South Sudan’s civil war has killed at least 382,000 people, a new study by UK-based London School of Hygiene and Tropical Medicine says.

The study suggests that direct violence accounted for about half of the estimated 382,900 lives lost.

Disease and starvation stemming from the war are said to have caused most of the remaining deaths.

The new report, according to the Washington Post , was funded by the U.S. State Department and that the study was commissioned by the United States Institute for Peace.

That findings far exceeds previous estimates of South Sudan’s death toll, with the United Nations reporting in March 2016 that South Sudan’s civil war killed 50,000 people.

The death toll was concentrated in the states of Jonglei, Unity and the Equatorias, with the highest number of fatalities occurring in 2016-2017, according to the study.