Medical journal The Lancet published a letter on Friday claiming that the death toll in Gaza, including direct and indirect deaths, could amount to 186K or more fatalities over an indefinite period. The letter does not claim that the war has currently killed 186K people.
The figure was determined by multiplying the number of deaths reported by Gaza's health ministry by four, based on the ratio of direct to indirect deaths in other recent conflicts. Indirect deaths can be caused by disease, lack of treatment, and other factors.
Gaza's health ministry has reported that the war has killed over 38K people, with over 88K being wounded. The ministry does not differentiate between civilians and combatants in its toll, and Israel has accused it of distorting casualty figures.
The Lancet's estimate is based on well-established trends in wars similar to this one and is likely an underestimate. Given the intensity of Israel's war on Gaza, the sheer amount of destruction it has wrought, and the complete lack of safe zones, it would be absurd to doubt the figures produced by the health ministry and estimates made by the Lancet. This figure does not even include the estimated 10K people trapped under the rubble.
Though plenty of commentators are misrepresenting this letter, its estimate is purely speculation made by anti-Israel figures. The letter does not claim that Israel has killed 186K people. Nonetheless, the figure has taken on a life of its own as bad faith pro-Palestine narratives tout it as the actual death toll, which is simply not based in fact or reality.