Comparative medical imaging in mass-fatality identification: Evidence from the October 7, 2023 Event

Comparative Medical Imaging (CMI) is an established tool in forensic identification, yet remains formally classified as a secondary identifier within INTERPOL Disaster Victim Identification (DVI) guidelines. This study evaluates the operational contribution of CMI during the forensic response to the October 7, 2023, Hamas massacre in southern Israel, which resulted in 1219 fatalities and the abduction of civilians and security personnel into the Gaza Strip. Ante-mortem (AM) imaging data from 400 missing individuals and postmortem (PM) imaging of recovered remains were systematically analyzed across two operational phases: the initial recovery of victims within Israel, and the subsequent identification of deceased hostages returned over a two-year period. PM imaging was acquired using multidetector computed tomography (MDCT) and plane radiography, adapted to taphonomic conditions. Radiographic comparison resulted in the identification of 39 individuals, with notably higher contribution in the later, closed-disaster phase involving the returned hostages (29.9%). Identifying features encompassed four categories: anatomical skeletal variation was the most frequent marker (89.7%), followed by degenerative changes (38.5%), medical interventions (38.5%), and pathological findings (15.4%). Most identifications relied on multiple concordant features across several anatomical regions. Reliable comparison was achieved despite AM-PM intervals of up to 17 years and across diverse taphonomic categories, including skeletonized, saponified, mummified, and thermally altered remains. These findings demonstrate that CMI provides individualization markers of high specificity, temporal stability, and resilience under challenging PM conditions; these properties are consistent with the evidentiary criteria defining primary identification methods. The data support reassessment of the current classification of CMI within international DVI frameworks.