Hundreds of thousands of children have been infected with suspected cholera in Yemen in the first six months of 2019 and the death toll is set to soar as the rainy season begins, aid groups warn.

There have been 440,000 suspected cholera cases reported in the civil war hit nation in 2019, already eclipsing the total of the previous year, the charity Save the Children said.

Data from the World Health Organisation shows that nearly half (203,000) of the infected cases are children, and the charity warns there have been 193 child deaths so far.

Death rates from the disease have doubled as conflict, now in its fourth year, has destroyed clean water and sanitation infrastructure that is necessary to prevent cholera spreading.

The bacteria lives in contaminated water and causes uncontrollable vomiting, diarrhoea and severe cases can lead to death by dehydration within hours.

Children suffering from acute malnutrition in Yemen Show all 17 1 /17 Children suffering from acute malnutrition in Yemen Children suffering from acute malnutrition in Yemen Doctors take some blood of Yemeni Yousef Abdullah Bakhit Ali, 13, suffering from severe acute malnutrition. With ongoing and unending conflict in Yemen, humanitarian situation continues to deteriorate across the country Unicef/Huwais Children suffering from acute malnutrition in Yemen A doctor weighs Yemeni baby Yahya Hamoud Ali Al Huzef, 9 months suffering from malnutrition Unicef/Huwais Children suffering from acute malnutrition in Yemen Ali Mohammed Ahmed Jamal,12 years old and suffering from severe acute malnutrition. He arrives with his family at a Unicef supported treatment centre in a hospital in Sanaa Unicef/Huwais Children suffering from acute malnutrition in Yemen A doctor measures the arm of Yemeni Ali Mohammed Ahmed Jamal, 12, who is suffering from malnutrition at a treatment centre in a hospital in Sanaa Unicef/Huwais Children suffering from acute malnutrition in Yemen There are over 400,000 severely malnourished children in need urgent lifesaving assistance in Yemen Unicef/Abdulhaleem Children suffering from acute malnutrition in Yemen Ali Mohammed Ahmed Jamal is weighed Unicef/Huwais Children suffering from acute malnutrition in Yemen A doctor measures the arm of baby Yahya Hamoud Ali Al Huzef Unicef/Huwais Children suffering from acute malnutrition in Yemen Unicef are currently working to reach 275,000 malnourished children with critical life-saving supplies and care for over 5 million people with safe and clean water to stop the spread of life-threatening diseases Unicef/Huwais Children suffering from acute malnutrition in Yemen Yahya Hamoud Ali Al Huzef with his family in his house in the outskirts of the capital Sanaa Unicef/Huwais Children suffering from acute malnutrition in Yemen The country is on the brink of famine and children's chances of survival are becoming slimmer by the day Unicef/Abdulhaleem Children suffering from acute malnutrition in Yemen Ali Mohammed Ahmed Jamal has his arm measured Unicef/Huwais Children suffering from acute malnutrition in Yemen Unicef are currently working to provide nearly 1 million children with vaccines and healthcare Unicef/Huwais Children suffering from acute malnutrition in Yemen Doctors take some blood of Yemeni Yousef Abdullah Bakhit Ali, 13 years old suffering from severe acute malnutrition at a treatment centre in a hospital in the capital Sanaa on November 2, 2018. (Release obtained) With ongoing and unending conflict in Yemen, humanitarian situation continues to deteriorate across the country. There are over 400,000 severely malnourished children in need urgent lifesaving assistance in Yemen. The country is on the brink of famine and childrenâ€™s chances of survival are becoming slimmer by the day. UNICEF are working with partners around-the clock to save children suffering from malnutrition and disease. We are currently working to reach: â€¢ 275,000 malnourished children with critical life-saving supplies and care â€¢ Over 5 million people with safe and clean water to stop the spread of life-threatening diseases â€¢ Nearly 1 million children with vaccines and healthcare â€¢ 9 million people with emergency cash assistance to help families buy basic commodities so they can survive Â© UNICEF/UN0253367/ Huwais Unicef/Huwais Children suffering from acute malnutrition in Yemen Unicef are working with partners around-the clock to save children suffering from malnutrition and disease Unicef/Abdulhaleem Children suffering from acute malnutrition in Yemen Unicef are currently working to provide 9 million people with emergency cash assistance to help families buy basic commodities so they can survive Unicef/Huwais Children suffering from acute malnutrition in Yemen Ali Mohammed Ahmed Jamal is suffering from malnutrition Unicef Children suffering from acute malnutrition in Yemen On 31 October 2018 in Yemen, the Al Thawra Hospital in Hodeidah where children are being treated for severe acute malnutrition. UNICEF Regional Director for Middle East and North Africa Geert Cappelaere visited Yemen from 29 October through 1 November 2018. As of 30 October 2018, over 11 million children â€“ 80 per cent of all children in the country â€“ require humanitarian assistance, due to the impact of the ongoing conflict. Worsening years of underdevelopment, attacks against civilians and civilian infrastructure and lack of salary payments for most civil servants have pushed basic services for children to the brink. Children face food shortages, disease, displacement and an acute lack of access to basic social services. One out of three children in Yemen is at risk of acute malnutrition. Â© UNICEF/UN0253574/Abdulhaleem Unicef/Abdulhaleem

Compared with the end of June 2018, nine times more people have died so far in 2019 and Save the Children is appealing for a renewed aid effort ahead of the country’s rainy season

“Disease outbreaks are now rife due to the collapse of the health system and weak sanitation systems and a population made increasingly vulnerable by forced displacement and malnutrition,” Tamer Kirolos, Save the Children’s country director in Yemen, said.

“The number of suspected cases has been relatively steady for some weeks, but the disease is endemic and we’re fearing a sharp spike because of the rains and flooding.”

Health services are also under strain with only half of health hospitals and clinics fully operational – the rest are closed or only partially operational.

The conflict in Yemen has left around 9.2 million children without proper access to safe water. Fuel availability is fluctuating, limiting the pumping of sewage and rubbish collection, leaving many parts of Yemen a breeding ground for infectious and waterborne diseases such as cholera.

Malnourished children are three times as likely to die from cholera infection and the disease itself is a major contributor to malnutrition in the country.

Aid groups are distributing rehydration supplements as well as water purification and medical facilities – though without an end to the war these solutions are only temporary.

“As long as the conflict rages on, clean water systems are breaking down and funding of aid in Yemen remains too low, all we can do is try and keep as many children as possible alive,” Mr Kirolos added.

Save the Children is calling on the UK to continue using its power at the UN Security Council to press all parties to implement the Stockholm Agreement in good faith.