Modelling excess mortality from non-communicable diseases during wartime: application to the Gaza Strip, occupied...

Patients with non-communicable diseases (NCDs) face multiple risks of excess mortality during wars. The Gaza Strip's health services have been severely disrupted by Israel's campaign since October 2023. We developed a modelling approach to project NCD excess mortality under three defined scenarios.

We projected excess mortality from cancer (lung, colorectal, and breast), cardiovascular disease, diabetes mellitus type 1 patients, and chronic kidney disease requiring haemodialysis from February 2024 to August 2024. We defined three scenarios of treatment coverage: (i) ceasefire, (ii) status quo, and (iii) escalation. We used pre-war incidence and prevalence data to probabilistically simulate deaths among patient cohorts exposed to varying time-dependent mortality depending on their treatment status. We subtracted the expected non-crisis mortality based on pre-war data to compute excess deaths.

We projected 1,680, 2,480 and 2,680 excess deaths under the ceasefire, status quo and escalation scenarios, respectively, from February till August 2024, plus 1489 in the war's earlier phase. Most deaths were projected among individuals aged >50 years old and from ischaemic heart disease.

To our knowledge this is the first attempt to project NCD mortality in a live war setting, demonstrating potential impacts on NCD burden, particularly due to cardiovascular causes. The model focusses only on a subset of NCDs and neglects the impact of the crisis on disease progression, thereby plausibly underestimating actual mortality. It could inform better humanitarian resource allocation and service planning but requires refinement and improved parameterisation.