An estimated 383,000 people have died as a result of South Sudan’s civil war, according to a new report that documents the extraordinary scale of devastation after five years of fighting in the world’s youngest country.

The report, published by the London School of Hygiene and Tropical Medicine and financed by the State Department, revealed that about half of the dead were killed in fighting between ethnic rivals as it spread across the country, and the other half died from disease, hunger and other causes exacerbated by the conflict.

The number far surpasses earlier estimates from the United Nations and brings into focus the tragedy of a conflict that has received little global attention.

The researchers behind the report hope it will be instrumental in understanding the conflict and strengthening humanitarian responses.