Malawi’s cholera outbreak has claimed more than 1,000 lives, according to the country’s health minister, who warned that some cultural beliefs and hostility toward health workers were slowing efforts to curb infections.

Cholera had killed 1,002 people as of Tuesday, while 1,115 people were hospitalized from the outbreak that started in March 2022, Minister of Health Khumbize Kandodo Chiponda said. It’s the country’s worst outbreak of the waterborne illness in two decades.

The country of 20 million people recorded 12 deaths from 626 new cases in 24 hours, she said.

Frustration and suspicion over the rising cases resulted in weekend violence. Angry villagers beat up health workers and damaged a facility at the Nandumbo Health Centre in the Southern Region’s Balaka district.

Residents accused health workers of denying them an opportunity to conduct dignified burials. They forced some health workers to vacate the facility, stoned a cholera isolation ward and forced the discharge of 22 cholera patients.

Esnath Suwedi, vice-chairperson of the Nandumbo area’s development committee, a traditional local authority, said people thought the health workers were acting “mysteriously.”

Suwedi said residents alleged the workers were using contaminated syringes to inject people. The Balaka district is one of the worst affected areas, recording 46 deaths from 1,450 cases in the outbreak.

Cultural burial rites are also becoming a source of contention, Chiponda, the health minister, said during a daily briefing Tuesday.

“For example, people who are dying of or who have died from cholera may be washed by family members, who then prepare funeral feasts for family and friends held very soon after death. Outbreaks of cholera commonly follow these feasts,” the minister said.