In a far corner of Eastern Europe lies a war-torn territory roughly the size of Belgium and occupied by around 4 million people where coronavirus cases aren't being counted in global tallies, yet health experts warn the situation there is bad and likely to grow worse.
The territory in eastern Ukraine's Donetsk and Luhansk regions is divided into two parts that Moscow and the Russia-backed forces that hold them call republics. But neither is recognized by the international community, contributing to the area's current status as a coronavirus black hole.
The number of coronavirus infections is rising rapidly, there is no personal protective equipment to be bought anywhere, and there is a shortage of capable doctors, according to a local nurse who spoke to RFE/RL on condition of anonymity.
There are also a very limited number of tests for the coronavirus, and no ventilators for patients who need assistance with their breathing due to COVID-19, the deadly disease caused by the virus, the nurse said.
Many residents are not taking the pandemic seriously, and because local authorities have allowed many businesses to remain open, the streets are still bustling with people -- a strange sight at a time when much of the world is practicing social distancing.
No Recognition
Local separatists, backed with money, arms, and soldiers from Moscow, have fought an armed conflict against Ukrainian government forces since April 2014 that has killed more than 13,200 people. And despite the coronavirus pandemic, fighting rages on..
Because Kyiv does not control the separatist-held territories and no UN member, including Russia, considers them independent states, they are not included in global coronavirus tallies such as those maintained by the World Health Organization and Johns Hopkins University.
The coronavirus was officially slow to arrive in the separatist-held areas. The forces in control claimed zero cases in March, although Ukrainian officials in Kyiv suggested an uptick in pneumonia cases there likely meant coronavirus cases were going undiagnosed in these territories, and confirmed the first ones only in early April.
But, now that its arrival is acknowledged, concerns that the deadly virus could wreak havoc in a region woefully unprepared to handle such a public-health crisis are being raised.
Ravaged by six years of armed conflict, and challenged with an ailing health-care system and a sizable elderly population, the separatist-held areas could face a paralyzing COVID-19 outbreak, according to local health experts and international humanitarian groups.
As of April 17, the Russia-backed separatists in Donetsk had reported 32 cases of the coronavirus and their counterparts in Luhansk had confirmed 21 infections.
"There is panic" among medical workers, the nurse said.
The medical worker, as well as several other residents of Donetsk, Luhansk, and surrounding cities, spoke to RFE/RL on condition of anonymity out of fear of reprisals by the de facto authorities, who have exhibited a penchant for violence against those who criticize them, as well as imprisonment and even torture.
Kyiv's lack of control over the territories, along with the separatist forces' hesitance to allow international organizations access to the areas they occupy, could also mean that they receive little outside help.
With the Russia-backed separatists barring most humanitarian organizations to the areas, "there's a sharp new limit on the availability of supplies," Rachel Denber, deputy director for Europe and Central Asia at Human Rights Watch (HRW), told RFE/RL by phone from Moscow.
Looking for help from Moscow might also not be an option, with the Kremlin facing its own deepening health crisis within its official borders.
The Ukrainian state has effectively cut all ties with the Russia-backed separatists who control the areas, meaning that the type of assistance with medical supplies provided to other parts of the country is unlikely to be allocated to separatist-held territories.
Ukraine's Foreign Ministry on April 15 called on Russia "as an occupying country to ensure the protection of life and health of the population of the temporarily occupied territories of Ukraine in the context of the COVID-19 pandemic."
'We Can't Afford To Shut Down'
According to the nurse, "transport, large enterprises, food establishments, shopping centers, supermarkets, and other businesses are still functioning" in Donetsk and surrounding cities.
Secondary schools and universities have closed their doors for an indefinite period of time and are doing distance-learning online, "but kindergartens are still open," she said.
An entrepreneur from Donetsk said many people "don't seem to be scared" of contracting the coronavirus and are not taking precautions, let alone self-isolating at home like people in much of the world.
Asked if people wear masks on the streets there, a woman from Makiyivka, a Donetsk suburb, said, "No, they don't want to be embarrassed." The woman said that when another woman was recently spotted by a group of passers-by wearing a mask on the street, "they laughed at her."
A woman in Luhansk told RFE/RL that the situation there is very similar. She said masks are worn "only in the hospitals" and by a few workers in local supermarkets.
She admitted, however, that such supplies are hard, if not impossible, to come by. She said some of her acquaintances have begun making their own protective gear, including cloth masks.
In place of hand sanitizer, which is also in short supply, she said they are making their own with recipes found online, or using homemade alcohol, known as samogon, or cheap vodka to douse their hands.
Some people think that the de facto authorities "hide the true information about the [number of] sick people" and the overall scope of the health crisis, a woman from Donetsk said by phone.
"You understand that everything in the republic is shrouded in secrecy, in the best traditions of the Soviet Union, so you don't know what is really happening," she said.
For Denber of HRW, transparency and access to accurate information about the coronavirus and how to prevent its spread is one of the biggest concerns in the region.
"Accurate information is probably one of the most important tools in fighting the spread of coronavirus," she said. "When there are impediments to spreading and receiving accurate information, that's only going to jeopardize public health."
The reason for the lack of transparency seems to be that the Russia-backed separatists in Donetsk and Luhansk view a shutdown of their already struggling economies to be worse than the pandemic itself, and they don't want to cause panic.
"I'll be totally honest. For a variety of reasons, including economic ones, we can't afford to shut down businesses or announce a period of no work, especially as, I repeat, right now we have no one suffering from COVID-19," Denis Pushilin, the Kremlin-approved head of the Donetsk separatists, told residents in a video address in late March, before he and his office had confirmed the area's first coronavirus cases.
There have been some measures put in place to help slow the spread of the coronavirus.
Separatist leaders in Donetsk have ordered people over the age of 65 to self-isolate at home, allowing them to go outside only to purchase groceries or to walk a pet -- and even then they are permitted to venture just 100 meters away.
They have also limited gatherings to fewer than 50 people, and suggested voluntary self-isolation for the rest of the population of some 4 million people in the two separatist regions combined.
Separatists in the Luhank and Donestk regions have also ordered the unofficial boundaries with the rest of Ukraine and the border with Russia to be closed, and even shut down the regional border between themselves to stop the flow of people and, in effect, the virus.
In the separatist-held part of the Luhansk region, the cities of Pervomaisk, Antratsyt, and Krasniy Luch have been completely closed off over fears that unwitting infected persons had come in contact with many others before showing symptoms of the virus.
Possible 'Outbreak Of Considerable Scale'
The measures might not be enough.
Among the international groups sounding the alarm is the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), which wrote in its Humanitarian Response Plan for the coronavirus pandemic in March that the risk of rapid local transmission in Donetsk and Luhansk is high and the regions "may face a COVID-19 outbreak of considerable scale."
It cited the proportion of elderly people living in the separatist-held areas, who are particularly vulnerable to the disease and account for about 36 percent of total population, and the deterioration of the health-care system as a result of the ongoing armed conflict.
The health-care systems in the two self-proclaimed republics, the OCHA said, had been "functioning at a sub-optimal level" and were struggling to cope with the existing health-care needs of the population even before the emergence of the coronavirus.
"In areas outside government control (NGCA), the health-care system has experienced severe deterioration due to the complete breakdown of medical supply chains with [government-controlled areas], causing shortages of medicines, medical supplies, and medical equipment and insufficient numbers of health-care workers," the OCHA said.
Denber agreed with that assessment, telling RFE/RL that the medical facilities in the separatist-held areas are "known to be kind of parlous."
'The War Is A Bigger Threat'
Ironically, living in a war zone may have prepared some people for crises like this, according to Katharine Quinn-Judge, a Kyiv-based senior analyst for Crisis Group.
"People there are used to a degree of social distancing already, or certain aspects of social distancing are sort of innate at this point, because people are used to situations where they have to stay in their basements for days on end, or have their movements limited," she said.
But while many people in Donetsk and Luhansk may take shelter in moments when the fighting there is fierce, judging by the number of people out and about, residents say that many do not appear willing -- at least not yet -- to hide from a virus.
The entrepreneur from Donetsk said that the many people she knows there who are not taking the pandemic seriously believe the ongoing shooting war remains the bigger threat of the two crises.
"It is difficult to convince people here that something that they can't see may be more dangerous than the rockets and mortars falling on our heads," she said.
