On Monday a video emerged on social media of police in a store parking lot telling shoppers by loudspeaker to go home and stay there because of the coronavirus outbreak. The video wasn't taken in Rome or New York City—it was from Chinle, Arizona, on the Navajo Nation reservation.

Navajo Nation confirmed its 49th COVID-19 case Tuesday. With the global pandemic already overwhelming hospitals and medical equipment around the world, local health and government leaders are worried the same will happen there; the reservation has 170 hospital beds, 13 ICU beds, and 28 ventilators, total, to serve its population of 180,000 people.

Nationally, health experts and tribal leaders are sounding the alarm that Native Americans are particularly vulnerable to the spread of COVID-19. Native Americans are more likely to live in overcrowded and intergenerational housing, lack access to running water, and experience health disparities that increase their risk of hospitalization and even death during the outbreak. “When you look at the health disparities in Indian Country, they align exactly with the vulnerabilities the CDC is citing,” said Stacy Bohlen, CEO of the National Indian Health Board (NIHB). Native Americans face the highest rates of diabetes and asthma in the country, and are nearly twice as likely to die from influenza and pneumonia during the regular flu season.

Navajo Nation is one of 574 federally recognized tribes fighting not only the growing outbreak, but a federal health system that has been underfunded and left Native Americans behind for decades. “Between the lack of funding, the vulnerability of our communities, the lack of access to equipment, we are the perfect storm for acquiring this disease,” Bohlen said.

Roselyn Tso, the director of the Navajo-area Indian Health Service (IHS) told the Navajo Nation Council during a special session on Friday that she sent home 45 employees from one service unit earlier that week over concerns related to the virus. “I might as well close the door of that hospital if I get any more than that.”

Senate leaders and the White House announced early Wednesday morning they had reached a deal on the largest coronavirus relief package yet. According to Senator Tom Udall (D-NM) the $2 trillion bill includes $1.03 billion for Indian Health Services and a total of $10 billion for emergency and economic relief for tribes. In a press statement, Udall said “These are key victories… but Congress must do more to respond to the unique COVID-19 related public health and economic crises in Indian Country.” According to tribal leaders and health experts, Indian Health Services needs twice as much funding to save lives.

On March 17, the Congressional Native American Caucus asked the House Appropriations Committee for a total of $2.3 billion in funding for Indian Health Services. This would include $200 million for infrastructure needs (including ICU beds, emergency hospital structures, and isolation facilities), and $1.1 billion for direct services (including staffing, equipment, and testing). The letter also requests funding for sanitation, education, food distribution and economic relief for tribes.

“There is no question the federal government has a special obligation to provide healthcare to Native Americans,” Rep. Tom Cole (R-OK), who co-chairs the caucus, told VICE. “I always tell people, look, if you no longer want to meet these treaty obligations, just give us back northern Mississippi and we'll call it square,” he says, referring to the homelands of his tribe, Chickasaw Nation. “They never go for it.”

The first $40 million Congress did pass for tribes was held up by bureaucratic hurdles for two weeks. Friday, Health and Human Services announced funds were finally ready to be distributed, with a plan to get $30 million into the hands of tribes and IHS facilities as quickly as possible. But according to a CDC memo sent to Congress on March 20 the plan for distributing phase one of funding excluded tribes and IHS facilities in North Dakota, South Dakota, Nebraska, and Iowa. One source told VICE because funding is so limited, tribes are competing with each other over resources.

“Our people entered into treaties with the United States, that cost us billions of acres of land and our way of life,” said Bohlen of NIHB. “And through those treaties, we were promised healthcare.” The Indian Health Services was Congress’s answer to that promise. But the agency—which predates both Medicare and Medicaid—is not an entitlement program, meaning its funding levels fluctuate with Congressional appropriations and politics.

“IHS has been grossly underfunded since the day it was born,” Bohlen said. According to tribes, IHS needed $36.8 billion to be fully funded. For 2020, Congress appropriated $6.04 billion. In other words, for every dollar the IHS needs, the U.S. federal government pays only 16 cents.

“When you’re that underfunded, you are starting the race—starting the battle—way, way, way behind,” Navajo Nation Councilman Slater said. He gets emotional when he tries to explain the importance of elders in his tribe, who carry knowledge, language, medicine, and simply, “what it means to be Navajo.” Because of their age, they’re particularly vulnerable to complications from the virus. “We just can't afford to lose our elders in the way you've seen in Italy,” he says.

IHS reported that as of March 19, the agency has counted 37 ICU beds, 130 negative pressure rooms, 81 ventilators and 1,257 hospital beds among all of their facilities for the 2.5 million people they serve, but “the actual number may be higher” because they’re still counting. States can request critical equipment through the Strategic National Stockpile, which is reported to have at least 10,000 ventilators, but under current regulations, tribes can not. Even in places with a low number of or no confirmed cases, tribes and IHS service providers say they are already struggling to get basic supplies, like hand sanitizer and masks.

Without direct access to the national stockpile, tribes are being told to go through their state. But when one regional health director, who asked to remain anonymous, asked her state for testing supplies, the state sent her back to IHS. By the time the bureaucratic confusion had been settled, and she was able to submit a request, the state had already distributed all of its testing supplies.

Another facility administrator, who asked to withhold their name for fear of reprisal, told VICE that they were completely unable to order hand sanitizer or cleaning supplies and that the gloves and face masks they requested were still on backorder.

As of March 13, only 4 percent of tribes surveyed by NIHB had received personal protective equipment from the federal government—only 2 percent had received that equipment from states. Senators Tom Udall (D-NM) and Elizabeth Warren (D-MA) have introduced legislation to provide tribes direct access to the national stockpile, but so far Congress has not fixed the problem.

While experts warn of coming staffing shortages during the pandemic, IHS facilities already are operating short-staffed--with vacancy rates ranging from 25-31 percent. For years, the United States Public Health Commission Corps—a uniformed service under the Surgeon General—has filled this gap. But now, officers are being called away from tribal hospitals in response to the coronavirus. IHS confirmed that 125 Commission Corps officers have already left, and another 75 have been requested. To compound the impact, IHS facilities continue to pay the officers’ salaries, while their posts remain vacant.

If Congress fully funds the $2.3 billion request for emergency funding to Indian Health Services in response to the coronavirus pandemic, the agency would still not be fully funded. Instead of paying 16 cents on the dollar for its treaty obligations, the U.S. government would be paying closer to 23 cents.

“Indians are always the last ones,” Councilman Slater said. “We’re always left out.”