An estimated 190,000 people have been killed in South Sudan’s civil war and when factors such as population displacement, disruption to health facilities and lack of food are included the death toll is at least 383,000, an independent study said.

Fighting broke out in December 2013 after a political disagreement between President Salva Kiir and the former vice president he had sacked, Riek Machar.

A U.N. official said in 2016 that 50,000 people had been killed and nearly a quarter of the population of 12 million uprooted by the fighting, which has often been along ethnic lines.

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