Background: Death registration system in Palestineis incomplete or unreliable in determining cause and manner of death. Autopsy is a more reliable method to uncover the hidden possible underlying causes of death. The main objective of this study is to assess the epidemiology of autopsy-referred cases in the north of West Bank through the study period (2010-2012).Results: Total number of cases was 159 (77.4% males and 22.6% females). Natural and accidental deaths were the two leading manners (39%and 28.9%; respectively) followed by homicidal (18.2%) and suicidal deaths (13.8%).Males contributed to most cases in all manners. Cardiovascular related diseases were leading causes of natural deaths (62.9%), followed by respiratory diseases (9.5%). Trauma was the direct cause of accidental deaths for 45.6% due to falling down followed by asphyxia and suffocation (28.3%) due to accidental burns and trapping in closed places. Hanging was a major cause for suicidal deaths (41%) followed by intoxication (27%). In homicidal deaths, fire arm and stab wounds were major causes (35% for each) followed by manual strangulation and hanging (24%).According to age group, least number of deaths was in extremes of age (infants 6.9% and elderly 11.9%) and was attributed mainly to natural causes of death. Most accidental deaths were in children, most homicides and natural deaths were middle aged people. However, most suicides were adults. Moreover, 72% of cases were from villages, 5% from refugee camps and 4.23% from cities. There was no association between the manners of death and seasons of the year (P value0.798). Conclusion: Autopsy is a more reliable method to uncover possible hidden causes of death where it can reveal the actual manner and cause of death that is vital improve public health. As the majority of deaths were natural or unwitnessed, this probably refers to a weak health system. Therefore, we recommend health system development in elderly and in chronically ill. Since most of cases were from villages, improving health care system in rural areas as well as increasing awareness campaigns with toxins and proper storage methods for agricultural pesticides is recommended.