There is only one thing as alarming as the steadily rising tally of cases of coronavirus around the world: the low numbers reported in places that it could devastate. They may have less interaction with the worst-hit nations than more developed countries. But it may also be that the countries most at risk are least equipped to monitor its spread.

Afghanistan, which has reported 22 cases, has only one hospital which can diagnose the disease, and Covid-19 is ravaging neighbouring Iran. Syria has insisted it is free of the virus, though its five neighbours have all reported cases; there is suspicion that the regime is suppressing bad news.

Coronavirus threatens us all. But poorer countries will suffer more than richer ones. Inevitably people are more susceptible when they are malnourished or already in poor health. Infections spread fast in cramped conditions.

Health services which are already failing to meet basic needs will quickly be overwhelmed. “Wash your hands” is great advice, but of limited use to the two-fifths of the world’s population who lack access to soap and clean water at home. Unicef says one in six healthcare sites have no functional toilets or hand-washing facilities where patients are treated.

The Spanish flu pandemic of 1918 shows how widely outcomes can diverge. Worldwide, between 50 million and 100 million people died. But 13 million to 15 million of those may have been in India alone, according to the book Pale Rider by Laura Spinney. People in parts of Asia were 30 times more likely to die than those in parts of Europe.

Leadership and quick reactions still make a difference. Mongolia – where 28% of the population lives below the poverty line and health services are extremely variable – moved fast to close its border with China and halt all public gatherings, stopping all flights and closing schools not long after. It has reported four cases to date. An outbreak in Somalia, struggling to emerge from dictatorship, civil war and terrorism, could be catastrophic. But it appears that the one case detected so far was found because air passengers from coronavirus hotspots have been screened, isolated and tested. It has now suspended all flights.

For those already suffering from war and other disasters, the prospect of the worst is almost unthinkable. Refugees crowded into camps are particularly vulnerable, warned Jan Egeland, secretary general of the Norwegian Refugee Council, adding: “There will also be carnage when the virus reaches parts of Syria, Yemen and Venezuela, where hospitals have been demolished and health systems have collapsed.” There are, at last, some signs of support, albeit far short of what is needed. The World Health Organization will start testing for the virus in rebel-held Idlib in north-west Syria later this week. The regime and its Russian backers have deliberately and repeatedly targeted health facilities there and around 1 million people are displaced, in many cases living without shelter never mind sanitation.

The International Rescue Committee is stepping up its work to provide sanitation and hygiene facilities in Afghanistan and Iran. Bloomberg Philanthropies, the multibillionaire Michael Bloomberg’s charitable foundation, says it will fund a $40m global initiative to fight the virus’s spread in low- and middle-income countries, especially in Africa. Jack Ma, the Chinese billionaire founder of Alibaba, has announced that he is donating test kits, masks and protective suits for medics to each African country. When the world is threatened, people think first and foremost about their own communities. But the most vulnerable must not be abandoned.

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