They have survived ethnic militias, jihadists and machetes.
Now the 1,000 men, women and children sheltering amid clouds of flies and mounds of rubbish in the ‘Faladie Garbal refugee camp near the Malian capital of Bamako say their community is being slowly destroyed by coronavirus.
“We been told about the disease but we have nothing to protect ourselves against it. No gel, nothing,” said Hama Diallo, the head of the camp. “We all live closely together … and more people are arriving every day from the war.
“People who usually come to give us food are not coming anymore because of the coronavirus. We have nothing to eat and we are afraid to go out and fetch food because the police stop us,” he added.
With over 200,000 displaced people, an estimated 1.3 million in dire need of food, and the fastest growing Islamist insurgency on earth, Mali was buckling under a humanitarian crisis even before novel coronavirus arrived last month.
But it is only one of dozens of global trouble spots where aid agencies are warning the impact of the coronavirus epidemic could dwarf anything seen in China or Europe.
More than 1.2 million people could dies of Covid 19 in Africa and Asia’s poorest countries unless immediate action is taken, 165 serving and former world leaders including Gordon Brown warned on Tuesday.
In a letter backed by Save the Children and Oxfam, the former British prime minister called on G20 governments to ditch debt payments and and provide $150 billion in urgent funding to help developing countries cope with the public health and economic fallout of the pandemic.
Particularly alarming are the world’s active conflict zones.
“We are seeing how this Covid pandemic is playing out in advanced countries with sophisticated health systems that are totally overrun. Now think about that happening in Somalia, or Syria, or Yemen, where the health infrastructure has been destroyed,” said Robert Mardini, Director General of the International Committee of the Red Cross.
“The only thing we can do now, and we are doing as much as possible, is to work on the prevention side. Because if it reaches the point it has elsewhere, it would be a catastrophe.”
It is already clear that poorer countries which cannot afford the measures rich countries in East Asia, Europe, and North America have adopted to save lives – rapidly expanding and retooling health systems and shutting down sections of the economy – are likely to suffer higher death tolls and greater economic shock from the global coronavirus crisis.
Add in hospitals destroyed in bombing campaigns, supply-chains wrecked by the threat of attack, and thousands of people living in tightly packed, often squalid refugee camps, and the chances of “flattening the curve” fade to nothing.
The implications are so alarming Antonio Guterres, the United Nations Secretary General has made an extraordinary appeal for a global “Covid-19” ceasefire in all war zones to allow everyone to focus on defeating the pandemic.
So far, few are heeding the secretary general’s call for sanity.
The UN said in a statement on Friday that fighting has increased in Afghanistan in recent weeks despite peace talks earlier in the year. Global health experts believe a largely unmonitored coronavirus pandemic, borne by refugees returning from neighbouring Iran, is already underway in the country.
In Libya, fighting between the UN-recognised government and General Khalifa Haftar’s Libyan National Army has escalated rapidly since the country’s first coronavirus cases were reported late last month, despite both sides promising to respect a “humanitarian pause.”
Meanwhile a fresh conflict between US forces and Iranian-backed militia is threatening to break out in Iraq, where official figures stood at 772 confirmed covid-19 infections and 56 deaths on Friday.
Aid agencies, conscious of the disaster uncontrolled outbreaks could cause, are concentrating on trying to prevent coronavirus breaking into refugee camps, migrant detention centres, and prisons.
In Cox’s Bazar, Bangladesh, the UNHCR has been scrambling to set up rudimentary isolation units and extra handwashing facilities in a bid to prevent the virus getting into the overcrowded camps that house more than 800,000 Rohingya refugees who fled a genocide campaign in Myanmar in 2017. Their current goal is to get just ten intensive care beds up and running.
In northeast Syria, The Red Cross has attempted to set up quarantine measures at the already overburdened hospital in the al-Hol detention camp, which houses tens of thousands of displaced people and where malnutrition and other diseases are already rife.
In many places, however, the virus has already arrived.
In Gaza, at least 12 people have already been infected with the coronavirus according to Hamas, the Islamist terror group in control of the territory. It will almost certainly spread rapidly through the extremely dense population of two million people, and many inhabitants are only too well aware that the fragile healthcare system will likely be overwhelmed.
“The world is not only not paying attention to Gaza, it is not paying attention to anything except the virus,” said Fadia Nassar, a 37-year-old mother. “This means everyone of us must take utmost care and not wait for others or the world to tell us what to do and what not to do. To be honest, I can’t blame the world in such conditions.”
Other refugees, like Mr Diallo in Mali, have received little more than well-meaning but next to useless advice.
“They told us to wash your hands with soap and eat good things to be safe from corona,” said Gul Mir, a 46-year-old living in a make-shift refugee camp on the outskirts of the Afghan city of Herat.
“But we don’t even have water to drink, let alone washing our hands with water and soap. The price of everything skyrocketed due to corona and this quarantine, most of the refugees here who had good conditions are now near to begging.”
His sons used to scrape a living of £1 to £1.50 a day trawling for rubbish, but have seen even that precarious source of income cut off after authorities imposed a curfew to fight coronavirus infections.
Like Mr Diallo’s community in Mali, they are living a more brutal iteration of a cruel dilemma facing millions of people in poorer countries around the globe: to protect themselves from coronavirus, or starve.
As Imran Khan, the prime minister of Pakistan, summed up in a televised address to the nation on March 17: “If we shutdown the cities – people are already facing difficult circumstances – we will save them from corona at one end, but they will die from hunger on the other side.”
Pakistan’s Ministry of Planning has estimated that 12.3 million to 18.5 million people in the country will lose their jobs as a result of the coronavirus shock, and in provinces that have implemented shutdowns, the pain is already being felt.
Abdul Rauf, a 43-year-old resident of Karachi’s North Nazimabad neighbourhood, who usually makes £5 a day as a house painter, told the Telegraph he had not had a day’s work for a fortnight.
Across the border in India, Prime Minister Narendra Modi took the other path, announcing a three-week shutdown on March 25 in an attempt to protect the underfunded and understaffed healthcare system of the world’s second most populous state.
But ninety percent of Indians work in the informal sector, typically without contracts or monthly salaries, and many were left facing starvation overnight. Millions of internal migrant workers and left their rented homes in urban areas to walk hundreds of kilometres to ancestral villages.
The upshot was the biggest mass migration since partition in 1947 and a humanitarian crisis on top of the existing health one.
“The whole thing is completely medieval,” said Manish Tewari, an MP for the Congress party and a former minister for Information and Broadcasting. “You have millions of poor, marginalised, displaced on the march and the government has left them to their own fate.”
The entire shock of quarantine has been compounded by the knock on effects of shutdowns in rich countries in East Asia and Europe.
In Cambodia, one of several South East Asian economies that had repurposed as the workshop of the globalised clothing trade, at least 91 garment factories employing 61,500 workers have already suspended work due to quarantine restrictions and a collapse in global demand, a spokesman for the labour ministry said on Wednesday.
The shuttered factories account for almost a sixth of Cambodia’s $7 billion garment and footwear industry, which supplies such global brands as H&M, Adidas, PUMA and Levi Strauss and is the country’s largest employer, with about 850,000 workers. Trade unions across the region have called on multinational brands to honour contracts.
And just as national governments are left with few good options, nor is there any no obvious way for international institutions to respond.
The UNHCR and the ICRC have both launched emergency appeals for funding for trouble spots, though with rich donor nations struggling to contain their own epidemics and the global economy headed for recession, the pool of funding available for aid is likely to contract dramatically.
Meanwhile, international financial institutions are looking at emergency funding for both middle income and low income countries, but they will also ultimately rely on the generosity of major shareholders.
One possible option would be debt relief. Daniel Munevar, a former UN economist with the European Network on Debt and Development, a Brussels-based NGO, estimates 45 of the world’s poorest countries will require at least US$ 93.8 billion in assistance from the World Bank or IMF to face the crisis until the end of 2020.
Without a suspension of external debt payments, US$ 21.8 billion of that would be diverted away from COVID-19 response efforts towards creditors, he said.
Doing nothing, however, is not an option.
“If you think you can lock down 1.2 billion people, think they do not exist, and that it is not going to come back and haunt you, then I have a story to tell you about Syria,” said Mr Munevar.
Reporting by Will Brown, Joe Wallen in Delhi, Ben Farmer in Islamabad, James Rothwell in Jerusalem, and Nicola Smith in Taipei