Many thousands were killed as a direct result of factional fighting; hundreds or thousands of prisoners and civilians were executed by tribal, ethnic, or religious rivals; and a large number of combatants—and some noncombatants—were killed during the U.S. offensive. Moreover, tens of thousands died of starvation or of a variety of diseases, many of which in less-troubled times could have been easily treated, and hundreds of thousands were killed or injured by the numerous land mines in the country. (Afghanistan was, by the end of the 20th century, one of the most heavily mined countries in the world, and vast quantities of unexploded ordnance littered the countryside.) The number of Afghan refugees living abroad fluctuated over the years with the fighting and reached a peak of some six million people in the late 1980s.
