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The spread of the coronavirus in Africa has lagged much of the globe, but it’s picking up speed. Health authorities say the highly infectious virus poses a heightened threat to countries with weak healthcare systems and especially to vulnerable populations of refugees, migrants and forcibly displaced people.

The continent passed a milestone of 750,000 confirmed cases, Reuters reported Wednesday. The news service, using government and World Health Organization data, tallied 751,151 cases, 15,721 deaths and 407,461 recoveries. It noted that Africa had 500,000 confirmed cases on July 8.

“I think what we're starting to see is a continued acceleration of transmission in a number of countries in sub-Saharan Africa, and I think that has to be taken very, very seriously,” epidemiologist Michael Ryan, who leads the WHO’s health emergencies program, told journalists at a news briefing earlier this week.

As Ryan pointed out, “Many of those countries exist in the midst of fragility and conflict.”

Yet COVID-19 so far has hit hardest at one of the continent’s wealthiest nations.

South Africa accounted for just over half of the continent’s confirmed infections – which the Africa Centers for Disease Control and Prevention recorded at over 751,000 as of Tuesday – and roughly a third of its nearly 16,000 fatalities.

Infections have ravaged urban areas, especially poor Black townships, but now have “moved into more rural areas, affecting different populations,” said Dr. Maria Van Kerkhove, a WHO epidemiologist specializing in emerging infectious diseases who joined in the briefing.

“South Africa may unfortunately be a precursor,” Ryan said. “It may be a warning for what will happen in the rest of Africa.”

Preparation time

The pandemic’s relatively slow arrival gave the Africa Centers for Disease Control and Prevention time to coordinate with government health ministries beginning early in the year, according to a Nature journal article whose co-authors include the centers’ director, John Nkengasong. Africans implemented lockdowns, ramped up surveillance at border entry points, and increased clinical testing and research, including on new uses for traditional medicines.

But many African nations have poor healthcare systems with inadequate supplies and too few workers. Nurses and doctors in Zimbabwe have gone on strike over the lack of personal protective equipment (PPE); thousands across the continent have been infected. The Africa CDC warns the pandemic could bring about “a catastrophic shortage of healthcare professionals.”

Who is most at risk?

Aside from frontline workers, the most vulnerable to the novel coronavirus are refugees, migrants and people who have been forcibly displaced. A record 29 million people in Africa fall into that category, the Africa Center for Strategic Studies reported in June.

Roughly nine in 10 are fleeing armed conflict, especially from Central Africa and the Greater Horn.

“COVID has not stopped conflict,” said Wendy Williams, an adjunct research fellow at the center and the report’s author. The pandemic, she told VOA, “is not the priority” for combatants – or for people on the run from violence. “They’re just simply trying to get out of harm’s way.”

Though the bulk of these displaced people melt into urban centers or other communities, millions have wound up in managed camps and informal settlements in Sudan, Ethiopia, Uganda and elsewhere.

“These people tend to be women, elderly, children … fleeing a conflict with little to no resources, and they're finding themselves in these camps, which tend to be in rural areas, not well developed,” said Williams, who earlier worked with the International Federation of Red Cross and Red Crescent Societies, providing policy guidance on population flows. “And so already they're there in a very vulnerable situation. They're living hand to mouth.”

The pandemic has strained vital humanitarian aid, exacerbating food insecurity and medicine, Williams said.

“With borders closing, with international staff not traveling anymore – the idea of being able to get this assistance to the camps, to keep people from crowding around to get the food when it arrives, is not possible. And when they get sick, to have the medicines delivered and brought to them is also even further complicated.”

The Africa Center has identified risk factors for COVID transmission, “reflecting levels of international exposure, urbanization, demography, fragility and governance” that contribute to vulnerability.

COVID uncertainties

Still, much remains unknown about COVID – from its transmission to a better sense of who exactly has been infected.

Global reporting systems are not very good, said Dr. Paul Spiegel, an epidemiologist who heads the Center for Humanitarian Health at Johns Hopkins University.

“It’s not just that there is lack of testing,” he told VOA. There’s also insufficient data. “A lot of our models that we’re working on rely currently on data from China, the U.S., Europe. So we don’t actually have that much data in refugee settings.”

Spiegel, a former official with the U.N. Refugee Agency, worries about the potential devastation of COVID-19 spreading in camps too densely packed for social distancing, with poor sanitation and limited access to clean water needed for handwashing. He frets that refugees’ wariness of COVID infection will keep them from seeking clinical care for other health concerns. And he fears that vulnerable people will lose out when infections surge.

“Will the government say, ‘We don’t have enough tests. We don’t have enough hospital beds,” he wondered. “… When the vaccine becomes available, how can we be sure that it’s provided in an equitable fashion?”

But many displaced people have at least one factor in their favor. “Refugees, like many others in low-income settings, are spending more time outdoors,” Spiegel noted.

He emphasized that they tend to be younger, which may be a protective factor for COVID-19. Africa has the world’s youngest population, the World Economic Forum says, citing U.N. data.

Efforts to help

Spiegel’s center is collecting and sharing humanitarian workers’ input on the safest ways to provide life-saving services amid the pandemic.

Ryan, the WHO epidemiologist, said many sub-Saharan countries need “much more support for community-based interventions and much more support for improving clinical pathways, so people who are sick get adequate care.”

Most African countries’ health spending falls short of the minimum 15 percent of  national budgets pledged by leaders in 2001, Human Rights Watch said in a June report on COVID-19 and the impact of inadequate investment.

United Nations agencies including the WHO, the UN Refugee Agency (UNHCR) and the International Organization for Migration (IOM) all have issued funding appeals to fight COVID-19 globally but face sizable gaps.

The United States is funneling hundreds of millions of dollars into Africa to address COVID-related health and humanitarian needs, the State Department reported earlier this month. Aid amounts are listed by country. The most, $43.6 million, was earmarked for South Sudan for efforts such as infection prevention and control, emergency food, and health worker training.