How many people have been killed in the post-9/11 war on terror? The question is a contentious one, as there has been no formal accounting for the deadly cost of the initial U.S. interventions in Iraq and Afghanistan, not to mention the secondary conflicts that continue to wreak havoc across the Middle East and the opaque, covert war still expanding across Asia and Africa.

But even as the U.S. government evades responsibility for the human cost of its overseas endeavors, some researchers are determined to keep count.

Brown University’s Costs of War Project this month released a new estimate of the total death toll from the U.S. wars in three countries: Iraq, Afghanistan, and Pakistan. The numbers, while conservatively estimated, are staggering. Brown’s researchers estimate that at least 480,000 people have been directly killed by violence over the course of these conflicts, more than 244,000 of them civilians. In addition to those killed by direct acts violence, the number of indirect deaths — those resulting from disease, displacement, and the loss of critical infrastructure — is believed to be several times higher, running into the millions.

The report, which uses data spanning from October 2001 to October 2018, compiles previous analysis from nongovernmental organizations, U.S. and foreign government data, and media reports. In a statement, the report authors said the figures still just “scratches the surface of the human consequences of 17 years of war.” Due to challenges in data collection, their total estimate is an undercount, they added. The study also focuses on only the three countries where the United States launched its so-called war on terror. If the conflicts in Libya, Yemen, Somalia, or Syria — where the U.S. has conducted major military operations in recent years — had been included, the death toll would likely be significantly higher.

Some American politicians have lately evinced a refreshing willingness to make call for public accountability for the war in Yemen, where Saudi Arabia is the party that is doing the immediate harm to civilians, albeit with logistical support and weapons from the U.S. But there has been far less appetite to similarly criticize, or even account for, the many conflicts in which the United States is directly responsible for the violence — despite monumental death tolls, refugee crises, and other sobering evidence of human suffering.

“With everything going on in the United States at the moment, the fact that we’re even at war has largely fallen off the radar.”

“The major challenge in tracking the full costs of these wars is that the U.S. military doesn’t even meaningfully investigate civilian death tolls. Generally, they know it’s not good to have civilian casualties, but their focus is mainly on fighting, and there is little pressure to make protecting civilians a key priority,” said Daphne Eviatar, director of the Security With Human Rights program at Amnesty International USA. “Meanwhile, the U.S. public simply doesn’t see deaths in other countries. They don’t see civilians being killed in Iraq or Afghanistan. With everything going on in the United States at the moment, the fact that we’re even at war has largely fallen off the radar.”

The post-9/11 wars in Afghanistan and Iraq have raged on for well over a decade now. In that time, both the nature of the warfare and the enemies the U.S. is at war with have evolved. In addition, the initial invasions have generated violent new conflicts across the region between local governments and non-state actors, some of which the U.S. is also involved in.

Although public attention has almost completely drifted from Afghanistan — the war there was not even mentioned during the last two 2016 presidential debates — the United States actually dropped more bombs in that country this year than in any year since the war began. American casualties have been minimized in recent years by a greater reliance on airstrikes over ground forces, something that has also helped take American minds off the war. But U.S.-allied Afghans fighting on the ground continue to pay a horrendous toll, with thousands killed this year in the face of advances by a resurgent Taliban.

Despite all these deaths, it remains highly questionable what exactly the United States has gained from these wars. The initial confrontation with Al Qaeda, a clandestine organization numbering perhaps a few hundred people at the time of the 9/11 attacks, has somehow metamorphosed into an endless war against an expanding universe of even more extreme terrorist groups, many of which did not even exist on September 11, 2001. Entire cities have been left in ruins, with the United States offering no coherent strategy for a return to stability, or even normalcy, in the places it has been at war.

“It matters how you fight and what you do afterwards,” said Eviatar. “Hundreds of thousands of people have now been killed in the name of fighting terrorism. We need to ask who has benefitted from this, who has suffered, and what the cumulative effects are.”