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U.N. relief officials and aid organizations are bracing for what they fear could be a cataclysmic second phase of the pandemic: spreading in the close-quarters encampments of the world’s more than 25 million refugees and another 40 million internally displaced people.

More than 3 billion people lack access to hand-washing facilities, depriving them of one of the most effective first lines of defense against the spread of the coronavirus, according to UNICEF

the effort to ramp up an international aid response is being hampered by the quest to ensure the safety of international staff. Those concerns have been amplified by the announcement last week that David Beasley, the executive director of the Rome-based World Food Program, had been infected with the coronavirus. Some international relief agencies have recalled senior field officers, fearing they could be infected.

Konyndyk, who worked on the response to the Ebola epidemic in West Africa for the U.S. Agency for International Development, said that U.N. and relief agencies are having to balance ensuring the health of their own staff with delivering care to needy communities.

“You would have a hard time designing a more dangerous setting for the spread of this disease than an informal IDP settlement,” he said. “You have a crowded population, very poor sanitation … very poor disease surveillance, very poor health services. This could be extraordinarily dangerous … and I don’t think that’s getting enough global attention yet.”

In conflict-riven countries from Afghanistan to South Sudan to Yemen, dismal health care infrastructures are already overburdened after years of fighting

After five years of war, with millions of people on the brink of famine, Yemen’s population is more vulnerable to a coronavirus outbreak than those of most other countries. The conflict has left most of the country’s population effectively immunocompromised,

“For many population groups, living in overcrowded conditions, social distancing is a challenge or impossible,” according to the Assessment Capacities Project report. Many countries that host refugee camps, such as Afghanistan and Bangladesh, are likely to be overwhelmed by the health needs of their own citizens. Nations with weak health systems “may struggle to screen, test, and contain the epidemic for the host population let alone the refugees,”

In Gaza, the U.N. Relief and Works Agency (UNRWA), which provides primary care for about 70 percent of the territory’s more than 1.8 million people, is bracing for the likely arrival of the coronavirus in one of the most densely populated place in the world. The U.N. agency—which the Trump administration defunded last year and has sought to dismantle—has some 22 medical clinics in Gaza, putting it on the front lines of the defense of the coronavirus.

“I’m told that there are 60 ICU beds in the hospitals,” Matthias Schmale, the director of Gaza’s UNRWA operations, told Foreign Policy. “If there is a full-scale outbreak the hospital sector won’t cope.”

The leaders of major relief organizations are pressing donors to grant them greater flexibility to redirect funding from existing programs that are likely to be paralyzed by the pandemic and use that money for programs—including clean water and sanitation projects—that could help stem the crisis.

“As bad as it is now in the well-organized and affluent north, with health systems, good sanitation, and big infrastructure, imagine how it will be when it will hit crowded camps with refugees and displaced people,” said Egeland, who spoke by telephone from quarantine in Norway.

sweeping U.S. and U.N. economic sanctions imposed on governments in Iran, North Korea, and Venezuela are hampering relief efforts.

Egeland acknowledged that most U.N. sanctions regimes, including those for Iran and North Korea, include exemptions for the import of humanitarian goods. But the sanctions have scared financial institutions from providing vital financial services to relief agencies. “Not a single bank had the guts to transfer money, because they were all afraid to be sued by the U.S. government,”

The World Health Organization announced earlier this year that more than $675 million will be required through April—including $61 million for its own activities—to mount an international campaign against the virus. Though WHO’s Director-General Tedros Adhanom Ghebreyesus said recently that more money would be needed. On Feb. 17, UNICEF issued an urgent request for $42.3 million to support the coronavirus response. It will be used to reduce transmission of the virus by promoting distance learning for kids who can’t attend school and public information aimed at shooting down misinformation.

Guterres, meanwhile, expressed concern that the pandemic could claw back decades of efforts to raise international health standards and to scale back the most extreme levels of poverty, and undercut U.N. sustainable development goals, which are designed to improve the standard of living around the world by the year 2030.

“COVID-19 is killing people, as well as attacking the real economy at its core—trade, supply chains, businesses, jobs,” Guterres said. “Workers around the world could lose as much as $3.4 trillion.”

“We need to focus on people—the most vulnerable, low-wage workers, small and medium enterprises,” Guterres said. “That means wage support, insurance, social protection, preventing bankruptcies and job loss. That also means designing fiscal and monetary responses to ensure that the burden does not fall on those who can least afford it. The recovery must not come on the backs of the poorest—and we cannot create a legion of new poor. We need to get resources directly into the hands of people.”