A cholera outbreak in Yemen has killed at least 180 people since 27 April, the International Committee ofthe Red Cross has said.

Two years into a war between Houthi rebels and government forces allied with a Saudi-led Arab military coalition, which has killed more than 8,000 people, Yemen has declared a state of emergency in the capital Sana’a over the outbreak.

Fighting has taken a toll on medical facilities in the war-torn country, as more than half of Yemen’s facilities, which are now operated by Houthi rebels, no longer function.

The U.N. says some 17 million of Yemen’s 26 million people lack sufficient food and at least three million malnourished children are in “grave peril.”

U.N. Humanitarian Coordinator Jamie McGoldrick and other international officials met with the health ministry in the Houthi-run capital of Sana’a, urging aid donors to assist to avoid an “unprecedented disaster.”

Yemen, which is the Arab world’s poorest nation, is now classified by the World Health Organization as a level three emergency, alongside Syria, South Sudan, Nigeria and Iraq.

Cholera is an acute enteric infection caused by the ingestion of bacterium Vibrio cholerae present in faecally contaminated water or food. Primarily linked to insufficient access to safe water and proper sanitation, its impact can be even more dramatic in areas where basic environmental infrastructures are disrupted or have been destroyed. Countries facing complex emergencies are particularly vulnerable to cholera outbreaks.

Massive displacement of IDPs or refugees to overcrowded settings, where the provision of potable water and sanitation is challenging, constitutes also a risk factor. In consequence, it is of paramount importance to be able to rely on accurate surveillance data to monitor the evolution of the outbreak and to put in place adequate intervention measures Coordination of the different sectors involved is essential, and WHO calls for the cooperation of all to limit the effect of cholera on populations.

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