A suburb of Baghdad is currently experiencing a wave of cholera, triggered by increasingly poor hygiene and depleted resources as the Iraqi government struggles to expand its control over territories coveted by the Islamic State terrorist group.

The Parliamentary Health and Environment Committee of Iraq announced on Sunday that they had confirmed 41 cases of cholera in Iraq–most in or near Baghdad, and in Najaf and Babel provinces. At least four of those diagnosed had died at the time of the announcement. Some close to the outbreak suggest that the number might be much greater, however. Voice of America cites sources reporting at least 100 cases of the disease. Vice notes that a number of medical groups claim upwards of 300 cases of cholera so far. Many of these are symptomatic patients whose diagnosis has not been confirmed yet.

At least one of these individual outbreaks, in Abu Ghreib near Baghdad, is being blamed on poor sanitation and a lack of clean water. A combination of deteriorating infrastructure, diminishing resources due to the ongoing war with the Islamic State, and an influx of displaced Iraqis from ISIS-controlled areas is contributing to potentially create a much larger problem. To respond to the outbreak, the Iraqi government has announced that it will conduct daily water tests and dedicate more resources, including public broadcasting, to teaching Iraqis how best to avoid potentially contaminated food and water.

The Iraqi government can also only report on regions over which it has control. It is believed that a number of ISIS-controlled towns and cities are suffering severe medical and sanitation problems due to the lack of knowledge and organization on the part of the Islamic State. While the terrorist group is attempting to brand itself as a legitimate state, even releasing propaganda videos claiming they are running clean and well-stocked hospitals, reports from those inside tell a different story.

In December, reports began surfacing out of Mosul, the largest city in Iraq currently controlled by the Islamic State, of a water-borne illness that had begun ravaging jihadis and captive civilians alike. An anonymous doctor told reporters that, at its peak, Mosul General Hospital was seeing 15 patients a day with the disease, all of whom had had contact with tainted tap water. Some were even diagnosed with major diseases like hepatitis believed to have originated in the water supply. A month later, Iraqi doctors reported anonymously that they believed they had seen patients infected with Ebola.

Outside of Iraq, the Islamic State’s “capital” of Raqqa has also been suffering severe food, water, and electricity shortages. The Islamic State has apparently not yet developed a system to take care of refuse, making the city a hotbed for diseases, and the frequent entry and exit of jihadists potentially bringing diseases with them from around the world creates an even greater danger.

The International Red Cross warned this month that cholera outbreaks are possible and even expected in large cities inaccessible to international aid groups. “Over the next two years we will begin to see in cities like Aleppo potentially the rise of these big health epidemics that we haven’t seen in this context until now – typhoid, cholera and so on,” warned Patrick Hamilton, ICRC operations coordinator for the Near and Middle East.