Childhood mortality during Gaza genocide in 2024: A comparative analysis with global disease burden

<i>Aims:</i> Global childhood mortality frameworks systematically exclude politically sensitive causes of death, such as genocide. This study quantified child mortality in Gaza during 2024, compared these deaths with established global causes of childhood mortality, and assessed how their omission distorts international health assessments. <i>Methods:</i> We analyzed official Palestinian Ministry of Health (MoH) mortality reports and triangulated them with published capture-recapture studies and indirect-to-direct death ratios (4:1 and 10:1) applied in conflict settings to provide low, medium and high childhood mortality estimates. Annualized deaths among children under 15 years were calculated for 2024 and compared with Global Burden of Disease (GBD) 2021 estimates. Infant and under-five mortality rates were derived using live birth estimates and contrasted with pre-war trends. <i>Results:</i> Official reports cite 60,199 deaths in Gaza as of July 2025; upper sensitivity analysis estimate of total fatalities may reach 601,990 (28% of 2.13 million population). Child deaths (under 15) range from 14,824 (reported) to 59,296 (medium estimate) to 148,240 (high estimate), equating to 2%, 7%, and 17% of the under-15 population, respectively. Under-five mortality likely increased 14-34 times, from 13.9 per 1,000 live births in 2022 to 191.1 (medium) and 477.8 (high) in 2024. Infant mortality potentially increased 4-9 times, from 10.8 to 39.0 and 97.5 per 1,000 live births. For 2024, official reported child deaths rank Gaza 18th globally despite Gaza's being less than 1% of global population; medium and high estimates rank it 15th and 10th, respectively. The estimated 41.74 (med) and 104.36 (high) deaths per 1,000 population position Gaza genocide as the leading cause of child mortality worldwide. <b><i>Conclusions:</i> Genocide-related child deaths in Gaza represent one of the leading global causes of childhood mortality but remain excluded from international surveillance frameworks. Recognizing and coding genocide as a preventable cause of death is critical for accountability, accurate health metrics, and urgent humanitarian response</b>.