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Worst virus fears are realized in poor or war-torn countries

For months, experts have warned of a potential nightmare scenario: After overwhelming health systems in some of the world’s wealthiest regions, the coronavirus gains a foothold in poor or war-torn countries ill-equipped to contain it and sweeps through the population.

Now some of those fears are being realized.

In southern Yemen, health workers are leaving their posts en masse because of a lack of protective equipment, and some hospitals are turning away patients struggling to breathe. In Sudan’s war-ravaged Darfur region, where there is little testing capacity, a mysterious illness resembling COVID-19 is spreading through camps for the internally displaced.

FILE - In this Thursday, April 30, 2020 file photo, medical workers in protective suits bury the body of an elderly man believed to have died from the coronavirus in Mogadishu, Somalia. For months, experts have warned of a potential nightmare scenario: After overwhelming health systems in some of the world's wealthiest regions, the coronavirus gains a foothold in poor or war-torn countries ill-equipped to contain it and sweeps through the population. (AP Photo, File)

Cases are soaring in India and Pakistan, together home to more than 1.5 billion people and where authorities say nationwide lockdowns are no longer an option because of high poverty.

In Latin America, Brazil has a confirmed caseload and death count second only to the United States, and its leader is unwilling to take steps to stem the spread of the virus. Alarming escalations are unfolding in Peru, Chile, Ecuador and Panama, even after they imposed early lockdowns.

The first reports of disarray are also emerging from hospitals in South Africa, which has its continent’s most developed economy. Sick patients are lying on beds in corridors as one hospital runs out of space. At another, an emergency morgue was needed to hold more than 700 bodies.

FILE - in this Wednesday, June 3, 2020 file photo, children run down a street past an informational mural warning people about the dangers of the new coronavirus, in the Kibera slum, or informal settlement, of Nairobi, Kenya. (AP PhotoBrian Inganga, File)

“We are reaping the whirlwind now,” said Francois Venter, a South African health expert at the University of Witswatersrand in Johannesburg.

Worldwide, there are 10 million confirmed cases and over 500,000 reported deaths, according to tally by Johns Hopkins University of government reports. Experts say both those numbers are serious undercounts of the true toll of the pandemic, due to limited testing and missed mild cases.

South Africa has more than a third of Africa’s confirmed cases of COVID-19. It's ahead of other African countries in the pandemic timeline and approaching its peak. If its facilities break under the strain, it will be a grim forewarning because South Africa’s health system is reputed to be the continent's best.

FILE - In this Thursday, June 25, 2020 file photo, police officers stop motorcyclists from entering a restricted area that is sealed off to control the spread of the coronavirus, in Lahore, Pakistan. For months, experts have warned of a potential nightmare scenario: After overwhelming health systems in some of the world's wealthiest regions, the coronavirus gains a foothold in poor or war-torn countries ill-equipped to contain it and sweeps through the population. (AP PhotoK.M. Chaudhry, File)

Most poor countries took action early on. Some, like Uganda, which already had a sophisticated detection system built up during its yearslong battle with viral hemorrhagic fever, have thus far been arguably more successful than the U.S. and other wealthy countries in battling coronavirus.

But since the beginning of the pandemic, poor and conflict-ravaged countries have generally been at a major disadvantage, and they remain so.

The global scramble for protective equipment sent prices soaring. Testing kits have also been hard to come by. Tracking and quarantining patients requires large numbers of health workers.

FILE - In this Friday, June 26, 2020 file photo, health workers take a nasal swab sample during a testing and screening operation for the new coronavirus, in Hyderabad, Pakistan. (AP PhotoPervez Masih, File)

“It’s all a domino effect,” said Kate White, head of emergencies for Doctors Without Borders. “Whenever you have countries that are economically not as well off as others, then they will be adversely affected.”

Global health experts say testing is key, but months into the pandemic, few developing countries can keep carrying out the tens of thousands of tests every week that are needed to detect and contain outbreaks.

“The majority of the places that we work in are not able to have that level of testing capacity, and that’s the level that you need to be able to get things really under control,” White said.

FILE — In this April 29 2020 file photo a resident from the Alexandra township gets tested for COVID-19 , in Johannesburg, South Africa. For months, experts have warned of a potential nightmare scenario: After overwhelming health systems in some of the world's wealthiest regions, the coronavirus gains a foothold in poor or war-torn countries ill-equipped to contain it and sweeps through the population. (AP PhotoJerome Delay, File)

South Africa leads Africa in testing, but an initially promising program has now been overrun in Cape Town, which alone has more reported cases than any other African country except Egypt. Critical shortages of kits have forced city officials to abandon testing anyone for under 55 unless they have a serious health condition or are in a hospital.

Venter said a Cape Town-like surge could easily play out next in “the big cities of Nigeria, Congo, Kenya,” and they “do not have the health resources that we do.”

Lockdowns are likely the most effective safeguard, but they have exacted a heavy toll even on middle-class families in Europe and North America, and are economically devastating in developing countries.

FILE — In this May 6, 2020 file photo a man wears a plastic bag for a mask on his face as a precaution against the spread of the coronavirus, in Katlehong, Johannesburg. (AP PhotoThemba Hadebe, File)

India's lockdown, the world's largest, caused countless migrant workers in major cities to lose their jobs overnight. Fearing hunger, thousands took to the highways by foot to return to their home villages, and many were killed in traffic accidents or died from dehydration.

The government has since set up quarantine facilities and now provides special rail service to get people home safely, but there are concerns the migration has already spread the virus to India's rural areas, where the health infrastructure is even weaker.

Poverty has also accelerated the pandemic in Latin America, where millions with informal jobs had to go out and keep working, and then returned to crowded homes where they spread the virus to relatives.

FILE — In this May 2, 2020 file photo thousands line up to receive food handouts in the Olievenhoutbos township of Midrand, South Africa. (AP PhotoJerome Delay, File)

Peru's strict three-month lockdown failed to contain its outbreak, and it now has the world's sixth-highest number of cases in a population of 32 million, according to by Johns Hopkins University. Intensive care units are nearly 88% occupied, and the virus shows no sign of slowing.

“Hospitals are on the verge of collapse,” said epidemiologist Ciro Maguiña, a professor of medicine at Cayetano Heredia University in the capital, Lima.

Aid groups have tried to help, but they have faced their own struggles. Doctors Without Borders says the price it pays for masks went up threefold at one point and is still higher than normal.

FILE - In this Wednesday, June 17, 2020 file photo Cemetery workers place into a grave the coffin that contains the remains Juliana Ramos at the Martires 19 de Julio cemetery, on the outskirts of Lima, Peru. (AP PhotoMartin Mejia, File)

The group also faces obstacles in transporting medical supplies to remote areas as international and domestic flights have been drastically reduced. And as wealthy donor countries struggle with their own outbreaks, there are concerns they will cut back on humanitarian aid.

Mired in civil war for the past five years, Yemen was already home to the world’s worst humanitarian crisis before the virus hit. Now the Houthi rebels are suppressing all information about an outbreak in the north, and the health system in the government-controlled south is collapsing.

“Coronavirus has invaded our homes, our cities, our countryside,” said Dr. Abdul Rahman al-Azraqi, an internal medicine specialist and former hospital director in the city of Taiz, which is split between the rival forces. He estimates that 90% of Yemeni patients die at home.

FILE - In this Monday, June 8, 2020 file photo Siblings Estiben Aquiño, 4, Estefany Aquino, 11, and Javier Aquino, 14, eat dinner illuminated by a candle in their home in the Nueva Esperanza neighborhood that has no access to electricity, in Lima, Peru. (AP PhotoRodrigo Abd, File)

“Our hospital doesn’t have any doctors, only a few nurses and administrators. There is effectively no medical treatment.”

Follow all of AP’s coronavirus coverage at https://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

FILE - In this Wednesday, June 17, 2020 file photo an Indian health worker wearing personal protective equipment checks the temperature a woman during a check up camp at a slum in Mumbai, India. For months, experts have warned of a potential nightmare scenario: After overwhelming health systems in some of the world's wealthiest regions, the coronavirus gains a foothold in poor or war-torn countries ill-equipped to contain it and sweeps through the population.(AP PhotoRafiq Maqbool, File)

FILE - In this Saturday, June 27, 2020 file photo an employee takes the fingerprints of a woman who died from the new coronavirus before her remains are cremated at La Recoleta crematorium in Santiago, Chile. (AP PhotoEsteban Felix, File)

FILE - In this Monday, June 22, 2020 file photo a cemetery employee works in a section where COVID-19 victims were buried at the Sao Luiz cemetery in Sao Paulo, Brazil. For months, experts have warned of a potential nightmare scenario: After overwhelming health systems in some of the world's wealthiest regions, the coronavirus gains a foothold in poor or war-torn countries ill-equipped to contain it and sweeps through the population. (AP PhotoAndre Penner, File)

FILE - In this Tuesday, June 9, 2020 file photo COVID-19 patients lie on beds in a field hospital built inside a gym in Santo Andre, on the outskirts of Sao Paulo, Brazil. For months, experts have warned of a potential nightmare scenario: After overwhelming health systems in some of the world's wealthiest regions, the coronavirus gains a foothold in poor or war-torn countries ill-equipped to contain it and sweeps through the population. (AP PhotoAndre Penner, File)

FILE - In this Thursday, May 7, 2020 file photo, members of a team dedicated to burying Muslim victims of the new coronavirus spray disinfectant into the grave before burying Mohamed Ali Hassan, whose cousin said had been unaware he had the new coronavirus and died in his house in the Eastleigh area, at the Langata Muslim cemetery in Nairobi, Kenya. (AP PhotoBrian Inganga, File)

FILE - In this Friday, May 22, 2020 file photo migrant workers line up to board buses for their onward journey by train to their home states, at Dharavi, one of Asia's largest slums, in Mumbai, India. (AP PhotoRafiq Maqbool)

FILE - In this Tuesday, June 16, 2020 file photo a woman reacts after getting a nasal swab taken to test for the coronavirus in Noida, on the outskirts of New Delhi, India. (AP PhotoAltaf Qadri, File)

FILE - In this Monday, June 15, 2020 file photo workers walk across a banquet hall which is generally used for weddings that has been converted to makeshift coronavirus hospital as the Indian capital struggles to contain a spike in cases. in New Delhi, India. (AP PhotoManish Swarup, File)

FILE - In this Tuesday, May 26, 2020 file photo a person stands in an aisle of a converted field hospital at the Cape Town International Convention Centre, in Cape Town, South Africa. (AP PhotoNardus Engelbrecht, File)

FILE - In this Monday, April 13, 2020 file photo volunteer disinfects the Karachi Press Club building in an effort to contain the outbreak of the coronavirus, in Karachi, Pakistan. (AP PhotoFareed Khan, File)