Late last year, what is thought to be a bat-associated coronavirus infected humans in Wuhan, a city of 11 million in China, possibly after a stopover in illegally traded pangolins—setting off a global pandemic. This kind of thing has happened before—with AIDS, SARS, and MERS, for example. Much remains unknown about the biology of COVID-19, which is alarmingly communicable by people with few or no symptoms. But an epidemic is only part biology. It is also driven by cultural factors, and urbanization is a crucial aspect. As sites of large gatherings and dense living conditions, cities offer the perfect settings for the spread of infection, yet their role seems to have often gone unremarked in discussions of the pandemic.

On May 6, Médecins Sans Frontières (MSF) announced it had started to treat COVID-19 patients in Tijuana, in northwestern Mexico. Tijuana, which is on the border with San Diego, has the greatest number of cases in Mexico and one of the highest death rates.

“We will be providing support to health institutions [by] relieving the hospital burden in Tijuana,” said Maria Rodríguez Rado, MSF’s COVID-19 Emergency Response Coordinator in Mexico, according to the group’s website. “Through this support, we want to relieve the enormous workload of health workers who are responding to this pandemic and help alleviate the suffering of patients.”

The move is welcome. Across Central America, megacities such as Guatemala City, Tegucigalpa in Honduras, and Managua in Nicaragua are vulnerable to the rapid spread of COVID-19.

Since the onset of the pandemic, nurses and midwives have been asked in some facilities to work without personal protective equipment. Nurses have been sent home and lost their jobs simply because they insisted on following evidence-based practices, such as wearing masks. Some question whether the masks, gloves, gowns, and other commodities in short supply are more important than nurses who question the ethics of showing up when essentials aren’t available.

“While COVID-19 has wreaked havoc the world over, history has proven, and recent data agrees that the hardest hit will be the world’s women and girls and populations already impacted by racism and discrimination,” said Sarah Barnes, Project Director of the Maternal Health Initiative and Women and Gender Advisor at the Wilson Center, at a recent event on the impact of COVID-19 on race and gender inequities. Coronavirus has hurt women and girls in many ways. Among them, women have been pushed back into the home.  And healthcare workers and caregivers who are mostly women are jeopardizing their own health, caring for others.

Refugees and migrants are the most vulnerable and will bear the brunt of the Covid-19 pandemic, said James Hollifield, a Wilson Center Global Fellow, in a recent episode of Wilson NOW. These populations are often already at higher risk due to insufficient water and food supplies, and those confined in large camps are at greater risk of spreading the disease. According to Hollifield, although we have not yet seen the full extent of the damage, “we can see with both refugees and migrants in particular, especially seasonal migrants, that there’s a great danger here of the virus spreading like wildfire in the camps and in the dormitories.”

Development specialists are sounding the alarm. The pandemic will not be stopped unless we provide safe water to the world’s most vulnerable people, according to UN experts. Soap and clean water are part of the arsenal of weapons we can deploy on the frontlines of the battle to halt the virus’ spread. Yet Covid-19 continues to pose an unprecedented threat to more than 2 billion of the world’s poorest people who lack the access to safe water, sanitation, and health services (WASH) needed to protect them during infectious disease outbreaks, according to the World Health Organization.

“Today is the International Day of the Midwife, a day when we come together as a global health community to celebrate midwives, and the commitment of the midwifery profession globally to saving lives and upholding the rights of women to a safe and positive birth,” write the authors of the Global Call to Action: Protecting Midwives to Sustain Care for Women, Newborns and their Families in the COVID-19 Pandemic. Midwives are essential to the health and protection of women and newborns. The World Health Organization (WHO) estimates that 83 percent of all maternal deaths, stillbirths, and newborn deaths could be averted with the full package of midwifery care.