Â鶹ÒùÔº

Sudan's civil war has left at least an estimated 62,000 dead—but the true figure could be far higher

The has often been overlooked amid higher-profile conflicts raging across multiple continents. Yet the lack of media and geopolitical attention to this 18-month-long conflict has not made its devastation in terms of human lives any less stark.

Since fighting broke out in April 2023 between the Sudanese Armed Forces and the paramilitary Rapid Support Forces, both of which had been part of a power-sharing military government, the country has seen the displacement of and the carving up of the country by geography and ideology.

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

As scholars of , conflict and and , we are keenly aware of how fraught it can be to estimate mortality in war for a slew of practical and political reasons. But such estimates are of critical importance: They allow us to understand and compare conflicts, target humanitarian aid for those still at risk, trigger investigations of war crimes, bear witness to conflict and compel states and armed groups to intervene or change.

The difficult work of counting the dead

A profound humanitarian crisis is occurring in Sudan, characterized by , , and the , complicated further by flooding in the northern states.

Considering a death toll in such a conflict includes counting not only those who are killed as a direct result of violence—itself a difficult thing to determine in real time—but also those who have died by conflict-exacerbated factors, such as the absence of emergency care, the breakdown of vaccination programs and a lack of essential food and medicine. Estimating this latter death toll, called indirect mortality, presents its own challenge, as the definition itself varies among researchers.

In congressional testimony, U.S. special envoy to Sudan Tom Perriello when noting there had been anywhere between 15,000 and 150,000 deaths in Sudan—an exceedingly wide range that was attributable, in part, to the complexity of determining indirect mortality.

(ACLED), a nonprofit specializing in conflict-related data collection, an average of more than 1,200 direct conflict deaths per month in Sudan, with nearly 19,000 deaths in the first 15 months of the conflict. This figure is similar to the 20,000 deaths by the Sudan Doctors Union and the 19,000 the Sudan Protection Cluster, a centralized group of U.N. agencies and NGOs that used World Health Organization data.

ACLED of deaths from traditional media, reports from international NGOs and local observers, supplemented by new media such as verified Telegram and WhatsApp accounts. The Sudan Doctors Union, on the other hand, gives on-the-ground estimates of conflict deaths.

When available, distinct data sources such as surveys, civil registers and official body counts can make an estimation more accurate. However, this data is often available only in retrospect, after the cessation of conflict. It is therefore critical to use both the available data and precedents from previous conflicts to capture a reasonable estimate of the human costs of an ongoing conflict.

A 2010 article in The Lancet estimated that there are , based 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 Sudan conflict, there are an additional 43,507 indirect deaths—or more than 62,000 total deaths.

We believe our estimate is very conservative. When estimating mortality in the ongoing conflict in Gaza, a different group of scholars, , used a multiplier of four indirect deaths for every direct death to estimate the overall mortality there.

Meanwhile, a showed an average of 5.8 indirect deaths for every direct death across 13 armed conflicts from 1974 to 2007.

Using that latter multiplier, the number of indirect deaths in Sudan would jump to nearly 110,000—meaning the total deaths in the region amount to 130,000—double our estimate.

This range is wide, but it acknowledges how difficult it can be to estimate indirect deaths and how they can vary significantly with the shape of a conflict.

The Sudanese conflict in context

For all the tremendous loss of life these numbers reflect, they surely underestimate the true human costs of the conflict.

Sudan and before the fighting started. And compared with other ongoing conflicts such as in and , there was already a more precarious baseline, with and lower life expectancy.

Since the began, there have been of , forced disappearances, , deliberate blocking of food and medicine, and other forms of .

Much of the violence is ethnically targeted, and the Darfur region—where a —has suffered disproportionately.

The destruction of civilian infrastructure and are preventing medicine, food, clean water and vaccinations from getting to in-need populations.

Health care workers and facilities, not only in at-risk Darfur but also throughout the country, . Nearly 80% of medical facilities have been rendered inoperable. And at least 58 physicians , in addition to the many that were .

Given the persistent targeting of health care systems and , indirect deaths in Sudan are likely to grow as hospitals shut down, even in the capital Khartoum, due to bombardments, ground attacks and a lack of critical supplies.

The costs for Sudanese children are especially alarming. Thirteen children die per day in Zamzam camp in North Darfur, according to Doctors Without Borders, mostly due to .

And nearly 800,000 Sudanese children will through 2024, a condition that requires intensive care and supplemental nutrition merely to prevent death. Even before the conflict, children were severely threatened , including basic preventive care such as early immunization.

Finally, the transmission of communicable diseases , where there has been widespread population displacement, malnutrition, limited water and sanitation, and lack of appropriate sheltering.

In August, a led to a of more than 31 deaths per 1,000 cholera cases. And instances of such disease effects are likely to be underestimates in a country lacking health care penetration and monitoring.

The limitations of estimations

The massive internal displacement of in Sudan complicates the estimation of death tolls, as shifting populations make establishing baselines nearly impossible.

Moreover, there is typically a during conflicts.

So establishing a concrete estimate of the true impact of armed conflict after the cessation of hostilities, .

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

But as scholars working at the intersection of public health and human rights, we believe such work, however imperfect, is necessary for the documentation of conflict—and its future prevention. And while there are many current global conflicts that require our urgent attention, the conflict in Sudan must not be lost in the mix.

Israa Hassan, a physical medicine and rehabilitation resident at Texas Rehabilitation Hospital-Fort Worth and , contributed to this article.