Note that the 186k figure is not an estimate of deaths to date; the bulk of it is anticipated future deaths attributable to the destruction of hospitals and so forth. Lancet has also published some criticism of that correspondence - https://www.thelancet.com/journals/lancet/article/PIIS0140-6... https://www.thelancet.com/journals/lancet/article/PIIS0140-6... https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

The Gaza heath ministry's figures remain the best (and basically only) source of casualties to date. While they're no longer able to record many deaths in hospitals or morgues, they've adapted by collecting casualty reports from other sources like a Google form (which makes the data a bit iffy, but better than nothing).