A new report estimates that South Sudan’s civil war has caused nearly 400,000 “excess deaths” since fighting erupted in late 2013.

The report funded by the U.S. State Department and issued by the London School of Hygiene & Tropical Medicine estimates that violence caused about half of those 382,900 deaths.

For years the toll in South Sudan’s civil war has been uncertain, with estimates in the tens of thousands.

The report, based on statistical modeling and not peer-reviewed, comes weeks after the warring sides signed a “final final” peace deal to end the conflict. The United States and others have expressed skepticism that this new deal will hold.

The conflict also has sent more than 2 million people fleeing in Africa’s largest refugee crisis since the 1994 Rwandan genocide.
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