{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T22:42:01Z","timestamp":1788302521385,"version":"build-2803163510"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T00:00:00Z","timestamp":1719273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>There is a need for statistical methodologies that scrutinize civilian casualties in conflicts, evaluating the degree to which the conduct of war affects civilians and breaches the laws of war. Employing an epidemiological method, this study introduced, developed, and applied a novel approach for investigating mortality of civilians versus combatants in conflicts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A deterministic mathematical model, structured by age and sex, was developed to describe the process of conflict-related deaths among both combatants and civilians. The model was calibrated using demographic and conflict-related data from different Israel-Gaza conflicts. To quantify the extent of the impact on civilians and determine whether they are the primary focus of a conflict, a statistical metric, the index of killing civilians, along with associated criteria, was devised.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The model-estimated proportion of deaths in Gaza categorized as combatants was 62.1% (95% uncertainty interval (UI): 57.6\u201366.2%), 51.1% (95% UI: 47.1\u201354.9%), and 12.7% (95% UI: 9.7\u201315.4%) in the 2008\u20132009, 2014, and 2023 Israel-Gaza conflicts, respectively. The index of killing civilians was 0.61 (95% UI: 0.51\u20130.74), 0.96 (95% UI: 0.82\u20131.12), and 7.01 (95% UI: 5.50\u20139.29) in the 2008\u20132009, 2014, and 2023 conflicts, respectively. These index values indicate strong evidence for civilians being an object of war in the 2008\u20132009 and 2014 conflicts, but combatants were still identified as the primary focus of the conflict. In the 2023 conflict, there is robust evidence for civilians being an object of war, with civilians identified as the primary focus of the conflict.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Findings imply a progressive shift in Israel\u2019s rules of engagement over time, with a trend towards higher acceptance of casualties among civilians. The 2023 conflict stands apart from preceding Israel-Gaza conflicts, with civilians identified as the primary focus of the conflict.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1359189","type":"journal-article","created":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T04:23:25Z","timestamp":1719289405000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Comparative analysis and evolution of civilian versus combatant mortality ratios in Israel-Gaza conflicts, 2008\u20132023"],"prefix":"10.3389","volume":"12","author":[{"given":"Houssein H.","family":"Ayoub","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiam","family":"Chemaitelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laith J.","family":"Abu-Raddad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,6,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1177\/096701069102200410","article-title":"War-related deaths since 3000 BC","volume":"22","author":"Eckhardt","year":"1990","journal-title":"Peace Res"},{"key":"ref2","author":"Leitenberg","year":"2006"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1353\/wp.2007.0004","article-title":"Covenants without the sword international law and the protection of civilians in times of war","volume":"58","author":"Valentino","year":"2006","journal-title":"World Polit"},{"key":"ref4","author":"Leatherby","year":"2023"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1038\/s41390-024-03124-4","article-title":"Trauma and warfare and clinicians' role","author":"McNicholas","year":"2024","journal-title":"Pediatr Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e0150088","DOI":"10.1371\/journal.pone.0150088","article-title":"Health service utilization among Syrian refugees with chronic health conditions in Jordan","volume":"11","author":"Doocy","year":"2016","journal-title":"PLoS One"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1016\/S0140-6736(06)69491-9","article-title":"Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey","volume":"368","author":"Burnham","year":"2006","journal-title":"Lancet"},{"key":"ref8","doi-asserted-by":"crossref","DOI":"10.4324\/9781003045823","volume-title":"Military spending and global security: Humanitarian and environmental perspectives","author":"Rufanges","year":"2020"},{"key":"ref9","volume-title":"Army of lies: Ethical considerations of deceiving civilians in war","author":"Rogers","year":"2020"},{"key":"ref10","author":"Johnson","year":"2003"},{"key":"ref11","first-page":"307","article-title":"Civilian casualties in modern warfare: the death of the collateral damage rule","volume":"41","author":"Epps","year":"2012","journal-title":"GA J Int Comp Law"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"765261","DOI":"10.3389\/fpubh.2021.765261","article-title":"Estimating the number of civilian casualties in modern armed conflicts-a systematic review","volume":"9","author":"Khorram-Manesh","year":"2021","journal-title":"Front Public Health"},{"key":"ref13","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780198545996.001.0001","volume-title":"Infectious diseases of humans: dynamics and control","author":"Anderson","year":"1991"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1603","DOI":"10.1126\/science.1132338","article-title":"Dual infection with HIV and malaria fuels the spread of both diseases in sub-Saharan Africa","volume":"314","author":"Abu-Raddad","year":"2006","journal-title":"Science"},{"key":"ref15","volume-title":"Hamas: The Islamic resistance movement","author":"Milton-Edwards","year":"2010"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"5","DOI":"10.2307\/2538077","article-title":"Hamas: a historical and political background","volume":"22","author":"Abu-Amr","year":"1993","journal-title":"J Palest Stud"},{"key":"ref17","year":"2023"},{"key":"ref18","year":"2023"},{"key":"ref19","year":"2023"},{"key":"ref20","year":"2023"},{"key":"ref21","volume-title":"The language of technical computing","year":"2015"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1137\/S1052623496303470","article-title":"Convergence properties of the Nelder--Mead simplex method in low dimensions","volume":"9","author":"Lagarias","year":"1998","journal-title":"SIAM J Optim"},{"key":"ref23","year":"2024"},{"key":"ref24","year":"2024"},{"key":"ref25","year":"2023"},{"key":"ref26","author":"Loveluck","year":"2023"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1359189\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T04:23:34Z","timestamp":1719289414000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1359189\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,25]]},"references-count":26,"alternative-id":["10.3389\/fpubh.2024.1359189"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1359189","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,25]]},"article-number":"1359189"}}