Amid the oppressive stench of Guru Teg Bahadur Hospital in north-east Delhi, young men and women lie on stretchers outside the doors, their wails unanswered as they wait in vain to see a doctor. This, the largest public hospital in north-east Delhi, caters to millions, in the most densely populated part of one of the world’s most populous cities. The clearly exhausted doctors do their best, but the scene resembles a war zone. Urine seeps down corridors, soiled towels prop open doors and stray dogs wander through the emergency ward. India's public hospitals are some of the most under funded in the region, with annual healthcare spending less than £12 per person. To the alarm of global health officials, creaking institutions like Guru Teg Bahadur may soon be drummed into the front line to identify, treat and stop a new coronavirus strain which has killed more than 200, infected close to 10,000 and raised fears of a global pandemic.

India's public hospitals are some of the most under funded in the region Credit : Joe Wallen

This week India, Nepal and Sri Lanka have all confirmed one case each, while Kenya and Ethiopia are both investigating cases. Concerns the pneumonia-causing bug might be spreading unnoticed by doctors in poorly-prepared South Asian and African countries were at the forefront of the World Health Organization's decision to declare the outbreak a global health emergency on Thursday. For weeks the world has watched China wage war on the new form of coronavirus using the weight of its massive state. Engineers are building two 1,000-bed hospitals from scratch in days, while cities of millions have been sealed into quarantine with a bureaucratic command. Even with these resources, cases have mounted alarmingly. Yet as the virus spreads, and the tally of countries with cases reached 24 by Friday evening, it now stalks nations which have far fewer resources and which are far less able to cope. “Our greatest concern is the potential for the virus to spread to countries with weaker health systems, and which are ill-prepared to deal with it,” said the WHO chief, Tedros Adhanom Ghebreyesus.

Both South Asia and Africa have strong transport and commercial ties to China, with regular flows of workers, students and businesspeople. Worryingly for epidemiologists, some of their countries also have patchy disease surveillance, meagre healthcare, crowded cities and poor sanitation that risk boosting the outbreak into a new phase. “It's impossible to overstate the risk,” said Kevin Watkins, chief executive of Save the Children. “If this virus gets into the general population of low income countries, and even middle income countries in South Asia, with weak health systems, then the result could be absolutely catastrophic.”

WHO statistics give a stark indication of the difference in resources some South Asian countries have to tackle a rapidly spreading virus, compared with China. China has an average of 42 hospital beds per 10,000 people, while Bangladesh has eight, India has seven beds and Pakistan has six. Moreover China has 18 doctors per 10,000 people, while Pakistan has 10, India has eight and Bangladesh has five. Meanwhile, South Asia also has some of the world's most crowded cities, providing a rich environment for the virus to spread. A 2017 World Economic Forum report based on UN data said that the world's two busiest cities were Dhaka, cramming 44,500 people into each square km, and Mumbai squeezing in 31,000. China's building boom has meanwhile seen many of its cities get less crowded and more sprawling.

Creaking institutions like Guru Teg Bahadur may soon be on the front line to identify, treat and stop a new coronavirus strain Credit : Joe Wallen

At Guru Teg Bahadur hospital, doctors appear woefully unprepared. The Indian Government has said it has relayed an action plan to hospitals across the country, but the six doctors on the front line at the hospital said they were unaware of it. Dr Manish Singh, a doctor at a government polyclinic in nearby Mustafabad, said he had not been contacted once by either the central or local Delhi government regarding an action plan. As he reclined in his office watching a cricket match on his mobile phone, he dismissed the risk and said the hospital would only test for the virus in patients coming from China, despite confirmed cases across South Asia. “People from China are coming and if they are having some symptoms then only they should be referred,” he explained. “People here do not eat raw meat, they are mainly vegetarians. In China, they are eating anything they can, soup of bats or snakes and that is the problem.” Dr Singh said he would not test any Indian patients but if anyone caught the highly-contagious virus he would simply refer them to a different hospital.

The WHO's greatest concern is the potential for the virus to spread to countries with weaker health systems, and which are ill-prepared to deal with it Credit : Joe Wallen

Infection control was poor across countries in South Asia, said Dr Bharat Pankhania, a senior clinical lecturer at the University of Exeter Medical School. “As a result of having the perfect environment for the transmission of infection in a poorly resourced country, we can expect a great many number of people to get infected and cause further infections.” “We have overcrowding, we have poor sanitation, we have a new virus, we have the right temperatures and therefore it is a perfect mix for this virus, once it arrives to spread rapidly to vulnerable people,” said Dr Pankhania. It is possible the disease is already spreading, unseen and unidentified. Pakistan has for the past five years tried to build a monitoring network to spot disease outbreaks. British and American support has been enlisted to set up public health laboratories and to try to help forge the government coordination needed to make sure doctors and clinics spot and log cases quickly. Western officials say while progress has been made, major gaps remain. A horrendous outbreak of HIV in the city of Ratodero last year was only spotted once it had infected more than 900 children. Dr Faisal Mahmood, an infectious disease expert at Karachi's Agha Khan University, said Pakistan had “rudimentary surveillance systems in place” for some diseases.