Yesterday what I had been dreading finally happened. Seven new cases of coronavirus were announced late last night bringing the total to nine inside the Gaza Strip, revealing the virus is spreading. The first two cases of COVID-19 were confirmed on March 22. Two men were diagnosed while under quarantine after returning from Pakistan through the Egyptian border and are in stable condition. Scant details are available about the new cases, although the Palestinian ministry of health announced they are all security guards who had interacted in the same quarantine facility and have not exposed the general public.

Although the virus seems to be relatively contained for the moment, the spread raises the specter for what many of us have known for a long time: trapping millions in close quarters in Gaza is a death sentence.

This was on my mind when I read an op-ed published earlier this month by the Jerusalem Center for Public Affairs where the headline asked, “Will the Coronavirus (COVID-19) Quiet the Gaza Strip?” Even though the article made clear the word “quiet” was a reference to cross-fire at the border between Gaza and Israel, it struck me as shocking. Euphemistic phrases have long been used to describe heinous acts in Gaza. Its recent replacement of cold and clinical language is no less insensitive.

The most recent United Nations report from March 24 states that 1,400 people who recently reentered Gaza from both Rafah and Erez, the border crossings with Egypt and Israel, respectively, are quarantined in healthcare facilities and makeshift spaces like hotels and schools, while over 2,000 Gazans are quarantined at home.

To limit the spread of the virus within the Gaza Strip, authorities have barred public events and called on citizens to stay home. The call to prayer, the athan, that echoes through the Strip has been modified to include the plea, “pray in your homes.”

A COVID-19 outbreak in Gaza could quickly overwhelm its healthcare system. Gerald Rockenschaub, the head of the WHO Palestine office told AFP that Gaza has only 60 intensive care unit beds. Abdel Nasser Soboh, the head of WHO’s Gaza office, told the Associated Press healthcare facilities there have 62 oxygen ventilators and 15 are already being used on patients with other conditions. In addition to the siege, which slows the imports of medical supplies even though they are supposed to enter without restrictions, stifling power restrictions and the destruction of bombing campaigns all have damaged Gaza’s healthcare infrastructure. Compounded by the emigration of healthcare workers in the face of all sorts of instabilities, Gaza is grossly underequipped and understaffed in the face of this, or any, health crisis.

Soboh told the Media Line Sunday, “[T]he health system in the Gaza Strip can deal with 100 cases without considering it a heavy burden, but if the numbers increase, Gaza will be unable to control the situation. Then, there will be [a need for] an urgent international and global intervention to provide special resources to face the epidemic.”

Over the weekend the WHO delivered protective gear for healthcare workers and lab testing supplies to support Gaza’s response efforts. In addition, it is providing technical support for the establishment of a field hospital at the Rafah Crossing that will include a 38-bed treatment facility, as well as a medical checkpoint at the border with Israel.

However, WHO admits, “Substantial capacity gaps still need to be addressed including the procurement of essential medical supplies and equipment (including lab testing kits).”

To fulfill its occupier-duty to take care of its besieged masses, last week Israel provided Gaza with 200 testing kits and as of Tuesday Gaza has conducted 118 tests.

Gaza has repeatedly been described as the world’s largest open-air prison by human rights activists. In the United States, we are beginning to see a shift in the conversation around how to best mitigate disease spread among the incarcerated. In response to past disease outbreaks like influenza, prisons across the U.S. moved to suspend in-person visitations and tighten security restrictions allegedly to keep the disease from getting in or getting out. But on Monday, thanks to unrelenting pressure from prison abolitionists and other criminal justice advocates, NJ jails released 1,000 from jail in response to coronavirus, setting a precedent for others to follow suit. New York, California, Texas, Illinois, Ohio, and Pennsylvania have also started releasing incarcerated people.

But Gaza hasn’t received visitors for a long time. It has been in a state of siege—read: collective punishment—since 2007.

Gaza is also one of the most densely populated places on Earth. Gazans, in the absence of this global pandemic, were regularly denied permits to leave the strip for even chemotherapy. Gaza’s highly surveilled walls hold prisoners born sentenced to life for terrorism, which is functionally hereditary for Gazans, so far as Israel is concerned. So while public health professionals around the world are calling for social—or perhaps what is better branded physical—distancing, in order to mitigate the spread of coronavirus in the population, the besieged people of Gaza have nowhere they are allowed to go. Incarceration is a strong risk factor for acquiring infectious diseases like COVID-19.