Cholera cases and deaths in Sudan have surpassed 10,000, including 335 fatalities across nine states, the health ministry said on Wednesday.

The epidemic is spreading in eastern states including Kassala, Gedaref, and Red Sea, as well as in River Nile and Northern states in the north, and Al Jazirah, Sennar, White Nile and Khartoum in central and southern Sudan.

Activists say cholera has spread to five areas in Sennar state in southeast Sudan, with 48 confirmed cases. They complain of a lack of effective interventions by the health ministry or non-governmental organizations.

In the River Nile state, the health ministry reported 161 new cases, bringing the total to 2,635, with 64 deaths.

Sudan’s health situation has deteriorated, especially during the rainy season. Some 80% of health facilities in conflict areas have stopped operating amid a shortage of medicines.

A separate health ministry report said rains, floods and torrential rains have killed 225 people and injured 889. It said 73,521 families and 349,649 people have been affected, with 35,796 houses completely destroyed and 40,858 partially destroyed.