Syria’s first major cholera outbreak in more than a decade has killed seven people and infected more than 50, the health ministry said, amid water shortages and conflict-damaged water treatment infrastructure, Agerpres reports.

The ministry confirmed in a statement Tuesday evening the presence of 53 cholera cases in five of the country’s 14 provinces, with the largest number reported in the northern province of Aleppo. Seven people died from the disease, the ministry added.

The World Health Organization (WHO) warned on Tuesday about the “very high” risk of cholera spreading in Syria.

Cholera is an acute diarrheal infection that causes dehydration, sometimes fatal, and is contracted through drinking water or food contaminated with the bacterium Vibrio cholerae.

Cholera can spread in residential areas without sewage or potable water. According to the United Nations Children’s Fund (UNICEF), two-thirds of Syria’s sewage treatment plants, half of its pumping stations and a third of its water towers have been damaged during more than a decade of civil war in the country.

According to UNICEF, nearly half the population relies on alternative and often unreliable water sources, and at least 70% of wastewater is untreated.

This summer, for the first time since 2015, a cholera epidemic has hit Syria’s neighboring Iraq.

Worldwide, cholera affects 1.3 to 4 million people annually, causing 21,000 to 143,000 deaths.

• Read also: The reappearance of cholera brought the first victim in Iraq / Everything about this disease