MOGADISHU, SOMALIA - Years of conflict, instability and poverty have left Somalia ill-equipped to handle a health crisis like the coronavirus pandemic. In fact, no one really knows how many cases of COVID-19 it has.
The uncertainty has led to fear, confusion and panic even after authorities have tried to keep the public informed about the outbreak.
The official count of cases is now above 1,200, with 53 deaths, according to figures from Johns Hopkins University.
But some aid groups — and even authorities leading the fight — have warned that official figures could be far too low in a country with one of the world's weakest health systems after three decades of civil war and attacks by Islamic insurgents, as well as recurring humanitarian crises.
"We are not dismissing the fact that the death toll could be a lot higher than publicized," Mohamed Mohamud Ali, the head of Somalia's COVID-19 task force, told The Associated Press.
The numbers for the country are stark.
There is only one well-equipped quarantine facility for a population of more than 15 million people.
"Staff are reporting that people with symptoms are being told to stay home to save the limited health resources for those who become severely ill, showing that the official count is far off from reality," said Richard Crothers, the International Rescue Committee's country director, in remarks earlier this month.
Others who think they are infected often are too scared to even approach some clinics, adding to the unease in the population.
Somalia was one of the last nations in Africa to have the capacity to test for the virus. Just over 2,700 tests have been carried out, according to the World Health Organization.
Mogadishu Mayor Omar Mohamud Mohamed touched off a panic early this month when he estimated almost 500 deaths in the capital in less than two weeks. Then, Somalia's information minister, Mohamed Abdi Hayir, warned that everyone who dies would be referred to as a COVID-19 victim.
The health ministry quickly dismissed the remarks as "unproven" and "unsupported."
Still, Ali described the spread of the virus as "a speeding car with a failed brake."
About the only advantage Somalia might have is the relative youth of its population, he said.
"Our capacity to deal with all cases in the country is limited, and we are afraid that trying to do so would make us overstretched, which could lead to negligence in handling the cases we have now," Ali said.
Somalia's plight is echoed in other war-shattered countries where a fragile corps of health workers faces overwhelming odds.
"In places like Syria, Yemen and Libya, where health care infrastructure has been significantly damaged by ongoing conflict, mounting an effective response against COVID-19 poses an extremely difficult challenge," the United Nations has said. Aid groups have warned that those seeking shelter from fighting in crowded, squalid camps could find little escape from the virus if it arrives.
U.N. Secretary-General Antonio Guterres has pleaded for a global cease-fire to allow exhausted health workers to better deal with pandemic.
In Somalia, restrictions on flights and the difficulties of traveling in a country threatened by the al-Qaida-linked al-Shabab extremist group have left large regions without easy access to basic aid, let alone intensive care facilities.
"It has been extremely difficult to access these areas with humanitarian support during this long period of restriction and lockdown," the WHO said this week.
That has led some communities to take matters into their own hands.
Residents of Beledweyne in central Somalia set up their own quarantine measures. "We cannot wait for the government any longer," said Shafi'I Mohamed, a local infectious disease specialist. "We had to do something."
Evacuating patients to the capital "is not an option for now, since that could further contribute the spread of the virus," said Ali, the COVID-19 task force leader.
But he urged communities to share information, saying authorities would still try to reach affected areas.
"Fear is the problem here," he said.
At Martini Hospital, the main facility treating COVID-19 patients in Mogadishu, health care workers have received little training, and they have raised concerns about their personal safety. One of its nurses died of the disease this week.
"The hospital has only 76 beds, among them 20 ICU beds," said Dr. Abdirisak Yusuf. "The hospital cannot cover the needs of the population of people in Mogadishu. That is why we need to be planning to open other hospitals. I am very worried that the hospital will be overwhelmed by COVID-19 patients."
Hundreds of messages about virus prevention have been posted across Mogadishu, including in the crowded settlements of thousands of people displaced by drought and instability. Aid groups fear what will happen if the virus spreads among the country's 2.6 million displaced people, many with poor access to water and sanitation.
Meanwhile, workers in one of Mogadishu's largest cemeteries are preparing for more funerals.
Gravedigger Ali Dhere said they were burying 15-25 bodies a day, "and this has never happened before."
Many families do not even register the death, simply burying their relatives on the day they die in accordance with Islamic customs. While data on the outbreak is badly needed, the cause of death remains unknown.