As richer countries race to distribute COVID-19 vaccines, Somalia remains the rare place where much of the population hasn’t taken the coronavirus seriously. Some fear that’s proven to be deadlier than anyone knows.

“Certainly our people don’t use any form of protective measures, neither masks nor social distancing,” Abdirizak Yusuf Hirabeh, the government’s COVID-19 incident manager, said in an interview. “If you move around the city (of Mogadishu) or countrywide, nobody even talks about it.” And yet infections are rising, he said, reports AP.

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It is places like Somalia, the Horn of Africa nation torn apart by three decades of conflict, that will be last to see COVID-19 vaccines in any significant quantity. With part of the country still held by the al-Qaida-linked al-Shabab extremist group, the risk of the virus becoming endemic in some hard-to-reach areas is strong — a fear for parts of Africa amid the slow arrival of vaccines.

“There is no real or practical investigation into the matter,” said Hirabeh, who is also the director of the Martini hospital in Mogadishu, the largest treating COVID-19 patients, which saw seven new patients the day he spoke. He acknowledged that neither facilities nor equipment are adequate in Somalia to tackle the virus.

Fewer than 27,000 tests for the virus have been conducted in Somalia, a country of more than 15 million people, one of the lowest rates in the world. Fewer than 4,800 cases have been confirmed, including at least 130 deaths.

Some worry the virus will sink into the population as yet another poorly diagnosed but deadly fever.

For 45-year-old street beggar Hassan Mohamed Yusuf, that fear has turned into near-certainty. “In the beginning we saw this virus as just another form of the flu,” he said.

Then three of his young children died after having a cough and high fever. As residents of a makeshift camp for people displaced by conflict or drought, they had no access to coronavirus testing or proper care.

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At the same time, Yusuf said, the virus hurt his efforts to find money to treat his family as “we can’t get close enough” to people to beg.

Early in the pandemic, Somalia’s government did attempt some measures to limit the spread of the virus, closing all schools and shutting down all domestic and international flights. Mobile phones rang with messages about the virus.

But social distancing has long disappeared in the country’s streets, markets or restaurants. On Thursday, some 30,000 people crammed into a stadium in Mogadishu for a regional football match with no face masks or other anti-virus measures in sight.

Mosques in the Muslim nation never faced restrictions, for fear of the reactions.

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“Our religion taught us hundreds of years ago that we should wash our hands, faces and even legs five times every day and our women should take face veils as they’re often weaker. So that’s the whole prevention of the disease, if it really exists,” said Abdulkadir Sheikh Mohamud, an imam in Mogadishu.

“I left the matter to Allah to protect us,” said Ahmed Abdulle Ali, a shop owner in the capital. He attributed the rise in coughing during prayers to the changing of seasons.

A more important protective factor is the relative youth of Somalia’s people, said Dr. Abdurahman Abdullahi Abdi Bilaal, who works in a clinic in the capital. More than 80% of the country’s population is under age 30.

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“The virus is here, absolutely, but the resilience of people is owing to age,” he said.

It’s the lack of post-mortem investigations in the country that are allowing the true extent of the virus to go undetected, he said.

The next challenge in Somalia is not simply obtaining COVID-19 vaccines but also persuading the population to accept them.

That will take time, “just the same as what it took for our people to believe in the polio or measles vaccines,” a concerned Bilaal said.

Hirabeh, in charge of Somalia’s virus response, agreed that “our people have little confidence in the vaccines,” saying that many Somalis hate the needles. He called for serious awareness campaigns to change minds.

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The logistics of any COVID-19 vaccine rollout are another major concern. Hirabeh said Somalia is expecting the first vaccines in the first quarter of 2021, but he worries that the country has no way to handle a vaccine like the Pfizer one that requires being kept at a temperature of minus 70 degrees Celsius.

“One that could be kept between minus 10 and minus 20 might suit the Third World like our country,” he said.

Another new variant of the coronavirus appears to have emerged in Nigeria, Africa’s top public health official said Thursday, but he added that further investigation was needed.

The discovery could add to new alarm in the pandemic after similar variants were announced in Britain and South Africa, leading to the swift return of international travel restrictions and other measures just as the world enters a major holiday season, reports AP.

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“It’s a separate lineage from the UK and South Africa,” the head of the Africa Centers for Disease Control and Prevention, John Nkengasong, told reporters. He said the Nigeria CDC and the African Center of Excellence for Genomics of Infectious Diseases in that country — Africa’s most populous — will be analyzing more samples.

“Give us some time ... it’s still very early,” he said.

The alert about the apparent new variant was based on two or three genetic sequences, he said, but that and South Africa’s alert late last week were enough to prompt an emergency meeting of the Africa CDC this week.

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The variant was found in two patient samples collected on Aug. 3 and on Oct. 9 in Nigeria’s Osun state, according to a working research paper seen by The Associated Press.

Unlike the variant seen in the UK, “we haven’t observed such rapid rise of the lineage in Nigeria and do not have evidence to indicate that the P681H variant is contributing to increased transmission of the virus in Nigeria. However, the relative difference in scale of genomic surveillance in Nigeria vs the U.K. may imply a reduced power to detect such changes,” the paper says.

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The news comes as infections surge again in parts of the African continent.

The new variant in South Africa is now the predominant one there, Nkengasong said, as confirmed infections in the country approach 1 million. While the variant transmits quickly and viral loads are higher, it is not yet clear whether it leads to a more severe disease, he said.

“We believe this mutation will not have an effect” on the deployment of COVID-19 vaccines to the continent, he said of the South Africa variant.

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South Africa’s health minister late Wednesday announced an “alarming rate of spread” in that country, with more than 14,000 new cases confirmed in the past day, including more than 400 deaths. It was the largest single-day increase in cases.

The country has more than 950,000 infections and COVID-19 is “unrelenting,” Health Minister Zwelini Mkhize said.

The African continent now has more than 2.5 million confirmed cases, or 3.3% of global cases. Infections across the continent have risen 10.9% over the past four weeks, Nkengasong said, including a 52% increase in Nigeria and 40% increase in South Africa.

For the first time since confirming sub-Saharan Africa’s first virus case in February, Nigeria is in the spotlight during this pandemic as infections surge.

“Over recent weeks, we’ve had a huge increase in number of samples to (Nigeria CDC) reference lab,” the CDC director-general Chikwe Ihekweazu tweeted on Thursday. “This has led to an unusual delay with testing, but we’re working around the clock,” with many colleagues cutting short their holidays and returning to work.

Nigeria now has more than 80,000 confirmed coronavirus cases.

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The United Nations says food has now run out for the nearly 100,000 refugees from Eritrea who have been sheltering in camps in Ethiopia’s northern Tigray region, which has been cut off from the world for nearly a month amid fighting.

“Concerns are growing by the hour,” U.N. refugee spokesman Babar Baloch told reporters in Geneva on Tuesday. “The camps will have now run out of food supplies – making hunger and malnutrition a real danger, a warning we have been issuing since the conflict began nearly a month ago. We are also alarmed at unconfirmed reports of attacks, abductions and forced recruitment at the refugee camps.”

Wednesday marks a month since Ethiopian Prime Minister Abiy Ahmed announced that fighting had erupted in the Tigray region between federal forces and regional ones, as each government now regards the other as illegitimate due to a dispute over holding elections during the pandemic.

Communications and transport links to the Tigray region of 6 million people have been severed, and the U.N. and others have pleaded for access to deliver badly needed food, medicines and other supplies.

Abiy, last year’s Nobel Peace Prize winner, has rejected the idea of dialogue with the Tigray regional leaders, who are on the run but say they continue to fight even after Abiy over the weekend declared victory in the deadly conflict.

Under growing international pressure, Abiy on Monday said that “my message to friends of Ethiopia is that we may be poor but we are not a country that will negotiate our sovereignty. Threatening Ethiopia for coins will not work.”

Ethiopia’s government has said it will create and manage a “humanitarian corridor” for the delivery of aid, but the U.N. wants access that is neutral, unhindered and immediate.

The U.N. has said some 2 million people in Tigray now need assistance — a doubling from the number before the fighting — and some 1 million people are displaced, including more than 45,000 Ethiopians who have fled into Sudan as refugees.

The 96,000 Eritrean refugees are in an especially precarious position. They are in camps in Ethiopia near the border of their homeland, Eritrea, which they fled, and reports of have emerged that some have been attacked or abducted. The U.N. refugee chief has warned that, if true, any such actions “would be major violations of international norms.”

Eritrea has remained almost silent as the Tigray leaders accuse it of joining the conflict at Ethiopia’s request, which Abiy’s government has denied.

Some 1,000 of the Eritrean refugees have arrived in the Tigray regional capital, Mekele, looking for food and other help, the International Committee of the Red Cross said over the weekend.

“For almost two decades, Ethiopia has been a hospitable country for Eritrean refugees but now we fear they are caught in the conflict,” Baloch said. “UNHCR appeals to the government of Ethiopia to continue to fulfill its responsibility in hosting and protecting Eritrean refugees and allow humanitarians to access people who are now desperately in need.”

In Mekele, which the Ethiopian military has said is under its “full control” after its offensive last week, “aid workers report that people have been forced to rely on untreated water to survive following the damage and destruction of water infrastructure,” U.N. spokesman Stephane Dujarric told reporters Monday. “Our humanitarian colleagues are also warning that it is critical that essential supplies and services be restored immediately in Mekelle and across the Tigray region.”

U.N. Secretary-General Antonio Guterres underscored that need in a phone call with Abiy on Sunday, Dujarric said.

The fugitive leader of Ethiopia’s defiant Tigray region on Monday called on Prime Minister Abiy Ahmed to “stop the madness” and withdraw troops from the region as he asserted that fighting continues “on every front” two days after Abiy declared victory.

Debretsion Gebremichael, in a phone interview with The Associated Press, said he remains near the Tigray capital, Mekele, which the Ethiopian army on Saturday said it now controlled. Far from accepting Abiy’s declaration of victory, the Tigray leader asserted that “we are sure we’ll win.”

He also accused the Ethiopian forces of carrying out a “genocidal campaign” against the Tigray people. With the Tigray region still cut off a month after the fighting began, no one knows how many people have been killed, and it’s difficult to verify the warring sides’ claims.

Each government regards the other as illegal after Abiy sidelined the once-dominant Tigray People’s Liberation Front after taking office in early 2018.

The fight is about self-determination of the region of around 6 million people, the Tigray leader said, and it “will continue until the invaders are out.” He asserted that his forces held an undetermined number of “captives” among the Ethiopian forces, including the pilot of a fighter jet that his side claims to have shot down over the weekend.

The Tigray leader also asserted that his forces still have several missiles and “we can use them whenever we want,” though he rejected a question about striking at the Ethiopian capital, Addis Ababa, saying the primary aim is to “clear Tigray from the invaders.” He again accused Abiy of collaborating with neighboring Eritrea in the offensive in Tigray, something the Ethiopian government has denied.

As for the idea of talks with the government, something Abiy has repeatedly rejected, the Tigray leader said that “depends on the content” and Ethiopian forces would first have to leave the region.

“Civilian casualties are so high,” he said, though denied having any estimate of the toll. He accused Ethiopian forces of “looting wherever they go.”

“The suffering is greater and greater every day,” he said, calling it collective punishment against the Tigray people for their belief in their leaders.

The fighting has threatened to destabilize Ethiopia, the linchpin of the strategic Horn of Africa, and its neighbors.

Abiy in remarks to lawmakers on Monday asserted that “the defense force has not killed a single person in any city. No nation’s military could have shown better competency than us.” But one of his own cabinet ministers, Zadig Abraha, told the AP on Saturday that “we have kept the civilian casualty very low.”

U.S. Secretary of State Mike Pompeo spoke with Abiy on Monday — the first known time since the fighting began — and reiterated the “grave concern regarding ongoing hostilities and the risks the conflict poses,” a spokesman said. Pompeo also “called for a complete end to the fighting and constructive dialogue to resolve the crisis” and for humanitarian access and protection of civilians, including refugees.

Hospitals and health centers in the Tigray region are running “dangerously low” on supplies to care for the wounded, the International Committee of the Red Cross has said. Food is also running low, the result of the region being cut off from outside aid.

In a rare report from inside Mekele, the ICRC also said a major hospital in northern Ethiopia, Ayder Referral Hospital, is lacking body bags and some 80% of its patients have trauma injuries.

Fears of a widespread humanitarian disaster are growing. The U.N. has been unable to access the Tigray region. Human rights groups and others worry about the atrocities that might emerge once transport and other links are restored.

Nearly 1 million people have been displaced, including about 44,000 who fled into Sudan. Camps in Tigray that are home to 96,000 Eritrean refugees have been in the line of fire.

“We need first and foremost access” to Tigray, U.N. refugee chief Filippo Grandi said Sunday, adding that his U.N. colleagues in Addis Ababa are in discussions with the government. Abiy’s government has promised a “humanitarian corridor” managed by itself, but the U.N. has stressed the importance of neutrality.

The Ethiopian Human Rights Commission on Monday urged the government to quickly restore basic services and humanitarian aid access to the Tigray region and allow access to independent investigations into “grave human rights violations.” It also expressed concern about profiling of ethnic Tigrayans.

At least 110 people were killed in the weekend attack on farm workers in northeast Nigeria by Boko Haram, the UN humanitarian coordinator in the country said on Sunday, making it the deadliest raid on civilians this year in the country.

“At least 110 civilians were ruthlessly killed and many others were wounded in this attack,” Edward Kallon said in a statement after initial tolls indicated 43 and then at least 70 dead from the massacre on Saturday by suspected Boko Haram fighters.

“The incident is the most violent direct attack against innocent civilians this year,” Kallon said, adding: “I call for the perpetrators of this heinous and senseless act to be brought to justice.”

The attack took place in the village of Koshobe near the main city of Maiduguri, with assailants targeting farmers on rice fields. The Borno state governor, Babagana Umara Zulum, attended the burial on Sunday in the nearby village of Zabarmari of 43 bodies recovered on Saturday, saying the toll could rise after search operations resumed.

The assailants tied up the agricultural workers and slit their throats, according to a pro-government anti-jihadist militia. The victims were among labourers from Sokoto state in north-west Nigeria, about 1,000km (600 miles) away, who had travelled to the north-east to find work, it said. Six others were wounded in the attack and eight remained missing as of Saturday.

Kallon cited “reports that several women may have been kidnapped”, and called for their immediate release and return to safety.

The Nigerian president, Muhammadu Buhari ,condemned the attack, saying: “The entire country has been wounded by these senseless killings.”

The attack took place as voters went to the polls in long-delayed local elections in Borno state. The polls had been repeatedly postponed because of an increase in attacks by Boko Haram and a rival dissident faction, ISWAP.

The two groups have been blamed for increasing attacks on loggers, farmers and fishermen, whom they accuse of spying for the army and pro-government militias.