Sudan’s civil war has left at least 62,000 dead, but the real figure could be much higher

The ongoing war in Sudan it has often been overlooked amid higher-profile conflicts raging across multiple continents. However, the lack of media and geopolitical attention to this 18-month conflict has not made its devastation in terms of human lives any less serious.

Since fighting broke out in April 2023 between the Sudanese Armed Forces and the paramilitary Rapid Support Force, both part of a power-sharing military government, the country has seen the displacement over 14 million people and dividing the country by geography and ideology.

And while we may never know the exact death toll, conflict in Sudan is certainly among the deadliest in the world today.

As scholars you have public healthconflict and human rights and Sudanese American Health Care Workerswe are well aware of how difficult it can be to estimate war mortality for a number of practical and political reasons. But such estimates are critically important: they allow us to understand and compare conflicts, target humanitarian aid for those still at risk, it triggers war crimes investigations, bears witness to conflict, and compels states and armed groups to intervene or change.

The hard work of counting the dead

A deep humanitarian crisis is taking place in Sudan, characterized by ethnic cleansing, mass displacement, food shortage and the the spread of the diseasefurther complicated by flooding in northern states.

Counting the death toll in such a conflict includes counting not only those who are killed as a direct result of the violence—itself difficult to determine in real time—but also those who die from exacerbating factors of conflict, such as the absence of emergency care, the breakdown of vaccination programs and the lack of essential food and medicine. Estimating the latter the death tollcalled indirect mortality, presents its own challenge because the definition itself varies among researchers.

US special envoy to Sudan Tom Perriello testifies to Congress acknowledged the estimation challenges when we observed that there were between 15,000 and 150,000 deaths in Sudan—an extremely wide range that was attributed, in part, to the complexity of determining indirect mortality.

Data on the location and event of the armed conflict (ACLED), a non-profit organization specializing in the collection of conflict-related data, recorded an average of over 1,200 direct conflict deaths per month in Sudan, with nearly 19,000 deaths in the first 15 months of conflict. This figure is similar to the 20,000 dead estimate by the Sudanese Doctors Union and the 19,000 figure used by Sudan Protection Cluster, a centralized group of UN agencies and NGOs that used World Health Organization data.

ACLED sources of its estimates of deaths from traditional media, reports from international NGOs and local observers, supplemented by new media such as Telegram and WhatsApp verified accounts. The Sudanese Medical Union, on the other hand, provides field estimates of conflict deaths.

When available, separate data sources such as surveys, civil registers and official body counts can make a more accurate estimate. However, this data is often only available retrospectively, after the end of the conflict. It is therefore essential to use both available data and precedents from previous conflicts to obtain a reasonable estimate of the human costs of an ongoing conflict.

An article from 2010 in The Lancet estimated to exist 2.3 indirect deaths for each direct conflict deathbased on data from 24 small-scale surveys conducted in Darfur from 2003 to 2005. As such, using ACLED’s data of 18,916 direct deaths, we estimate that in the current conflict in Sudan, there are an additional 43,507 indirect deaths—or more than 62,000. total deaths.

We believe our estimate is very conservative. In estimating mortality in the ongoing conflict in Gaza, another group of scholars, also writing The Lancetused a multiplier of four indirect deaths for each direct death to estimate overall mortality there.

Meanwhile, a report of the Secretariat of the Geneva Declaration showed an average of 5.8 indirect deaths for every direct death in 13 armed conflicts from 1974 to 2007.

Using this last multiplier, the indirect death toll in Sudan would rise to nearly 110,000 – bringing total deaths in the region to 130,000 – double our estimate.

This range is wide, but recognizes how difficult it can be to estimate indirect deaths and how they can vary significantly depending on the form of a conflict.

The Sudanese conflict in context

For all the huge loss of life these figures reflect, they certainly underestimate the true human costs of the conflict.

Sudan he already had a fragile one and underfunded health system before the fight begins. And compared to other ongoing conflicts such as in aerate and Ukrainethere was already a more precarious baseline, with higher infant mortality and shorter life expectancy.

Since war in Sudan began, existed consistent reports of mass murdersenforced disappearances, sexual violencedeliberate blocking of food and medicine and other forms of violence against civilians.

Much of the violence is ethnically targeted, and the Darfur region, where a widespread famine was declared— suffered disproportionately.

Destruction of civilian infrastructure and aid mechanisms interrupted prevent medicines, food, clean water and vaccines from reaching populations in need.

Health workers and institutions, not only in Darfur at risk, but throughout the country, were the target of attacks. Almost 80% of medical facilities were rendered inoperable. And at least 58 doctors they were killedin addition to the many that have been targeted in previous crises.

Given the persistent targeting of health care systems and restricted access to humanitarian corridorsindirect deaths in Sudan are likely to rise as hospitals close, even in the capital Khartoum, due to bombings, ground attacks and shortages of critical supplies.

The costs to Sudanese children are particularly alarming. Thirteen children die a day in Zamzam camp in North Darfur, according to Doctors Without Borders, mostly from malnutrition and food scarcity.

And nearly 800,000 Sudanese children will they face acute, severe malnutrition by 2024, a condition that requires intensive care and supplemental nutrition just to prevent death. Even before the conflict, children were under serious threat through lack of access to careincluding basic preventive care such as early immunization.

Finally, the transmission of communicable diseases it thrives in conflicts like the one in Sudanwhere there was large-scale population displacement, malnutrition, limited water and sanitation, and a lack of adequate shelter.

In August, a cholera epidemic led to a increase in mortality rate of over 31 deaths per 1,000 cholera cases. And cases of such disease effects are likely to be underestimated in a country lacking penetration and monitoring of healthcare.

Limitations of estimates

Mass internal displacement a over 14 million people in Sudan complicates estimating the death toll, as changing populations make it nearly impossible to establish baselines.

In addition, there is usually a lack of official information collected and released during conflicts.

So establishing a concrete estimate of the real impact of armed conflicts comes often after the cessation of hostilities, when teams of experts they are capable to lead field studies.

Even then, estimates will require assumptions about direct deaths, the ratio of indirect-to-direct deaths, and the quality of existing data.

But as scholars working at the intersection of public health and human rightswe believe that such work, however imperfect, is necessary for documenting the conflict—and preventing it in the future. And while there are many current global conflicts that require our urgent attention, the conflict in Sudan must not get lost in the shuffle.

Israa Hassan, physical medicine and rehabilitation resident at Texas Rehabilitation Hospital-Fort Worth and director of advocacy at the American Medical Association of Sudancontributed to this article.

This article is republished from conversation under a Creative Commons license. Read on original article.