The “war on terror” that the United States launched in Iraq, Afghanistan and Pakistan after the attacks in the US on September 11, 2001 has killed at least 5 lakh people, a study released on Thursday said.

A report of the study conducted by Brown University’s Watson Institute for International and Public Affairs put the toll between 4,80,000 and 5,07,000 people, but said the actual number is likely to be higher since there are “limits in reporting”.

The new toll “is a more than 110,000 increase over the last count, issued just two years ago in August 2016,” Brown University said in a statement, according to AFP. “Though the war on terror is often overlooked by the American public, press and lawmakers, the increased body count signals that, far from diminishing, this war remains intense.” Those killed in the wars include insurgents, local police and security forces, civilians and US and allied troops, journalists and NGO workers.

Neta Crawford, who wrote the report, said many of those reported by US and local forces as militants may actually have been civilians. “We may never know the total direct death toll in these wars,” Crawford said in the report. “For example, tens of thousands of civilians may have died in retaking Mosul and other cities from ISIS [Islamic State group] but their bodies have likely not been recovered.”

According to the report, between 1,82,272 and 2,04,575 civilians have been killed in Iraq, while 38,480 have been killed in Afghanistan, and 23,372 in Pakistan. Nearly 7,000 US troops have been killed in Iraq and Afghanistan.

The report said the numbers do not include people who died of indirect consequences of a war, like loss of infrastructure, access to food, water and electricity.