An outbreak of cholera in Ghana has killed at least 67 people and infected more than 5,000 others since June, according to Ghanaian health officials. The disease has been particularly active within poor neighborhoods, where overtaxed sanitation systems have aided the spread of the highly contagious illness, Reuters reports.

The capital city of Accra is the epicenter of Ghana’s battle against cholera. At least 54 people who live within or near Accra have died from the disease, while hundreds more are infected every day. Poor urban areas, many of which lack adequate plumbing, have struggled to combat the illness.

In a bid to slow the outbreak, local health officials are attempting to treat the infected while simultaneously addressing the infrastructure issues that allow cholera to rapidly spread. "It is not only a health issue, there is a big element of environmental sanitation," said Linda Van-Otoo, director of the Ghana Health Service in greater Accra.

But progress has been slow. Earlier this month, Van-Otoo described the scale of the cholera outbreak as “staggering.”

“It is a total outbreak and the cases in Accra keep increasingly daily,” she told Agence France-Presse. “We are in a pandemic situation and doing our best to deal with it.”

Cholera is an infection that can cause diarrhea, dehydration and, in some cases, death. Otoo urged residents to avoid physical contact and areas in which the sewage system has overflowed.

“[People] should wash their hands with tap water and soap and if possible avoid handshakes at public gatherings," Otoo said. “People continue to buy food near choked drains and public toilets and that is dangerous.

So far, Ghana has managed to mostly avoid the Ebola crisis that has killed more than 1,400 people in the neighboring nations of Liberia, Guinea and Sierra Leone, reporting no new cases since March. The Liberian government’s efforts on Wednesday to quarantine a neighborhood at the center of its Ebola outbreak led to clashes between protesters and local police.