A new study suggests the death toll in Sudan’s devastating civil war is far higher than is being reported, with as many as 61,000 killed in Khartoum state in the first 14 months of the war, which began in April of last year. Researchers from the London School of Hygiene and Tropical Medicine say over a third of those were violent deaths, while others were caused by starvation, illness and lack of medical care. Most deaths were not officially recorded, as many victims were never brought to a morgue or treated in a hospital, many of which have been destroyed in the fighting. This is Mohammed Omar, who helped bury his friend, the musician Khalid Sanhouri, in his front yard in the city of Omdurman.

Mohammed Omar: “My brother Khalid was sick, and the war started, and this is a frontline area. There were no hospitals or pharmacies where we could get medicine, not even markets to buy food, which is essential to one’s health. These were all factors which had an impact, until his body was frail and he got sick.”

The war in Sudan has forced some 11 million people to flee their homes and led to the world’s largest hunger crisis. Half of Sudan’s population — nearly 25 million people — are in need of aid. Earlier this week, the Darfur Women Action Group appealed to the U.N. Security Council to deploy peacekeepers to Sudan, citing the “scorched earth tactics” of the paramilitary Rapid Support Forces in North Darfur, including rampant sexual violence and indiscriminate killings.