A major outbreak of measles has killed almost 320 people and infected more than 20,000 in the southeast of the Democratic Republic of Congo, the United Nations has announced.

“The toll is heavy and worrying: since January 1, 2015, more than 20,000 cases of measles have been registered in Katanga province alone” and “almost 320 people have died,” the U.N. Office for the Coordination of Humanitarian Affairs (OCHA) said in a statement this week.

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“Dozens of others may have succumbed to the illness but they don’t figure on official records,” the statement added.

The outbreak in mineral-rich Katanga is the worst since 2011, according to Medecins Sans Frontieres (MSF – Doctors without Borders), which is on the front line of a vaccination campaign in remote areas. In 2011, MSF staff immunised about 1.5 million children.

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In 2013, 9,400 cases of measles were registered in Katanga, compared with more than 12,000 the following year.

OCHA warned that in 2015 the situation “is only getting worse” and said that some of the affected areas also face malnutrition and cholera.

“In populations with high levels of malnutrition and a lack of adequate health care, up to 10 percent of measles cases result in death,” the U.N. World Health Organization (WHO) noted on its website.

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Aid agencies say that about a third of the affected areas in Katanga are covered by a vaccination programme.

The United Nations and medical charities estimate that more than 2.4 million dollars (2.15 million euros) are needed to complete vaccinations and provide other essential care. But to contain the disease of “an epidemic nature,” other serious obstacles must be confronted.