During this pandemic, much of the world’s attention has been focused on China and on how Covid-19 outbreaks are being handled in various countries, notably Italy, Spain, the United Kingdom, the United States, Singapore, South Korea and Iran. However, little attention has been given to South Asia, and in particular Pakistan. The number of confirmed cases there remains low but, if it’s not managed properly, the pandemic could devastate a country that’s already under severe stress on many fronts.

According to the latest figures ^[1], Pakistan has recorded almost 10,000 cases and over 200 Covid-19-related deaths ^[2]. Those numbers seem small for the world’s fifth most populous country, with 220 million people, and probably reflect Pakistan’s limited testing capacity. Only around 111,000 people ^[3] have been tested so far. There’s also anecdotal evidence that the poor, in particular, won’t admit that they may have the virus. And, even if these figures were accepted at face value, the number of known cases continues to grow. There’s no sign of the curve flattening in Pakistan.

Prime Minister Imran Khan initially downplayed the potential devastation, rejecting calls from provincial governments and medical experts for a nationwide lockdown. He argued that a lockdown would wreck the economy and instead urged people to practise social distancing. Under pressure to avoid a disaster down the road, the military stepped in and, working with provincial governments, enforced a partial lockdown on 22 March. ^[4] The agricultural sector remained open.

The national government has since published a report ^[5] warning that the number of cases could soon rise to 50,000. A combination of factors could enable the virus to spread quickly throughout the country.

Much of Pakistan’s socioeconomic infrastructure is decrepit. The health system is poor ^[6] and under-resourced at the best of times. It has almost no capacity to deal with a surge in Covid-19 cases. Karachi, a city of more than 20 million people, has only 600 hundred beds in intensive care units, and there are only about 2,000 ventilators for the whole country. The shortage of resources is so dire that doctors and medical staff protested in Quetta, the capital of Balochistan province, over the lack of personal protective equipment. A number of them were beaten up and arrested ^[7] by riot police.

Compounding the medical side of the equation is the appalling socioeconomic state millions of Pakistanis live in, particularly those in urban areas. Two-thirds of the inhabitants of Karachi live in slums ^[8] with no proper sanitation, running water or electricity, amid open sewers filled with garbage, and often with 10 people sharing a room. For the overwhelming majority, using public transport means being cramped in small spaces. For millions, regular handwashing is a pipe dream and social distancing an impossibility. The situation isn’t any better in rural areas ^[7] where two-thirds of Pakistan’s population lives and where there’s often no access to hospitals or any medical facilities at all.

Complicating an already difficult socioeconomic environment is the unwillingness of many mullahs ^[4] to obey government orders to prevent worshippers from crowding mosques at Friday prayers. They’ve argued, instead, that the pandemic requires even larger numbers to pray to God for protection.

The religious leaders’ refusal to abide by the government’s directives took an extreme turn with a massive religious gathering on the outskirts of Lahore, Pakistan’s second largest city, last month. This event brought together 100,000 to 150,000 people ^[9], including foreigners from scores of countries. And, although it was eventually cut short, participants had already spent time together, eating and sleeping in tight spaces. Authorities have quarantined 20,000 of the participants ^[10] but are still looking for thousands more. Many have left the country.

Despite the virus thriving in mass gatherings, the government has agreed to allow congregational prayers ^[11] during the month-long period of Ramadan starting tomorrow. And although there will be social distancing restrictions in principle, such large crowds can only accelerate the spreading of the virus.

Many have come back from the Middle East without being tested or quarantined ^[12]. Hundreds returned from Iran, which has the seventh largest number of confirmed Covid-19-related deaths ^[2], before the border was closed.

These factors make for a potentially dire situation for a country whose economy was already in poor shape. Experts expect exports to drop by 50% in the next two months ^[13]. It’s too soon to know how Pakistan will weather this crisis. But the country depends heavily on the remittances of thousands of workers in the Middle East and the global lockdown is going to hurt it badly.

There is some good news; the Paris-based Financial Action Task Force, a global watchdog that aims to stop the financing of terrorist activity and money laundering, has postponed until October ^[14] the deadline for Pakistan to meet its obligations to avoid being put on a blacklist. Being on the list makes it very difficult to obtain international financing and investment. Iran and North Korea are the only countries to have been blacklisted so far. The International Monetary Fund has agreed to a US$1.4 billion emergency loan ^[15] on top of the US$6 billion Pakistan borrowed from the IMF last year. The IMF estimates that Pakistan’s economy will grow by only 0.8% in 2020.

Khan, ever the optimist, has said ^[5] that while no one is immune from the virus, ‘the country will emerge stronger from the challenge’ and will ultimately be ‘a totally different nation’. Let’s hope he’s right because it will take more than wishful thinking to ensure Pakistan comes out of this relatively undamaged.

Given the important role Pakistan plays in the critical geostrategic region of South Asia, the last thing the world needs is for such an important, nuclear-armed country to fail. This will be Khan’s ultimate test.