There are over 70 million people worldwide who have been driven from their homes by war and unrest, up to 10 million are packed into refugee camps and informal settlements, and almost none have been tested for the coronavirus.

While the relative isolation of many camps may have slowed the virus’ spread, none is hermetically sealed. Without testing, the virus can spread unchecked until people start showing symptoms. If it does, there will be few if any intensive care beds or ventilators. There might not even be gloves or masks.

“Testing is in short supply even in New York and Norway, but it is nonexistent in most of the countries in the (global) south for the people we try to help,” Jan Egeland, the head of the Norwegian Refugee Council, told The Associated Press.

His group recently conducted a review of all 30 countries where it operates and found virtually no testing before people became sick.

In Syria’s war-ravaged Idlib province, only one small health facility is equipped to receive suspected coronavirus cases. In Bangladesh, aid workers are racing to build isolation facilities in the world’s largest refugee camp. In two sprawling camps in Kenya, Somalis who survived decades of famine and war fear the worst is yet to come.

“If it’s killing people daily in America, then what do you think will happen to us?” asked Mariam Abdi, a vegetable vendor in Kenya’s Dadaab camp, where 217,000 people live in endless rows of tents. “We will all perish.”

In many camps, cramped conditions and poor infrastructure can make it impossible to practice social distancing and frequent hand-washing. On Wednesday, a Palestinian woman from war-ravaged Syria became the first refugee living in a camp in Lebanon to test positive, sparking a round of testing by health officials to see if any other residents have been infected.

Western countries, which by then may have contained their own outbreaks, will have to reckon with the fact that if the virus finds refuge among the world’s most vulnerable, it could return anytime.

There are no official figures for the number of refugees who live in camps, but Egeland estimates they make up 10% to 15% of all refugees and displaced people, a population the U.N. estimates at over 70 million.

Refugees have already tested positive in Italy, Germany, Iran, Australia and Greece, where authorities said Tuesday that 150 people living in a quarantined hotel for asylum-seekers had contracted the coronavirus.

Most people who become infected experience mild to moderate symptoms. But the virus can cause severe illness and lead to death, particularly among the elderly and infirm.

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A ‘MIRACLE’ THAT NO CASES HAVE BEEN FOUND

The coronavirus has already appeared in Syria, where the decade-long civil war has displaced more than half of the population of 23 million. At least 350 health facilities have been bombed, mostly by the government. More than 900 medical staff have been killed and countless more have fled.

But no cases have been reported yet in Syria’s northwestern Idlib province, where a government offensive displaced nearly a million people earlier this year and where authorities have carried out around 200 tests.

Zaher Sahloul, a Syrian physician based in Chicago who heads MedGlobal, an international health NGO, calls that a “miracle” and says an outbreak there would be “catastrophic.”

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‘NO DOCTORS CAN SAVE US’

There’s been little if any testing in Cox’s Bazar, in Bangladesh, where more than a million members of Myanmar’s Rohingya Muslim minority are packed into the world’s largest refugee camp.

Kate White, the emergency medical co-ordinator for Doctors Without Borders, said there is “very limited testing capacity” in Bangladesh, and most is in the capital.

While cases have been reported in the district, none have been detected inside the camp.

The U.N. refugee agency is building isolation and treatment centres that can house 150-200 patients.

Sakina Khatun, who lives with her husband and seven children in a small bamboo and tarp hut, said “the virus will kill everything it touches” if it enters the camps. “No doctors can save us then.”

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‘IT WILL CERTAINLY COME BACK’

There’s a similar sense of foreboding in conflict zones across Africa.

In Burkina Faso, 800,000 people have fled attacks by jihadis in recent months.

Aguirata Maiga says soap is so expensive for her that she has to choose between washing her children’s hands and their clothes.

The country's fragile health system has only 60 intensive care beds and a handful of ventilators, for a population of around 20 million.

In Kenya’s crowded Kakuma refugee camp, more than 190,000 refugees live in tents and rely on 19 wells.

There is no coronavirus testing at Kakuma or Dadaab, said the IRC’s Kenya health co-ordinator, John Kiogora. There are no intensive care units or ventilators, either.

“If the coronavirus is spread from Europe, via Turkey, to Idlib, and gains a stronghold there, it will certainly come back to Europe,” said Egeland.

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Krauss reported from Jerusalem, Jain from New Delhi and Anna from Johannesburg. Associated Press writers Sam Mednick in Ouagadougou, Burkina Faso, Sarah El Deeb in Beirut, Samya Kullab in Baghdad, Christine Armario in Bogota, Colombia, and Scott Smith in Caracas, Venezuela, contributed.

News from © The Associated Press, 2020