CAIRO/OMDURMAN, Sudan: More than 61,000 people are estimated to have died in Khartoum state in the first 14 months of Sudan’s war, with evidence suggesting the toll from the devastating conflict is significantly higher than previously recorded, according to a new report by researchers . in Great Britain and Sudan.

The estimate includes about 26,000 people who suffered violent deaths, a figure higher than that currently used by the United Nations for the entire country.

The preliminary study by the London School of Hygiene and Tropical Medicine’s Sudan Research Group, published ahead of peer review on Wednesday, suggested that famine and disease are increasingly becoming the leading causes of death reported in Sudan.

Estimated deaths from all causes in Khartoum state were 50 percent higher than the national average before the outbreak of conflict between the army and paramilitary rapid support forces in April 2023, the researchers said.

The UN says the conflict has driven 11 million people from their homes and triggered the world’s worst hunger crisis. Nearly 25 million people – half of Sudan’s population – are in need of aid as starvation has taken hold in at least one displacement camp.

But counting the dead was a challenge.

Even in peacetime, many deaths go unrecorded in Sudan, researchers say. As the fighting intensified, people were cut off from places that register deaths, including hospitals, morgues and cemeteries. Repeated outages in internet and telecommunications services have left millions of people unable to contact the outside world.

The study “attempted to capture that invisibility” using a sampling technique known as “capture-recapture,” said lead author Maysoon Dahab, an infectious disease epidemiologist and co-director of the Sudan Research Group.

Originally designed for ecological research, the technique has been used in published studies to estimate the number of people killed during pro-democracy protests in Sudan in 2019 and the COVID-19 pandemic, when complete counts were not possible, of she said. .

Using data from at least two independent sources, researchers look for people who appear on more than one list. The less overlap there is between lists, the greater the chance that deaths are not recorded, information that can be used to estimate the total number of deaths.

In this case, the researchers compiled three death lists.

One was based on a public survey distributed via social media platforms between November 2023 and June 2024. The second used community activists and other “study ambassadors” to distribute the survey privately to their networks. And the third was compiled from obituaries posted on social media, a common practice in the cities of Khartoum, Omdurman and Bahri, which together make up the large capital.

“Our findings suggest that deaths have largely gone undetected,” the researchers wrote.

UNNUMBERED TAX

The deaths recorded in the three lists represented only 5% of the estimated total for Khartoum State and 7% of those attributed to “intentional injury”. The findings suggest that other war-torn parts of the country may have suffered similar or worse tolls, the study said.

The researchers noted that their estimate of violent deaths in Khartoum state exceeded the 20,178 murders recorded across the country during the same period by the Armed Conflict Location & Event Data (ACLED) project, a US crisis monitoring group.

ACLED’s data, which is based on reports from sources including news organizations, human rights groups and local authorities, has been cited by UN officials and other aid workers.

Dahab said researchers do not have enough data to estimate death levels in other parts of the country or to determine how many deaths in total may be related to the war.

The study also notes other limitations. The methodology used assumes that each death has an equal chance of appearing in the data, for example. However, well-known individuals and those who had suffered violent deaths may have been more likely to be reported, the researchers said.

Paul Spiegel, who directs the Center for Humanitarian Health at the John Hopkins Bloomberg School of Public Health and was not involved in the study, said there are problems with all three data sources that could skew the estimates. But he said the researchers took such limitations into account in their methodology and analysis.

“While it is difficult to know how the various biases of this capture-recapture methodology might affect the overall numbers, it is a new and important attempt to estimate the death toll and draw attention to this horrific war in Sudan,” he said .

An official with the American Medical Association of Sudan, an organization that provides free health care throughout the country, said the findings appear credible.

“The number could be even higher,” its program manager, Abdulazim Awadalla, told Reuters, saying weakened immunity from malnutrition makes people more susceptible to infection.

“Simple diseases kill people,” he said.

The study was funded by the US Centers for Disease Control and Prevention and the UK Foreign, Commonwealth and Development Office.

“I buried him HERE”

Among the many casualties of the war was Khalid Sanhouri, a musician whose death in Omdurman’s Mulazmeen neighborhood was announced on social media last July.

A neighbor, Mohammed Omar, told Reuters that friends and relatives were unable to get medical attention for Sanhouri after he fell ill due to the intensity of the fighting at the time.

“There were no hospitals or pharmacies where we could get medicine, not even markets to buy food,” Omar said.

They couldn’t even get to the nearest cemetery.

“So I buried him here,” Omar said, pointing to a grave just beyond the bulletproof wall that surrounded the musician’s home.

Hundreds of graves have appeared near homes in Khartoum since last year, residents say. With the return of the army in some neighborhoods, they began to move the bodies to the main cemetery in Omdurman.

There are up to 50 funerals a day there, undertaker Abdin Khidir told Reuters. The cemetery expanded into an adjacent football field.

Still, the bodies keep coming, Khidir said.

The warring parties have traded blame for the growing toll.

Army spokesman Brigadier General Nabil Abdallah questioned the Health Ministry’s study estimates, but said: “The main cause of all this suffering is the terrorist militia Rapid Support (RSF), which did not hesitate from the first moment to target civilians. ”

The Health Ministry said in a statement to Reuters that it had seen far fewer deaths than the study estimated. Its war-related death toll is 5,565, it said.

RSF did not dispute the study’s estimates, blaming the deaths in the capital on “deliberate airstrikes on populated areas, in addition to artillery bombardment and drone strikes.”

“The army is known to be the only one to have (such weapons),” it said in a statement to Reuters.

The war erupted from a power struggle between the Sudanese Armed Forces and the RSF ahead of a planned transition to civilian rule. The RSF quickly took over most of the capital and has now spread to at least half the country, although the army has regained control of some neighborhoods in Omdurman and Bahri in recent months.

Both sides committed abuses that could amount to war crimes, including targeting civilians, a UN fact-finding mission said in September. The war also produced ethnically-driven violence in the western Darfur region, largely at the fault of the RSF.

However, the new report highlighted the significant and likely growing toll of the war’s indirect impacts, including starvation, disease and the collapse of health care.

Sick patients lined the corridors of al-Shuhada hospital in Bahri, which has seen an increase in cases of malnutrition and diseases such as malaria, cholera and dengue fever.

Fresh fruit, vegetables and meat were hard to come by until the army’s arrival opened up supply routes, said hospital manager Hadeel Malek.

“As we all know, malnutrition leads to poor immunity in general,” she said. “This is a factor … that has led to many deaths, especially among pregnant women and children.”

Both sides deny obstructing aid and trade supplies.