The conflict in South Sudan has likely led to nearly 400,000 excess deaths in the country’s population since it began in 2013, with around half of the lives lost estimated to be through violence, according to a major new report by the London School of Hygiene & Tropical Medicine. Most of the death toll occurred in the northeast and southern regions of the country, and appeared to peak in 2016 and 2017. Those killed were mostly adult males but also included women and children. Unexpectedly, the share of infant mortality was low, and estimates of the under-five death rate were no higher during the war period than before it.

As of early 2018, the war had caused the displacement of about two million people within South Sudan and a further 2.5 million as refugees to neighbouring countries. Although a Compromise Peace Agreement was signed in August 2015, temporarily leading to shared government, it broke down in July 2016, resulting in the conflict gaining intensity and spreading geographically. The humanitarian response to this crisis is among the largest worldwide, targeting about six million people with a total funding requirement of 1.7 billion USD in 2018, less than 50% met as of current UN figures.

The authors say the findings indicate that the humanitarian response in South Sudan must be strengthened, and that all parties should seek urgent conflict resolution. The research team used an innovative statistical approach to predict deaths which were attributable to crisis for every month and county of the period of interest, and say this approach has the potential to support those involved in humanitarian response and policy to make real-time decisions. The research was funded by the United States Institute of Peace.