The World Health Organization warned on Tuesday of a “very high” risk of cholera spreading in Syria after the country reported its first cases since 2009.

“The risk of cholera spreading to other governorates is very high,” the WHO said after cases of the disease were reported in at least five of the country’s 14 provinces.

“The source of infection may be related to human consumption of water from untreated sources” or “contamination of food due to irrigation of plants with contaminated water,” the WHO said in a statement.

On Monday, Syria’s health ministry reported two deaths from cholera in government-controlled areas.

On Saturday, Kurdish authorities reported three deaths in areas of northern and eastern Syria under their control.

WHO said the cases were the first reported in Syria since 2009, when 342 cases were confirmed in eastern Deir ez-Zor province and northern Raqqa province.

The disease is usually contracted through contaminated food or water and causes diarrhea and vomiting.

It can spread in residential areas without proper sewage networks or water supply.

A decade of civil war has damaged two-thirds of Syria’s sewage treatment plants, half of its pumping stations and one-third of its water towers, according to the United Nations Children’s Fund (UNICEF).

Almost half the population relies on alternative and often unsafe water sources, while at least 70 percent of sewage remains untreated, the report added.

On Monday, the UN made an urgent appeal to donor countries for additional funding to fight the outbreak.

“The outbreak poses a serious threat to people in Syria and the region,” said UN Resident and Humanitarian Coordinator for Syria Imran Riza.

“Rapid and urgent action is needed to prevent further illness and death.”

The UN said the source of the outbreak “is believed to be people drinking unsafe water from the Euphrates River and using contaminated water to irrigate crops, leading to food contamination.”

A cholera outbreak hit neighboring Iraq this summer for the first time since 2015.

The disease affects between 1.3 and four million people worldwide each year, killing between 21,000 and 143,000.

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