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Gaza's Health Ministry casualty numbers have been stuck at around 40,000 for months. This is consistent, but not reliable. From the beginning, the GHM has only ever counted deaths directly attributable to the war who make it to a hospital (including those who are dead on arrival). Dead due to preventable caused like lack of food, water, sanitation, medicine or shelter? Not counted. Dead because a building blew up and your body is under a pile of rubble? Not counted unless someone dug up your body and took it to a hospital.
Even developed and functioning countries take a long time after "small" disasters to get an accurate count of the dead. The disaster in Gaza is still ongoing, and their capability to count the dead has been declining the entire time.
The GHM's official numbers may be accurate for what they are. But what they are is a systemic undercount that is practically meaningless.