The Second Congo War, beginning in 1998, devastated the country. It involved nine African nations and some twenty armed groups. Despite the signing of peace accords in 2003, fighting continues in the east of the country. There, the prevalence of rape and other sexual violence is described as the worst in the world. The war is the world's deadliest conflict since World War II, killing 5.4 million people since 1998. The vast majority died from conditions of malaria, diarrhea, pneumonia and malnutrition.