Gemma Holliani Cahya in Jakarta and Rebecca Ratcliffe – Scenes that have for months haunted hospitals across Indonesia's Java island are appearing across the country, as the Delta variant spreads to new provinces, causing shortages of beds and oxygen.
Images have circulated on social media of overstretched hospitals in both Papua and Kalimantan. One video shows a patient lying inside an ambulance, with two of his relatives sitting next to him. "The people need help. [I] have brought them to hospitals but all of them rejected us. [The hospitals] said there is no oxygen. How come the government can't provide oxygen?" the ambulance driver, who recorded the video, can be heard saying. The Twitter account reported that the patient finally died.
In another image that has been shared widely, patients are treated on the terrace of a hospital in Jayapura, Papua, apparently due to a lack of space. A letter from one of the biggest hospitals in the city, also circulated online, urged the Jayapura city mayor and the head of the police precinct to provide more oxygen supply.
"This is a very difficult situation for us and this could risk the patients' lives," wrote Fansca Titaheluw, the hospital director, in the letter, dated 19 July.
Indonesia's daily infections have been among the highest in the world for the past week, with most cases recorded in Java, which is home to 60% of the population. Medical facilities in big cities across the island have for months been under immense pressure, unable to cope with the influx in patients. Many people have died at home, unable to find treatment.
According to health ministry data, the more aggressive Delta variant, which has been partly blamed for the crisis in Java, has spread to 11 provinces elsewhere. Health experts fear that such areas, which have weaker health systems, could face an even deeper crisis.
"From what I see the provinces outside Java will not be able to deal with this [surge]," said Trubus Rahadiansyah, a public policy expert from Trisakti University.
The limited budget for regional quarantine, a severe lack of medical staff and limited health facilities are just three of the serious hurdles that the provinces face, especially those in rural areas.
"Even before the pandemic they have been struggling with a shortage of medical workers and health facilities," Trubus said.
Pandu Riono, an epidemiologist at the University of Indonesia, fears that if there is a surge similar to the wave experienced by Java, the death rate could be higher, because there are fewer resources. "The people will suffer a lot if [there are] increasing cases, like in Java and Bali areas... The problem is it is very difficult to escalate the health facilities in those areas," said Pandu.
"The local government cannot do it by themselves. They can be helped by central government or by international organisations. They should be sending the equipment – the ventilators, oxygen – not only to Java island but also outside Java island."
Only 1.1% of the country's doctors and nurses, about 1,787 people, work outside Java, according to a 2020 survey by the Research and Development Department of Kompas.
The number of doctors, including general practitioners, pulmonary specialists and internal medicine specialists, in Indonesia totals 19,649 people. However, only 893 people, or 4.5%, serve outside Java.
The same inequality is also seen among Indonesia's 140,071 nurses. Only 894 nurses, or 0.6%, are based outside Java.
Pandu said the recruitment process for doctors who have recently graduated should also be accelerated, so that more staff can be urgently deployed.
Outside Jakarta and Yogyakarta, provinces with the highest cases per 100,000 include East Kalimantan, North Kalimantan, Riau Islands and West Papua. In each of these areas, at least one-third of tests conducted are positive; in West Papua, this is the case for 40.2% of tests.
On Tuesday, Papua's governor, Lukas Enembe, said people in the province should prepare for a lockdown for the entire month of August. The plan, which is still waiting for approval from President Joko Widodo, would include shutting down all transport in and out of the province.
"Papua not only has human resources shortage issues but also shortage of medicines and health facilities," said Adib Khumaidi, the head of the risk mitigation team at the Indonesian Medical Association, who said he was aware of the proposal.
Doctors in other provinces, including South Kalimantan, South Sumatra, Riau Islands and Lampung, have also reported rising cases, he said. "Some reported that their hospitals are full. Numbers of their medical workers also got infected by the virus,."
Trubus said the government needed to simplify its communications and give clear public health messages, and work with religious and community leaders to raise awareness of the dangers posed by Covid.
"This is a war with a very strong enemy so we have to face it together," he said.