The number of Palestinians killed in the Israeli military campaign against Hamas in Gaza passed 60,000 on Tuesday, local health authorities said. It is a figure public health analysts, doctors and conflict casualty monitors say is likely to be a significant undercount, as Israel’s ground operations and attacks on hospitals have upended the enclave’s health care infrastructure.

The toll reported by the Gaza Health Ministry, which is run by Hamas and whose numbers are widely accepted by the United Nations and other international institutions, includes combatants as well as civilians. The ministry does not distinguish between the two but says that more than half of those killed were women and children, an assertion supported by health systems experts, data scientists and an independent survey of mortality figures in Gaza cross-checked against the Health Ministry’s numbers.

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The ministry has recently begun reporting a separate toll: the growing number of deaths from hunger after months of Israeli aid restrictions raised the threat of mass starvation. More than 130 people have died of hunger, most of them in recent weeks, according to the Health Ministry. More than 1,000 have been shot waiting for aid, most in the scramble to reach first-come, first-served food distributed at points located inside Israeli military zones, including at least 14 people in central Gaza on Tuesday, according to the ministry.

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Also Tuesday, Prime Minister Keir Starmer said Britain will formally recognize a Palestinian state in September — unless Israel agrees to a ceasefire and commits to a two-state solution.

In a statement posted on social media, Israeli Prime Minister Benjamin Netanyahu accused Starmer of abetting terrorism. “Starmer rewards Hamas’s monstrous terrorism & punishes its victims,” Netanyahu said X.

Gaza as it was before the war — a tiny but bustling territory with high-rises, universities and seaside cafes — no longer exists. Entire cities have been reduced to rubble. The highways have been excoriated, exposing the sand beneath. Most of the population has been pushed into the 12 percent of the enclave that Israel has not ordered evacuated, and diseases such as polio and meningitis have emerged.

“The scale of human suffering and the stripping of human dignity have long exceeded every acceptable standard — both legal and moral,” Mirjana Spoljaric, president of the International Committee of the Red Cross, said in a statement Friday. “Every political hesitation, every attempt at justification of the horrors being committed under international watch will forever be judged as a collective failure to preserve humanity in war.”

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In a statement Tuesday, the Health Ministry said 60,034 people had been killed and another 145,870 injured since the start of the war on Oct. 7, 2023, when Hamas fighters attacked southern Israel, killing about 1,200 people and taking about 250 others back to Gaza as hostages.

Since then, the ministry has provided near-daily updates on casualties from the conflict and released multiple spreadsheets listing the names, ages and identification numbers of the majority of the dead. Some remains have yet to be identified, health officials say, and an estimate of the number of bodies still under the rubble stands at roughly 10,000, according to Health Ministry and U.N. figures.

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The Israeli military does not provide regular updates for its own assessment of how many Palestinians have been killed. In January, outgoing chief of staff Herzi Halevi said that the Israel Defense Forces had “eliminated close to 20,000 Hamas operatives.” On Monday, the IDF spokesperson’s unit said that 20,000 was the most recent number the military has “addressed on the record.” The military did not say how it reached that figure.

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On its latest spreadsheet released in June, the Gaza Health Ministry recorded at least 1,860 deaths of children under age 2 since the start of the war. In more than 2,600 families, all of the immediate family members have been killed, according to Zaher al-Waheidi, head of the ministry’s records department.

Israel resumed airdropping food into Gaza and announced “tactical pauses” in fighting on July 27, as deaths from starvation in the enclave worsened. (Video: Naomi Schanen/The Washington Post)

Israel and Hamas agreed to a ceasefire in January, described by the U.S. officials who helped negotiate it as a stepping stone to a lasting peace. Over the next two months, the fighting stopped, relief flowed to Gaza, and both Israeli hostages and Palestinian prisoners were released in choreographed exchanges.

But when the time came to negotiate the second phase of the agreement, which Hamas hoped would see a full withdrawal of Israeli forces, Israel refused to participate and imposed a blockade of all food, aid and fuel to Gaza. About two weeks later, it resumed military operations there.

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Talks between Israel and Hamas broke down again last week. President Donald Trump said Friday that Hamas “didn’t want to make” a deal; Hamas said that its latest response through Egyptian and Qatari mediators was close to a U.S.-proposed agreement on how to end the war. Hamas continues to hold about 50 hostages, according to Israeli authorities, roughly 20 of whom are believed to still be alive.

Many in Israel, including political opponents, families of the hostages and senior members of the security establishment, have accused Netanyahu of prolonging the campaign without a clear military rationale to ensure his own political survival. Some parts of his coalition have threatened to bring down the government if Netanyahu agrees to end the war. The prime minister is currently on trial for corruption and, if convicted, could face up to 10 years in prison once he leaves office.

Israeli military and defense officials including Yoav Gallant, Netanyahu’s former defense minister, said last year that Israel’s first war aim — to weaken Hamas’s ability to threaten Israel — had been accomplished, and that the return of the remaining hostages, a principal concern of much of the Israeli public, would be possible only as part of a deal.

But Netanyahu has for months resisted signing on to an agreement that would withdraw Israeli troops and release the remaining hostages, both dead and living, in stages as part of the process.

The Gaza Health Ministry says its death toll includes only those Palestinians who have been killed by Israel directly, such as in bombardments and by gunfire. Those who die from secondary effects of the war, such as diseases and malnutrition, are not recorded in the count.

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Early in the conflict, medical staff at each hospital in Gaza logged the name, gender and identification number of each person who passed through, and the ministry combined them to produce a daily toll. But as the months passed, and hospitals were attacked and went offline, counting the dead became more difficult, and the accuracy and transparency around the data deteriorated at times.

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This occurred “primarily during periods when hospitals were overwhelmed, and MoH staff had to rely on headcounts of bodies rather than detailed records,” wrote Michael Spagat, a researcher of war and armed conflict at the University of London and lead author of the Gaza Mortality Survey, an independent estimate of war-related deaths for the first 15 months of the war.

Spagat’s estimate — that the Gaza Health Ministry underreported violent deaths by about 35 percent during that period — aligned with what researchers at the London School of Hygiene and Tropical Medicine found and published in a peer-reviewed article in the Lancet earlier this year: The death toll from traumatic injuries during the first nine months of the war was likely to have been about 40 percent greater than the ministry’s numbers suggest.

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Videos verified by The Washington Post this month showed the final resting place of 12 of those whose deaths had slipped through the cracks: a residential block in Gaza City’s Tuffah neighborhood that was crushed by an Israeli airstrike on July 14.

Emergency personnel and relatives said that the Israeli military prevented rescue workers from reaching the site for roughly eight hours, targeting those who tried with drone strikes, as footage shared by the family of a woman named Hala Arafat showed her trapped and begging for rescue. “I can’t take this for much longer,” she whimpered. “Save me.”

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The Israeli military said the strike had targeted “several key Islamic Jihad terrorists” and claimed it had taken steps to mitigate the risk of harm to civilians. When asked if the military had any record of civilian casualties, a spokesman referred reporters to the previous statement.

By the time rescue workers reached the site the next day and extracted Arafat, she and her 12 relatives were dead, according to a relative, Anas Arafat. Because her body was the only one recovered from the rubble, Arafat alone was recorded in the Health Ministry’s official figures, said Waheidi of the ministry. The uncounted victims still under the rubble, whose names and ages were provided by Anas, ranged in age from Layan, 5, to Mohamed, 73.

As pressure builds on policymakers to end the conflict, there are small but notable signs that public opinion in Israel has begun to shift. For much of the war, the devastation in Gaza has only rarely been discussed on nightly newscasts or even at massive anti-war rallies, which typically focus on the plight of Israeli hostages.

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Alon-Lee Green, who co-heads the left-leaning Arab-Jewish anti-war group Standing Together, said a “flower march” in Tel Aviv last week to protest Israeli tactics in Gaza attracted hundreds. At an anti-war rally two days later, Green said, placards showing photos of starving Gazan children were quickly snatched up, a level of demand he didn’t see in the wake of Oct. 7, when fury toward Palestinians ran high.

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Then, on Wednesday night, a reporter on Israel’s most popular prime-time newscast said he had spoken to Gazans who reported going days without food, feeling dizzy and experiencing dramatic weight loss. “While responsibility lies with Hamas, it also lies with Israel,” Ohad Hemo told viewers. “It must end.”

Concerns have also emerged among some of the Israeli government’s staunchest defenders. Amit Segal, a prominent right-wing commentator, wrote in his newsletter Thursday that Gaza might be approaching a real hunger crisis.

“Shocked to be reading this from me? I don’t blame you,” Segal wrote. He speculated that fear of a mass famine on Netanyahu’s hands could push him to seek a ceasefire. “New research is real cause for concern,” he wrote.