South Sudan’s civil war has caused the deaths of at least 382,900 people — far higher than previous estimates and more than the conflict in Syria, according to a new study.

The statistical research carried out by the London School of Hygiene and Tropical Medicine was published Tuesday after being commissioned by the US Institute for Peace in partnership with the US State Department.

Researchers measured both the number of deaths that were a direct result of the violence as well as deaths caused by the increased risk of disease and reduced access to healthcare.

Previous estimates have put the toll in the tens of thousands.