DEIR AL-BALAH, Gaza Strip (AP) — The death toll in the Gaza Strip from the 13-month-old war between Israel and Hamas has surpassed 44,000, local health officials said Thursday.

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 over 17,000 militants, without providing evidence.

The Health Ministry said 44,056 people have been killed and 104,268 wounded since the start of the war. It has said the real toll is higher because thousands of bodies are buried under rubble or in areas that medics cannot access.

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.

The Israeli offensive has caused heavy destruction across wide areas of the coastal territory, leading many to wonder when or how it will ever be rebuilt. Around 90% of the population of 2.3 million people have been displaced, often multiple times, and hundreds of thousands are living in squalid tent camps with little food, water or basic services.

Israel says it tries to avoid harming civilians and blames their deaths on Hamas because the militants operate in residential areas, where they have built tunnels, rocket launchers and other military infrastructure.

Palestinian officials and rights groups accuse Israeli forces of war crimes and crimes against humanity, and the United Nations’ top court is considering allegations of genocide brought by South Africa. The Israeli government adamantly denies the allegations, accusing critics of being biased against it.

In recent weeks, the amount of humanitarian aid entering Gaza has plummeted, prompting the United States to threaten to reduce its military support for Israel before backing down, citing limited progress. Experts have warned that isolated, war-ravaged northern Gaza could already be experiencing famine.

The United States, Egypt and Qatar spent months trying to broker a cease-fire agreement in which Hamas would release the remaining hostages in exchange for an end to the war. Those talks ground to a halt over the summer, with Israel and Hamas each accusing the other of making unacceptable demands.

U.S. President-elect Donald Trump has vowed to end the wars in the Middle East without saying how. His previous administration gave unprecedented support to Israel and Prime Minister Benjamin Netanyahu’s hard-line policies toward the Palestinians.

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Khaled reported from Cairo.

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Find more of AP’s war coverage at https://apnews.com/hub/israel-hamas-war