The Navajo Nation is facing a unique set of challenges amid the coronavirus outbreak that has reportedly led to a death toll higher than that of 13 different states.

The nation, which straddles the borders of Arizona, Utah and New Mexico, is home to about 175,000 people — and yet it has more cases of COVID-19 than eight states, according to The New York Times data.

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The nation’s first positive case was reported on March 17, and as of Monday, there have been 1,197 confirmed cases and 44 deaths, meaning the per capita infection rate is 10 times higher than neighboring Arizona, NBC News reported.

The area has just 12 health care facilities across 27,000 square miles, and many Navajo citizens suffer chronic health issues like diabetes, heart disease and obesity, according to the outlet, which puts those who contract coronavirus at a higher risk of severe illness, the CDC has said.

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Dr. Diana Hu, a pediatrician at one of the reserve hospitals, told NBC News that while the staff has been okay so far when it comes to PPE equipment and available beds, they’ve seen a deficit in the number of critical nursing staff, leading the most critical patients to be transferred elsewhere.

“We have dietitians that are in the screening tent,” she said. “We have orthopedic surgeons that are doing triage.”

Dr. Jonathan Iralu of the Indian Health Service told CNN that in the nation’s largest ICU, there were just six rooms, and all were full, leading critically ill patients to be flown to places like Albuquerque for treatment.

“It’s very upsetting for members of the Navajo Nation to leave their Nation,” he said. “But unfortunately it’s become a necessity.”

Considering many residents have underlying health conditions and lack basic necessities such as as running water, Dr. Loretta Christensen, Chief Medical Officer of Navajo Area Indian Health Service, says they’re a particularly “vulnerable nation” unable to heed basic warnings.

“You’re telling people, ‘Wash your hands for 20 seconds multiple times a day,’ and they don’t have running water,” she told NBC News. “Or you’re saying, ‘Go buy groceries for two or three weeks and shelter in place and don’t come out,’ but people can’t afford groceries for two or three weeks. So it’s just a setup for frustration and concern by the population here.”

The U.S. government funds tribal health care, and American Indian tribes were reportedly allotted $8 billion in the stimulus package signed in March.

But President Jonathan Nez told NBC News that Navajo Nation has had to spend $4 million of its own since the outbreak began, as its traditional sources of revenue, like its casino and coal mine, have been shut down.

As of Monday afternoon, there have been 753,317 cases and 36,109 deaths attributed to coronavirus in the United States, according to The New York Times.