Cholera is spreading in war-torn Sudan, killing at least 388 people and sickening about 13,000 others over the past two months, health authorities said, as more than 17 months of fighting between the military and a notorious paramilitary group shows no sign of abating.

The disease is spreading in areas devastated by recent heavy rainfall and floods especially in eastern Sudan where millions of war displaced people sheltered.

The casualties from cholera included six dead and about 400 sickened over the weekend, according to Sunday’s report by the Health Ministry. The disease was detected in 10 of the country’s 18 provinces with the eastern Kassala and al-Qadarif provinces the most hit, the ministry said.

Cholera is a fast-developing, highly contagious infection that causes diarrhea, leading to severe dehydration and possible death within hours when not treated, according to the World Health Organization. It is transmitted through the ingestion of contaminated food or water.

The disease is not uncommon in Sudan. A previous major outbreak left at least 700 dead and sickened about 22,000 in less than two months in 2017.

Sudan was plunged into chaos in April last year when simmering tensions between the military and a powerful paramilitary group, the Rapid Support Forces, exploded into open warfare across the country.

The fighting, which wrecked the capital, Khartoum, and other urban areas has been marked by atrocities including mass rape and ethnically motivated killings that amount to war crimes and crimes against humanity, especially in the western region of Darfur, according to the United Nations and international rights groups.

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