The combined, cumulative death toll of war in Afghanistan and Pakistan since 2001 is 173,000, with 183,000 others seriously injured, according to a new study by the Costs of War project, based at Brown University’s Watson Institute for International and Public Affairs.

“While all eyes are on the war in Syria and Iraq and on terrorist attacks at home, the United States’ first post-9/11 war continues,” said Neta C. Crawford, author of the study and professor of political science at Boston University. “At this point, despite what President Obama recently described as ‘all the blood and treasure we’ve invested in Afghanistan over the years,’ the war in Afghanistan has increased in intensity.”

Crawford, who co-directs the Costs of War project with Catherine Lutz, the Thomas J. Watson Jr. Family Professor of Anthropology and International Studies at Brown, focused the report on the wars’ direct and indirect impact on human life, health and wellbeing in Afghanistan and Pakistan, including deaths, injuries and displacement.

The study, “Update on the Human Costs of War for Afghanistan and Pakistan, 2001 to mid-2016,” summarizes the pattern of killing in the Afghanistan-Pakistan conflict zone since 2001, with an emphasis on the most recent years.

Crawford notes in the report that the wars are interrelated. The war in Pakistan “began as Al Qaeda and the Taliban fled from Afghanistan into the northwest region of Pakistan in 2001,” Crawford wrote, and is “underreported partially because the news media have been targeted for killing by both militants and security forces, and because the Pakistani government controls journalists’ access.”

Specific data on deaths from U.S. drone strikes in Pakistan is difficult to access, Crawford notes, because the strike program remains largely secret even after the recent release of data by the Obama administration. That data covers drone strikes in Pakistan, Yemen and Somalia, but it is not disaggregated by war zone. The Costs of War study includes estimates from the Bureau of Investigative Journalism, the Long War Journal, the New America Foundation and the Pakistan Body Count. Those estimates range from a low of 158 civilian deaths caused by U.S. drone strikes to a high of 2,657.

Based on reports from several sources, Crawford found that in total, the number of deaths caused directly by the wars in the two countries has risen by 24,000 to 173,000 since March 2015, when the Costs of War project estimated the combined death toll to be 149,000 people.

In the intervening period, the intensity of the war in each country has changed, according to the report, with violence increasing in Afghanistan and diminishing, for a short period, in Pakistan in 2015. However, the report identifies an upward trend of violence in Pakistan in the first half of 2016.

“There is no disputing the fact that the wars in Afghanistan and Pakistan continue to be devastating for civilians,” Crawford wrote. “The first six months of 2016 indicate that there is as much or more war-related violence in Afghanistan as in 2015.”

And the increased intensity of the fighting in Afghanistan, Crawford noted, could have a “spillover” effect in Pakistan.

“It is crucial that a nation at war, as the United States has been for nearly fifteen years, look rigorously at the facts about the impact of that violence on all concerned,” added Lutz. “These numbers, moreover, reflect just those killed directly. Many more have died as an indirect result of the wars and their destruction of infrastructure and community health.”

The report is one of a series of periodic updates on the costs of the post-9/11 wars in Iraq, Afghanistan and Pakistan by the Costs of War project, which launched at Brown in 2011 and counts 35 scholars, legal experts, human rights practitioners and physicians among its team members. Previous reports have aggregated and evaluated different facets of the costs of the wars.

Other findings from the report include:

Afghanistan

Overall Security

The security situation has deteriorated, with the Afghan government controlling approximately 70 percent of the country. Twenty-three percent of the territory is contested, and about six percent is controlled by the Taliban and other insurgents.

Displacement

Between January 1 and April 30, 2016, 117,976 people in 24 out of 34 provinces in Afghanistan fled their homes. Nearly 1 million Afghans are internally displaced, and an additional 2.6 million Afghans are refugees in more than 70 countries.

Direct Civilian Deaths

An estimated 31,000 Afghan civilians have been killed in direct violence since October 2001.

Between 2007 and 2013, direct violent civilian deaths that could be attributed to pro-government forces declined from 41 percent to 12 percent, but that downward trend reversed in subsequent years, rising to 18 percent by 2015.

The number of Afghan civilians killed by unexploded ordnance tripled from 124 in 2014 to 431 in 2015.

Civilian Injuries

Traumatic amputations constitute a significant burden of the war for Afghan civilians, with the Red Cross and Handicap International together assisting more than 2,600 people who had suffered limb amputations in 2015.

Military and Department of Defense Deaths

Over the course of the war, 2,371 U.S. military and Department of Defense civil personnel have been killed in Afghanistan and other locations associated with the war. Some 1,100 allied troops have been killed with the largest share of losses coming from British forces.

Military Personnel Injuries

Approximately 20,000 U.S. soldiers were injured from 2001 to mid-2015, and 833 had major limb amputations.

Insurgent Deaths

Reliable estimates for numbers of insurgents and militants are difficult to ascertain, but roughly 7,000 insurgents were killed in 2015, according to the Afghan Ministry of Defense.

Humanitarian Deaths

Humanitarian and aid worker deaths since 2001 amount to 377, including 45 in 2014.

Pakistan

Overall Security

Militant suicide attacks in 2015 were lower than at any time since 2006.

Displacement

Approximately 1 million people were displaced by an anti-militant operation in North Waziristan that began in June 2014, and most had been unable to return by June 2015.

Civilian Deaths and Injuries

Approximately 22,100 Pakistani civilians have died and 40,792 were wounded.

Pakistani Security Deaths

A total of 8,214 Pakistani Security Forces personnel were killed.

Militant and Insurgent Deaths

An estimated 31,000 members of the Taliban and other militants were killed.

Contractor, Journalist and Humanitarian Deaths

A total 42 American civilian contractors were killed.

Fifty-eight journalists were killed.

And 92 non-governmental organizations’ humanitarian workers were killed.

This report’s full findings and archives are available online at www.costsofwar.org.