At least seven people have died in <a href="https://www.thenationalnews.com/mena/2022/09/12/us-general-says-al-hol-refugee-camp-in-syria-must-be-handled-with-empathy/" target="_blank">Syria</a> amid a <a href="https://www.thenationalnews.com/mena/2022/09/12/syria-reports-three-cholera-deaths-and-two-dozen-new-cases/" target="_blank">cholera outbreak</a> that has ravaged Aleppo governorate in the north of the country. The <a href="https://www.thenationalnews.com/health/2022/07/26/how-can-the-world-halt-spread-of-monkeypox/" target="_blank">World Health Organisation</a> expressed “serious concern” about the speed of the outbreak’s spread. It said cases had been found in the east of the country and the coastal governorate of Latakia, with five provinces affected in total. The WHO said the outbreak could spread to all 14 provinces in the country if not quickly controlled. In the east of the country, former ISIS stronghold Raqqa — a city that was largely destroyed in fighting to expel the terrorists in 2018, has reported cases. The neighbouring Deir-ez-Zor province has done likewise. Both governorates are controlled by a Kurdish-Sunni anti-government alliance backed by the US known as the Syrian Democratic Forces. In the north-east, cases were also detected in Al Hasakeh province, which is also under SDF control. The Syrian health ministry confirmed the deaths out of a total of 53 cases on Tuesday. Sewage contamination in the Euphrates, which runs through most of the affected governorates, was thought to be the cause of the outbreak. The Kurdish-led administration in the east called on international agencies, “especially the World Health Organisation, to provide the necessary support to limit the spread of cholera". Syria’s water infrastructure was already substandard before the country slipped into a bloody, decade-long civil war. The embers of this are still burning in the northern province of Idlib, which is occupied by Al Qaeda-linked rebels. In Idlib, which hosts hundreds of refugee camps, most of the provinces 3.4 million people depend on foreign aid. Disease outbreaks in camps are common due to poor water quality, aid agencies say. Urban outbreaks in government-held areas have been less frequent, but still occur due to damage to water lines and treatment facilities after the conflict. In 2009 — when the country suffered its last serious cholera outbreak ― 342 cases were reported in Deir-ez-Zor and Raqqa. These are governorates which suffered government neglect and later became central to the anti-government uprising, before being taken over by ISIS. International health organisations have been warning for years that the country was at risk of a major disease outbreak. This is because so much water infrastructure has been destroyed by the war. Cholera is generally contracted from contaminated food or water, and causes diarrhoea and vomiting. It can spread in residential areas that lack proper sewerage networks or mains drinking water. More than a decade of civil war has damaged two-thirds of Syria's water treatment plants, half of its pumping stations and one-third of its water towers, Unicef has said. Nearly half the population relies on alternative and often unsafe sources of water while at least 70 per cent of sewage goes untreated, it added. An outbreak of cholera hit neighbouring Iraq this summer for the first time since 2015. Worldwide, the disease affects between 1.3 million and four million people each year, killing between 21,000 and 143,000 people.