Inhabitants of the overcrowded Moria camp, on the Greek island of Lesbos, can’t practice social distancing when lining up for food three or more times a day – even in the midst of the pandemic.  They’re either not aware of the risk, or space is simply too small for crowds of that size.

Sanne van der Kooij, a Dutch gynecologist, has twice visited the overflowing camp. On her most recent visit, she was concerned by the conditions she found there.

“In February, it was raining and cold, and the ground was slippery and muddy. Lots of people just slept on the floor and needed to wait in line to go to a really nasty toilet or wash their hands,” she said.

Originally designed to accommodate 2,800 people, the camp crams in over 19,500 today. The surrounding olive groves are scattered with makeshift structures often built from scavenged materials. Inside the camp, there’s one water tap for every 1,300 people, one toilet for 167 people, and one shower for 242 people, according to the Guardian. Running water is not a given.

More than 100 refugees have joined forces to raise awareness of the threat posed by Covid-19 among camp residents, but they say progress has been slow. A Europe-wide letter-writing campaign is attempting to persuade nations there to accept more refugees from the Greek camps, but has yet to yield results.

Covid-19 has made its way into refugee populations in Greece, and now most recently onto the island of Lesbos. Experts and activists say it’s only a matter of time before Covid-19 spreads to the Moria camp.

“Coronavirus in Moria is something no one wants to touch,” said Deen Mohammad Alizadah, a pharmacist from Kabul, Afghanistan, and one of the 100-plus-member Moria Corona Awareness Team. “I hear a lot of people coughing; others are running a fever. If someone is sick, they have to go to an in-camp clinic where they wait six hours to see a doctor. Some don’t have the patience to sit around.”

Should someone in the camp have acute Covid-19 symptoms, Alizadah said that they are sent for testing outside the camp, but he has never seen anyone going there. “The doctors inside the camp give people antibiotics and paracetamol and send them away,” he said.

“It’s a miracle no one has gone down with the virus in this camp,” said Read Alabd, a Syrian refugee and former health care advisor living in Moria.

Doctors who bear the brunt of caring for camp residents are overwhelmed, said Tomas Simonek, a Slovak humanitarian doctor who has been working for Kitrinos Healthcare, a team of medical and non-medical volunteers in Moria, for two years now.

“Yes, the lines are big before refugees see a doctor, but we are doing the best we can,” he said.

Dr. Simonek reported that there are two governmental doctors handling the screening of new arrivals and, mostly (since new arrivals have frozen since early March), emergencies and critical-care situations. The rest of the work lies with doctors like himself, who have been struggling since March to meet refugees’ healthcare needs.

Tensions between locals and migrant populations drove many NGO doctors out of Lesbos, Dr. Simonek said.

Worried about the encroachment of Covid-19, members of the Maria Coronavirus Awareness Team distribute hand-sewn masks crafted by women in the camp. They also attempt to educate fellow refugees about how the virus is contracted and how they can protect themselves.

But they worry about Covid-19 spreading from workers coming in and out of the camp, and about cash changing hands at the local supermarket.

Alabd, also a member of the group, admits that he and his teammates are not exactly making inroads with their activism. “If we want to prevent a medical disaster, we need to evacuate the camp,” he said.

The situation has been complicated by the discovery of two positive cases on the island of Lesbos, although neither patient is living in a refugee camp.

“When I learned the news about the first coronavirus cases on Lesbos island, I stopped sleeping at night. I calculated that if the virus spread throughout the camp, we would have about 300 deaths of people who are elderly, have respiratory problems or other chronic health diseases. Our efforts and luck have saved us so far,” Dr. Simonek said.

On May 12, Kitrinos, in partnership with Doctors Without Borders, managed to open the first Covid-19 isolation unit in Moria, where patients will remain isolated until receiving their test results.

Even so, Simonek also agrees that it is “mathematically possible” for the virus to strike in Moria, especially now that Greece has exited the lockdown and there is word that the camp will open on May 26.

After Dr. van der Kooij returned from her February trip, she published a letter of complaint in a Dutch newspaper. Steven van de Vijver, a Dutch general practitioner who had also worked in the Moria camp, wrote another strongly worded letter.

Within three weeks, nearly 7,000 doctors – and about 50,000 health care providers and other citizens of Europe – had signed a public outcry, a letter to each signee’s respective government.

Meanwhile the Moria camp has all the needed ingredients for an outbreak: feeble hygiene, people with poor nutrition and compromised immune systems shoehorned into tight spaces, and a virus that behaves uncontrollably making its way around the world.

“Covid-19 has reached almost every corner of this planet, so I can’t imagine why it shouldn’t hit Moria,” said Dr. van de Vijver.

“We haven’t understood how crucial the situation is,” said Dr. van der Kooij, the gynecologist. “The question is not if we will have a coronavirus case in Moria, but when. And once it starts, it will spread dramatically and fast.”