CAIRO – A fast-spreading cholera outbreak has hit Sudan, killing 172 people, with more than 2,500 others becoming ill in the past week.

Centered around Khartoum, the disease has spread as many Sudanese who had fled the country’s war return to their homes in the capital and its twin city of Omdurman. There, they often can only find unclean water — a dangerous conduit for cholera — since much of the health and sanitation infrastructure has collapsed amid the fightiing.

It is the latest calamity for the African nation, where a 2-year-old civil war has caused one of the world’s worst humanitarian crises.

Here is what to know about the new outbreak:

What’s the latest development?

The latest outbreak has killed 172 people, with more than 2,500 others becoming ill over the past week, according to the Health Ministry.

UNICEF said Wednesday that the number of reported cases surged ninefold from 90 a day to 815 a day since from May 15-25. Since the beginning of the year, more than 7,700 people have been diagnosed with cholera, including more than 1,000 children under the age of 4, it said.

Most cases have been reported in Khartoum and Omdurman, but cholera was also detected in five surrounding provinces, the ministry said.

Joyce Bakker, the Sudan coordinator for Doctors Without Borders, said the group’s treatment centers in Omdurman are overwhelmed with patients.

The “scenes are disturbing,” Bakker said. “Many patients are arriving too late to be saved … We don’t know the true scale of the outbreak, and our teams can only see a fraction of the full picture.”

What’s driving the outbreak?

Khartoum and Omdurman were a battleground throughout the civil war, nearly emptying them of residents. The region of the capital was recaptured by the military in late March from its rival, the paramilitary Rapid Support Forces, or RSF.

Since then, some 34,000 people have returned. But the city has been wrecked by months of fighting. Many found their homes damaged. Clean water is difficult to find, in part because attacks on power plants have disrupted electricity and worsened water shortages, UNICEF said. Sanitation systems are damaged.

“People have been drinking polluted water and transferring water into unhygienic containers,” said Dr. Rania Elsayegh, with Sudan’s Doctors for Human Rights.

Health workers fear the outbreak could spread quickly, since many people are packed into displacement centers making it difficult to isolate those infected. The health system has also broken down. More than 80% of hospitals are out of service and those that are operating have shortages of water, electricity and medication, said Dr. Sayed Mohamed Abdullah, of Sudan’s Doctors Union.

What is cholera?

The World Health Organization describes cholera as a “disease of poverty” because it spreads where there is poor sanitation and a lack of clean water.

It is a diarrheal disease caused when people eat food or water contaminated with the bacterium Vibrio cholerae. It is easily treatable with rehydration solutions and antibiotics. Most of those infected have only mild symptoms but, in severe cases, the disease can kill within hours if left untreated.

The WHO’s global stockpile of oral cholera vaccines has dropped below its minimum threshold of 5 million doses, making it increasingly difficult to stop outbreaks. At the same time, cholera epidemics have been on the rise around the world since 2021, because of poverty, conflict and extreme climate events like floods and cyclones, the U.N. says.

Why is this happening in Sudan?

The civil war has devastated Sudan since it erupted in April 2023, when simmering tensions between the military and the RSF exploded into open warfare across the country.

At least 24,000 people have been reported killed, though the number is likely far higher. More than 14 million have been displaced and forced from their homes, including over 4 million who streamed into neighboring countries.

Famine was announced in at least five locations with the epicenter in the wrecked Darfur region.

The fighting has been marked by atrocities including mass rape and ethnically motivated killings that the U.N. and international rights groups say amount to war crimes and crimes against humanity.

Devastating seasonal floods have compounded Sudan’s misery. Each year, dozens of people have been killed and critical infrastructure washed away.

Were there previous cholera outbreaks?

Cholera is not uncommon in Sudan. In 2017, cholera left at least 700 dead and sickened about 22,000 in less than two months.

But the war’s destruction has fueled repeated outbreaks.

Cholera spread across 11 of the country’s 18 provinces in September and October, sickening more than 20,000 people and killing at least 626, according to health authorities.

Over the course of two weeks in February and March, another outbreak infected more than 2,600 people, and 90 people died, mostly in the White Nile province, according to Doctors Without Borders.

Other diseases have also spread. In the past week, an outbreak of dengue, a mosquito-borne illness, sickened about 12,900 people and killed at least 20, the Health Ministry said Tuesday. At the same time, at least 12 people died of meningitis, a highly contagious, serious airborne viral disease, it said.

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AP correspondent Fatma Khaled in Cairo contributed to this report.