Cholera is spreading in war-torn Sudan, killing at least 388 people and leaving around 13,000 others ill over the past two months, health authorities have said.

The crisis comes as more than 17 months of fighting between the military and a notorious paramilitary group shows no sign of abating.

The disease is spreading in areas devastated by recent heavy rainfall and floods especially in eastern Sudan, where millions of war displaced people sheltered.

The casualties from cholera included six dead and about 400 sickened over the weekend, according to Sunday’s report by the health ministry.

The disease was detected in 10 of the country’s 18 provinces with the eastern Kassala and al-Qadarif provinces the worst hit, the ministry said.

Cholera is a fast-developing, highly contagious infection that causes diarrhoea, leading to severe dehydration and possible death within hours when not treated, according to the World Health Organisation. It is transmitted through the ingestion of contaminated food or water.

The disease is not uncommon in Sudan. A previous major outbreak left at least 700 dead and sickened about 22,000 in less than two months in 2017.

Sudan was plunged into chaos in April last year when simmering tensions between the military and a powerful paramilitary group, the Rapid Support Forces (RSF), exploded into open warfare across the country.

The fighting, which wrecked the capital, Khartoum, and other urban areas has been marked by atrocities including mass rape and ethnically motivated killings that amount to war crimes and crimes against humanity, especially in the western region of Darfur, according to the United Nations and international rights groups.

It has killed at least 20,000 people and wounded tens of thousands others, according to the UN However, rights groups and activists say the toll was much higher.

The war also has created the world’s largest displacement crisis. More than 13 million people have been forced to flee their homes since the fighting began, according to the International Organisation for Migration. They include more than 2.3 million who fled to neighbouring countries.

Devastating seasonal floods and cholera have compounded misery in Sudan. At least 225 people have been killed and about 900 others were injured in the floods, the health ministry said. Critical infrastructure has been washed away, and more than 76,000 houses have been destroyed or damaged, it said.

Famine was also confirmed in July in the Zamzam camp for displaced people, which is located about 10 miles from North Darfur’s embattled capital of al-Fasher, according to global experts from the Famine Review Committee.

About 25.6 million people – more than half of Sudan’s population – will face acute hunger this year, they warned.

Fighting, meanwhile, rages in al-Fasher, the last major city in Darfur that is still held by the military. The RSF has been attempting to retake it since the start of the year.

Last week, the paramilitary force and its allied Arab militias launched a new attack on the city. The military said its forces, aided by rebel groups, managed to repel the attack and kill hundreds of RSF fighters, including two senior commanders.