After weeks of denials from officials in Damascus, Syria has confirmed its first case of Covid-19, as fears mount of an outbreak that will have catastrophic consequences on the war-torn country.

The patient is a 20-year-old woman who recently returned to Syria from an unspecified country and appropriate measures have been taken, the health minister Nizar Yaziji said.

The announcement came after insistence by the regime that Iran-backed fighters and Shia pilgrims had not already brought the coronavirus to Syria, despite reports from healthcare workers in the capital that patients have presented with symptoms consistent with Covid-19.

Nine years of war have devastated Syria’s infrastructure, economy and healthcare system. The World Health Organization (WHO) assesses that Syria’s “fragile health systems may not have the capacity to detect and respond” to the pandemic.

The risk is particularly acute in the opposition-held north-west and the Kurdish-controlled north-east, the two areas still outside of Bashar al-Assad’s control, where there are no testing kits available that could contain the spread of the virus.

In north-western Idlib province, about 900,000 people are living in makeshift accommodation and overcrowded tents, where adequate hygiene and social distancing measures are impossible.

While the area was granted some respite from a brutal regime offensive when a ceasefire was brokered on 5 March, bombing campaigns by Assad and his Russian backers have put 61 medical facilities out of action over the past year, and medicine, equipment and beds are already dangerously scarce.

A total of 60 beds are now available before a Covid-19 outbreak, which aid agencies have warned leaves the three-million-strong population desperately ill-prepared.

“In Idlib, when our partners go and talk to [displaced Syrians] about coronavirus preparedness, they start laughing,” said Sonia Khush, Save the Children’s Syria director.

“They’re trying to find places to live, a lot of them are still in fields. Their top priority is shelter and getting things like jerry cans to keep their water. For that population coronavirus has not hit their top five concerns. They’re still dealing with basic needs.”

In the north-east, the Kurdish authorities have 150 ventilators for patients diagnosed with Covid-19. The area is going into lockdown from Monday, with all movement between cities stopped and only markets and medical facilities allowed to stay open.