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An outbreak of cholera in South Sudan has reached the country’s second-largest city of Malakal, which has been ravaged by the three-year civil war, the Associated Press agency reports.

Cholera is a fast-developing, highly contagious infection that can spread in areas without clean drinking water and with poor sanitation.

The number of cases reported nationwide to have risen to 5,500. Cholera now has been confirmed in 14 counties, with at least 137 deaths since June.

BBC reports that the ongoing civil war and drought in the country has complicated the aid response especially in the northern county of Mayendit where local authorities told aid workers late last month to leave the area because of fighting, Farhan Haq, the deputy spokesman for the UN chief, is said to have told reporters on Friday.

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