More than 46,000 Palestinians have been killed inthe Israel-Hamas war, Gaza's Health Ministry said Thursday, as the conflict raged into a 16th month with no end in sight.

The ministry said a total of 46,006 Palestinians have been killed and 109,378 wounded. It has said women and childrenmake up more than half the fatalities, but does not say how many of the dead were fighters or civilians.

The Israeli military says it has killed over 17,000 militants, without providing evidence. It says it tries to avoid harming civilians and blames Hamas for their deaths because the militants operate in residential areas. Israel has also repeatedly struck what it claims are militants hiding in shelters and hospitals, often killing women and children.

The war began when Hamas-led militants stormed into Israel on Oct. 7, 2023, killing some 1,200 people, mostly civilians, and abducting around 250. Some 100 hostages are still inside Gaza. Israeli authorities believe at least a third of them were killed in the initial attack or have died in captivity.

The war has flattened large areas of Gaza and displaced around 90% of its 2.3 million people, with many forced to flee multiple times. Hundreds of thousands are packed into sprawling tent camps along the coast with limited access to food and other essentials.

In recent weeks, Israel and Hamashave appeared to inch closerto an agreement for a ceasefire and the release of hostages. But the indirect talks mediated by the United States, Qatar and Egypt have repeatedly stalled over the past year, and major obstacles remain.