Human Rights Watch (HRW) raised alarm on Wednesday over a spike in cholera cases in Haiti’s West department. The rights group emphasized “the urgent need for coordinated, long-term action to restore basic water and sanitation systems.” Haitian health authorities have already recorded “2,852 suspected cholera cases, 186 confirmed cases, and 48 deaths” from January 1 to October 30 this year.

The rights group said that the outbreak, concentrated in the capital Port-au-Prince and surrounding areas, is exacerbated by the “near collapse of the capital’s health infrastructure.” According to data from the UN, only 25 percent of Haitian households have adequate handwashing facilities, and 70 percent lack access to a proper sanitation system. HRW further highlighted the role of “extreme insecurity” caused by criminal groups, which have displaced over 1.4 million people this year and forced them into overcrowded settlements without clean water. Response efforts, coordinated by the Haitian Ministry of Public Health and Population (MSPP), have been severely hampered by gang control of key areas, which blocks humanitarian access.

Heavy rains from Hurricane Melissa, in addition to existing infrastructure challenges, “create ideal conditions for outbreaks to spread” according to Diana Manilla Arroyo from Médicins Sans Frontières. Nathalye Cotrino, senior Americas researcher for HRW, stated:

Cholera is once again threatening thousands of lives in Haiti because people lack access to the most basic services: clean water, sanitation, and medical care. Haitians need serious government and international efforts to address the outbreak and avoid more preventable deaths.

HRW called on Haiti’s transitional government to “urgently repair the national water and sewage network, guarantee safe humanitarian access to high-risk areas, and restore the operational capacity of public health institutions” with the support of the international community. It further urged an end to deportations to Haiti from countries such as the Dominican Republic and the United States, which has totaled over 225,000 this year according to the International Organization for Migration (IOM).

Haiti has struggled with cholera since 2010, after sewage from a UN peacekeeping base contaminated a river causing about 9,800 deaths. The UN apologized for the incident in 2016.