For decades, powerful Nigerians could ignore the government’s failure to invest adequately in the health-care system by seeking medical treatment abroad. The coronavirus pandemic means they can no longer escape.

Since Nigeria identified its first case in late February, President Muhammadu Buhari has responded by closing the borders and imposing a lockdown on two key cities and the state of Ogun, an industrial hub. Commercial flights and private jets have been grounded. Like most African countries, Nigeria is now largely cut off from the world.

The pandemic has forced much of Africa’s elite into a unique situation where it’s no longer possible to fly to the U.K., France or India to see a doctor, a practice that’s become commonplace even among the affluent middle class.

Buhari was widely criticized for spending more than five months in the U.K. in 2017 for an undisclosed ailment. Last year, Gabon’s president, Ali Bongo, recovered in Morocco from a stroke, while Robert Mugabe, Zimbabwe’s former leader, died in a hospital in Singapore.

In Nigeria, the coronavirus has so far infected 174 people, including Abba Kyari, Buhari’s chief of staff, a man regarded as the second-most powerful in the country.

Four out of 36 state governors and a son of former Vice President Atiku Abubakar have also tested positive. A former senior executive of the state oil company, Suleiman Achimugu, was the first Covid-19 fatality.

‘Total Collapse’

Dozens of senior public officials, including state governors and lawmakers, have gone into isolation. If they get sick, they will have to rely on a weak health system that is at risk of crumbling under the weight of a larger outbreak, according to Francis Faduyile, head of the Nigerian Medical Association, an umbrella group for doctors.

“The health system is not strong enough,” Faduyile said by phone from Lagos. “Over the years, it’s been denied normal funding and things are not where they’re supposed to be. If the burden of the coronavirus is added, it may be too heavy; it may actually cause a total collapse.”

Among Nigeria’s registered health professionals are 75,000 doctors, 180,709 nurses and 25,000 pharmacists, according to the health ministry. With 0.5% hospital beds per 1,000 people and a population of roughly 200 million, that’s far below thresholds set by the World Health Organization. Only five laboratories are able to test for the virus.

Health spending at around 5% of the budget in the past decade falls short of the African Union’s recommended minimum of 15% and has been mostly focused on recurrent spending, with little capital investment made over the years, according to BudgiT, a civil-society group that tracks government expenditure. A National Health Act that came into effect in 2015 and requires that 1% of government revenue is set aside for basic health care has yet to be implemented.

Even those numbers may not tell the whole story as officials of the medical association say about half of all registered doctors have emigrated to the U.K., the U.S., Canada, Australia and other parts of the world.

While Faduyile said there’s still time for the government to institute large-scale preventative measures, a wider coronavirus outbreak would leave everyone in Africa’s most populous country -- the rich, the poor and the middle class -- scrambling for service in poorly equipped hospitals.

“It’s going to be a lesson for those who think they can neglect the health system,” Faduyile said. “The highest of the government officials, some of them will be infected, and they’ll have no option but to get local treatment.”