Marwa Khaled’s teenage son was hospitalized with cholera after drinking polluted water in impoverished northern Lebanon – and yet she still buys the same polluted water, the only one she can afford.

“People know (the water is contaminated) but they have no choice,” said 35-year-old Khaled, standing next to her son, who is bedridden in a cholera field hospital.

“Everyone will end up with cholera.”

Last month, Lebanon recorded its first cholera case since 1993 in the nearby Rihaniye Syrian refugee camp – weeks after an outbreak in Syria, some 20 kilometers away.

Now the World Health Organization is warning that the waterborne disease is spreading “rapidly” as Lebanon struggles with crumbling infrastructure, poor sanitation and limited access to clean water after three years of economic collapse.

Over a quarter of the country’s more than 400 recorded cases are from Khaled’s hometown of Bebnine, where people are resorting to unsafe water sources as the state fails to provide clean water.

The real number of cases could be much higher as the Ministry of Health records more than 2,400 suspected and confirmed infections.

The mother-of-six and her family drink contaminated water that is transported to her home from nearby wells and water sources because they do not have access to running water and cannot afford bottled water.

Like much of Lebanon’s marginalized north, Bebnine suffers from decaying infrastructure and government neglect.

A quarter of the city’s residents are Syrian refugees living in miserable conditions.

Just 500 of Bebnine’s households are registered with the state water network in a crowded city of 80,000, according to engineer Tareq Hammoud of the North Lebanon Water Establishment.

But even these are not supplied with water around the clock.

A branch of the sewage-polluted Nahr al-Bared river flows through the city and has been contaminated with cholera, infecting nearby wells and water sources, field hospital director Nahed Saadeddine said.

Around 450 patients come to the hospital for treatment every day, she said.

The contaminated stream “provides water for all the crops in the area… There are wells, tanks and springs that draw water from it, even water filtration plants,” Saadeddine told AFP.

Cholera is generally transmitted through contaminated food or water and causes diarrhea and vomiting.

It can also spread in residential areas that lack proper sanitation and drinking water systems.

“The infrastructure needs to be changed, wells and water sources improved” to eradicate the disease, Saadeddine said.

“We want a long-term solution. Otherwise we will see many more disasters.”

The disease can be fatal within hours if left untreated, according to the WHO, but many of those infected have no or only mild symptoms.

It can be easily treated with oral rehydration solution, but more severe cases may require intravenous fluids and antibiotics.

Some patients at the hospital have contracted the disease more than once, including Rana Ajaj’s nine-year-old daughter.

“Five of us are sick at home. Even after the treatment, if we drink the same water, we’ll get nauseous again,” the 43-year-old said, handing a cup of water to her 17-year-old daughter who was lying in bed while her younger daughter sat next to her.

In the bed next door, 10-year-old Malek Hamad was struggling to drink his medicine, exhausted from a 30-pound weight loss after a two-week illness.

His mother is very concerned that her 10 other children may also be infected.

In front of the hospital, Headmistress Sabira Ali walked along the banks of the polluted creek and stared at the water.

“Coronavirus didn’t scare me as much as cholera,” said the 44-year-old, who lost two family members to cholera last month.

Jamal al-Sabsabi, 25, from Bebnine, accused local authorities of failing to act when disease struck the town.

“What is the community doing?” he asked.

“Sewage, diapers, garbage…everything is dumped into the creek,” al-Sabsabi said, pointing to the murky creek that flows a few meters (yards) from his home.

“No wonder the disease is spreading.”