For two months, the world watched as efforts to contain the coronavirus focused on China. But new outbreak epicentres thousands of miles away have been driving cross-border infections since mid-February – including to a handful of countries already hit with humanitarian crises.
Over the last two weeks, more than three dozen countries or territories have reported new coronavirus infections linked to people travelling from two hubs: Italy or Iran. Outbreaks in both countries have surged – from a handful in Italy and zero reported infections in Iran – to more than 1,500 each as of Monday.
As the following map shows, the growing list stretches from European and Middle East nations to as far away as New Zealand, the Caribbean, and South America. The data was compiled from national health authorities, World Health Organisation statements, and media reports.
Cases have also risen dramatically in South Korea, but cross-border infections have not been widely reported.
After earlier denials, Iran announced its first two coronavirus cases on 19 February. Since then, the outbreak has rapidly expanded and infections linked to Iran have emerged in Afghanistan, Pakistan, Iraq, and Lebanon – countries facing instability or home to large populations of refugees or displaced people.
Infections in Italy surged the same week, and cases with links to Italy are now emerging in the Caribbean and Africa.
In some countries – like France, Germany, and Malaysia – the new infections add to an existing caseload traced to patients who travelled in Asia. Other nations are seeing cases emerge for the first time.
Read more → Where the coronavirus is spreading
Health authorities in the Dominican Republic announced the country's first coronavirus case on 1 March, and Nigeria announced its first infection days earlier – both were traced to travellers who had left Italy. The WHO says Nigeria is one of 13 priority countries in Africa that need more help to fight epidemics.
The emergence of the coronavirus in the Dominican Republic has put a spotlight on neighbouring Haiti, which is particularly at risk of infectious diseases due to its fractured healthcare system, endemic poverty, and sporadic political unrest that often prevents the sick from seeking medical attention. The two countries also share a porous border, with frequent trade and cruise ships that routinely stop in both nations.
The quality of health systems varies greatly, but smaller island nations are especially unprepared to respond to epidemics in part due to long distances and poor infrastructure, according to the Global Health Security Index published last year.
Many countries have ratcheted up border closures or travel restrictions, but the WHO says this has delayed but not prevented infections. Public health experts say border closures can exacerbate outbreaks by driving migration underground – away from public health systems.
The WHO has launched a $675 million response plan aimed at helping countries with weaker health systems prepare for outbreaks. As of Monday, only $2.5 million had been received (though some $31 million was also pledged), according to the WHO.
On Sunday, the UN’s humanitarian aid arm, OCHA, said it would dip into its Central Emergency Response Fund – more often used to kickstart disaster relief – to help contain the virus.
Behind the headlines: How will COVID-19 impact crisis zones? | Thursday 19 March
Aid agencies are scrambling to adapt as the COVID-19 pandemic is felt throughout the world. Join Senior Editor Ben Parker as he speaks to leading experts and practitioners from across the humanitarian sector to discuss some of the most pressing issues.