A new study says South Sudan's civil war has caused the deaths of 382,000 people, far higher than previous estimates.
The report from the London School of Hygiene and Tropical Medicine says that about half of the deaths resulted from violence, with the rest caused by increased risk of disease and reduced access to health care.
The findings were based on statistical models that compared actual deaths with expected deaths based on census projections and previously collected mortality data.
The war in South Sudan broke out in December 2013, two and a half years after the country won independence from Sudan.
"It is clear that the war has severely affected the health of the South Sudanese population, and that the humanitarian response to the crisis has been insufficient," said Francesco Checchi, a professor of epidemiology and the lead author of the report.
He said combatants in South Sudan must give aid groups free and safe access to people in need across the country.
"More fundamentally, our estimates illuminate the human cost of the war and should spur warring parties and international actors to seek lasting conflict resolution," Checchi said.
The U.S. State Department and U.S. Institute of Peace funded the study, published Wednesday.
The conflict has displaced about two million people inside South Sudan and prompted another 2.5 million to flee to neighboring countries.
South Sudanese President Salva Kiir and chief rebel leader Riek Machar recently signed a renewed peace accord, in the latest attempt to stop the fighting and stabilize the Central African country.
