The phrase "terrible toll" means a very high and devastating cost or consequence. It suggests that something negative or tragic has caused a great amount of damage, loss, or suffering. Full definition
«Oil spills like the one nearly a year ago in the Gulf of Mexico exact a long and terrible toll on marine life,» especially species like the dwarf seahorse that have already been struggling to survive,» Curry remarked in a statement to the press. (earthtimes.org)
The terrible toll of deaths linked to pneumonia and influenza this year may be slowing as well. (fortune.com)
Vaccines are also critical to reducing preventable childhood deaths from pneumonia and diarrheal disease, which continue to take a terrible toll in Africa. (fortune.com)