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Of the admitted cholera patients who died, 18 were children, including five children who are no older than 5, and five others who were no older than 9, Marta Cazarola, MSF emergency coordinator for Sudan, told The Associated Press.

Sudan plunged into war nearly two years ago when tensions simmered between the Sudanese army and its rival paramilitary Rapid Support Forces group, or RSF, with battles in Khartoum and across the country.

RSF launched intense attacks last month in the White Nile State that , including infants. The Sudanese military announced at the time that it made advances there, cutting crucial supply routes to RSF.

During the RSF attacks in the state on Feb. 16, the group fired a projectile that hit the Rabak power plant, causing a mass power outage and triggering the latest wave of cholera, according to MSF. Subsequently, people in the area had to rely mainly on water obtained from donkey carts, because water pumps were no longer operational.

“Attacks on critical infrastructure have long-term detrimental effects on the health of vulnerable communities,� said Marta Cazorla, MSF emergency coordinator for Sudan.

The cholera outbreak in the state peaked between Feb. 20-24, when patients and their families rushed to Kosti Teaching Hospital, overwhelming the facility beyond its capacity, according to MSF. Most patients were severely dehydrated. MSF provided 25 tons of logistical items such as beds and tents to Kosti to help absorb more cholera patients.

Cazarola said that numbers in the cholera treatment center were declining and at low levels until this latest outbreak.

The White Nile State Health Ministry responded to the outbreak by providing the community access to clean water and banning the use of donkey carts to transport water. Health officials also administered a vaccination campaign when the outbreak began.

Sudan’s health ministry that there were 57,135 cholera cases, including 1,506 deaths, across 12 of the 18 states in Sudan. Cholera was officially declared an outbreak on Aug. 12 last year by the health ministry after a new wave of cases was reported starting July 22.

The war in Sudan has killed at least 20,000 people, though the number is likely far higher. The war has driven more than 14 million people from their homes, pushed parts of the country into famine, and caused disease outbreaks.