Last week, a doctor in his 30s working at a hospital in Syria near the Turkish border tested positive for Covid-19. Three more confirmed cases came after: two doctors and a nurse. The coronavirus had officially arrived in Idlib, the last rebel-held territory in Syria.

The outbreak threatens to exacerbate the ever-present humanitarian disaster in northwest Syria. The United Nations estimates about 4 million people now live in the region, almost half of whom have fled from other parts of the country, displaced, sometimes more than once, during the nine-year civil war.

“After nine years of conflict and the targeting of hospitals and medical staff, the medical system, particularly in the northwest, is on its knees,” Vanessa Jackson, the United Nations representative for the humanitarian aid agency CARE International, told me. “There really aren’t enough doctors and health care professionals available if there is a significant outbreak, let alone access to ICUs, let alone to ventilators, PPE [personal protective equipment].