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While all U.S. states have started easing Stay at Home orders, developing countries in the Middle East and Africa have begun to prepare for the worst possible outcome. The United Nations High Commissioner for Refugees (UNHCR) has set its sights on Syria, Yemen, and South Sudan: nations with millions living in crowded spaces with little to no access to basic healthcare services.

16 February 2016, Syria: People carry medical supplies found under the rubble of a destroyed Doctors Without Borders-supported hospital in Marat al-Numan, Idlib province. Photo: Ammar Abdullah/Reuters

6.5 million internally displaced people live in the Syrian Arab Republic. The country has been at war for almost nine years, and the fighting has taken a toll on the nation’s healthcare system. According to the World Health Organization, “only 64% of hospitals and 52% of primary healthcare centers are functioning, while 70% of the health workforce has left the country.” Thousands of doctors, nurses, and medical volunteers have been systematically targeted and killed by pro-government forces as a result of the conflict. As of May 26, Syria’s health ministry had reported 121 coronavirus cases, but Western intelligence officials believe the official tally is likely far too low, as the Assad regime has sought to limit case reporting and confirmation. The government has imposed preventative measures in the country’s largest cities, such as a nighttime curfew and travel restrictions. However, Syrians living in Idlib, the country’s last rebel-held area, remain highly vulnerable to an outbreak due to limited medical supplies and previous bombings of hospitals by the regime.

10 June 2018, Yemen. Houthi authorities in Yemen have arbitrarily detained, tortured, and forcibly disappeared numerous opponents, says Human Rights Watch. Photo: Yahya Arhab/EPA

Across the world, concerns have also been raised about the spread of the coronavirus within prisons and detention centers. In Yemen, regarded as one of the least developed countries in the world, officials urged warring parties to free the country’s political prisoners and detainees. The Group of Eminent International and Regional Experts on Yemen consider these war victims particularly high risk and vulnerable to infection, as prison overcrowding has made self-isolation and social distancing nearly impossible. On April 2, the Yemeni government released more than 470 prisoners, and a week later the Houthi movement followed suit. Nevertheless, Yemen’s collapsing health infrastructure and an increase in fighting have undermined the country’s ability to handle an outbreak. The first coronavirus cases in Yemen were confirmed in late April and have continued to increase since then, prompting renewed calls for a humanitarian cease-fire from the United Nations and other groups.

13 March 2020, Ethiopia: A South Sudanese refugee child prepares a meal at a Jewi refugee camp.  Photo: Eduardo Soteras Jalil/UNHCR

Similar circumstances plague the country of South Sudan. The African nation has a population of over 10 million, with approximately 2 million of those individuals being internally displaced. In crowded refugee camps throughout the country, individuals live just inches apart from each other. In mid-May, two coronavirus cases were reported in a camp outside the capital, raising concerns among humanitarians about an outbreak in the settlement. During the first week of April, government officials implemented a nationwide curfew, limited social gatherings, and closed down several establishments to stop the spread of the virus. Officials warn it may not be enough: with the combination of people living in such close proximity and the vast majority unable to access the most basic healthcare, the spread of COVID-19 could lead to high numbers of preventable deaths.

With the global economy in crisis, humanitarian aid has slowed and resources are dwindling. Developed countries are already feeling the strain of the COVID-19 pandemic, so the spread of the virus to developing countries is increasingly a cause for concern. As researchers continue working on a vaccine, how well governments respond to the pandemic and whether armed groups cease fire will determine the fate of millions of people in the world’s poorest countries.

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