a drone. Civilians trying to leave through an exit designated by the Israeli military were also shot at and injured.

Al-Quds Hospital is now inoperable due to a shortage of fuel and a power outage, as reported by the Palestine Red Crescent Society on Sunday. The World Health Organization (WHO) lost communication with its contacts at the hospital and received reports of people being killed while trying to flee. Disturbingly, UN shelters have also been targeted, with 66 internally displaced people killed and 588 injured while seeking refuge in these facilities.

The UN and international rights groups have repeatedly cautioned that Palestinians in Gaza, especially the most vulnerable, have nowhere safe to go. The lack of security and essential resources poses significant risks, including dehydration and waterborne diseases. It is important to note that hospitals are explicitly entitled to protection under international humanitarian law.

The Ministry of Health in Gaza continues to grapple with updating casualty figures amidst the ongoing targeting of hospitals, exacerbating an already dire situation for the people of Gaza. International efforts are urgently needed to address the mounting humanitarian crisis and provide support for medical services in the region.