The spread of coronavirus in Iran has raised concerns across the Middle East as Lebanon, Turkey, Iraq, Kuwait, Bahrain, Saudi Arabia and other countries reacted to the possibility that the virus could spread via pilgrims or others. Iran held parliamentary elections on Friday, but the deaths of at least two more people from the virus, which originated in China, has raised eyebrows.

Reports in Iran appear to point to a growing crisis. While only four or five deaths have been confirmed, the 18 cases detected are thought to be just a few of many that are as yet undetected in many cities. The head of the World Health Organization, Tedros Adhanom Ghebreyesus, expressed concern.

Iranian officials were quoted in regional media saying that the virus has spread to “many Iranian cities,” according to Al-Arabiya in Saudi Arabia. Iranians on social media are upset at the slow pace of official reaction, and the lack of clarity. “The situation is much worse than they say,” one person tweeted, basing his information on his daughter who is a nurse.

The Iranian outbreak began in the holy city of Qom where pilgrims are coming from all over the world, most of whom are Shi’ites. A seminary in the city has already closed due to the outbreak. But a female pilgrim returning to Lebanon was confirmed as Lebanon’s first case. A case in Canada is also linked to Iran, according to the BBC. Other cases have been reported in Rasht, Arak, Tehran and other areas of Iran.

Southern Iraq is now on edge because so many pilgrims from the Shi’ite community travel to Iran. Iraqi protesters say that coronavirus won’t stop their protests, which have gone on since October. Iraq’s Grand Ayatollah Ali Sistani has urged the authorities to prepare for an outbreak. The Kurdistan region is also on edge, but so far has remained free from the virus. Nevertheless, one southern Iraqi province was putting border controls in place.

Iraq has also put controls on travel to Iran. Iranians may be prohibited from entering Iraq entirely, but the huge flow of goods and people between the two countries would make that difficult. The National in the UAE reported that Iranians were already being banned. Kuwait is looking to prevent port traffic with the Islamic Republic.

Meanwhile, Bahrain and Oman are concerned the virus spread will harm their economy. US Secretary of State Mike Pompeo is in the region this weekend. He met with Oman’s Sultan Haitham bin Tarik Al Said on Friday. Next door, Saudi Arabia is concerned about pilgrims travelling to or from Iran. The UAE also says that it has two cases of coronavirus, but they are foreign nationals who were in contact with someone from China, according to local sources.

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Turkey is also concerned about the Iranian cases and is putting checks in place. A conference in Jordan has been cancelled. Egypt, which has had one case of the virus already, is wondering if worse is yet to come. In other countries, such as North Africa and Syria, time will tell what comes next.

Many countries in the region are suffering conflict, such as Yemen, Libya and Syria. In conflict areas the ability to detect the virus or even confront it is reduced. If the virus continues to spread from Iran and other countries, as officials and religious leaders fear it will, the ability of a Middle East that is recovering from conflict to confront it is questionable.

Many countries like Iraq already have health care systems that are inadequate in parts of the country. It’s not clear how they can even close their borders when many of these countries have widespread smuggling across them, or armed militias that control parts of their country or border areas.