Health officials in the Gaza Strip say the death toll from the 14-month war between Israel and Hamas militants has topped 45,000 people.

The Gaza Health Ministry does not distinguish between civilians and combatants in its count, but it has said that more than half of the fatalities are women and children. The Israeli military says it has killed more than 17,000 militants, without providing evidence.

The Health Ministry said 45,028 people have been killed and 106,962 have been wounded since the start of the war in October 2023. It has said the real toll is higher because thousands of bodies are still buried under rubble or in areas that medics cannot access. The latest war has been by far the deadliest round of fighting between Israel and Hamas, with the death toll now amounting to roughly 2% of Gaza’s entire prewar population of about 2.3 million.

Israel claims Hamas is responsible for the civilian death toll because it operates from within civilian areas in the densely populated Gaza Strip. Rights groups and Palestinians say Israel has failed to take sufficient precautions to avoid civilian deaths.

The war began when Hamas-led militants stormed into southern Israel on Oct. 7, 2023, killing some 1,200 people, mostly civilians,and abducting another 250. Around 100 hostages are still inside Gaza, at least a third of whom are believed to be dead. Most of the rest were released during a cease-fire last year.