Buildings in central Stepanakert after bombardment by the Azerbaijani military, mid-October 2020. Photo (c): Régis Gente. Used with permission. Nobody can self-isolate in a warzone. And a warzone is exactly what Nagorno-Karabakh has become. On September 27, heavy fighting broke out amid an attempt by Azerbaijan to recapture the South Caucasus territory. The ongoing war is now the most serious violence since 1994, when a brittle ceasefire left Nagorno-Karabakh under the control of ethnic Armenian forces as a de-facto state. Although Nagorno-Karabakh is unrecognised by Armenia, Yerevan provides extensive military and economic support, and most residents of the region are Armenian citizens. The Azerbaijani armed forces have bombarded the capital Stepanakert with artillery, drones, and according to a recent Human Rights Watch (HRW) report, cluster munitions. Civilian casualties have been reported in the city, many of whose 55,000 inhabitants have fled to neighbouring Armenia. Those who remain must take shelter in bomb shelters and basements. There has also been disruption to the city's electricity supply. So far, two Russian-brokered humanitarian ceasefires have collapsed. Azerbaijani armed forces have made rapid gains in the south of Nagorno-Karabakh, along the Iranian border. At the time of writing, Azerbaijani soldiers are a matter of kilometres from the main transport artery between Nagorno-Karabakh and Armenia, known as the Lachin Corridor. As fighting continues, the question is now not whether Karabakh faces a humanitarian crisis, but how it can be averted. This war is being fought in the shadow of a pandemic — COVID-19 looms over an internationally unrecognised state, nearly severed from its only link to external support, as winter approaches. The last figures from the de-facto Ministry of Healthcare of Nagorno-Karabakh were quoted by Armenian investigative website Hetq on September 26, the day before hostilities began. It stated that there were 421 recorded COVID-19 cases in the territory. That week, Armenian-language media also reported that Nagorno-Karabakh had recorded 12 new COVID-19 cases in a single day; already a large spike for the territory of 140,000. It appears that the healthcare authorities have not released new COVID-19 statistics since the war began. Global Voices attempted to contact the Nagorno-Karabakh Ministry of Healthcare without success. However, on October 22, de-facto Healthcare Minister Ararat Ohanjanyan told the Associated Press that many doctors and nurses in Karabakh had known that they were infected but kept quiet about it. “We didn't have time to track down those infected while Stepanakert came under heavy shelling, and that allowed contagion to spread,” said Ohanjanyan, who himself continues to work despite having tested positive for the virus. Effectively fighting a pandemic while attempting to survive a war may be nearly impossible. According to a EuroNews report from October 21, some COVID-19 patients in Stepanakert have had to take shelter from bombs alongside everybody else, increasing the risk of infection. “Objectively and subjectively, nobody can pay enough attention to the preventative measures,” explained Karabakh's Human Rights Ombudsman Artak Beglaryan in a telephone conversation. Lika Zakaryan, a Stepanakert-based journalist, put it more bluntly in an online exchange with Global Voices. “Nobody cares about COVID-19 right now. Many people are probably infected, as we have war wounded in the hospitals,” said the reporter for CivilNet, an Armenian online publication. Zakaryan added that to her knowledge most hospitals in Nagorno-Karabakh, including the general hospital in Stepanakert, are functioning. Mher Musaelyan, a medical clinic director at Stepanakert's Republican General Hospital, confirmed to Global Voices in a telephone conversation that he was not aware of any large-scale monitoring of the COVID-19 infection rate. “Our main task right now is to care for the wounded,” explained Dr. Musaelyan, who stressed that doctors would still do their best to care for anybody presenting COVID-19 symptoms. However, some medical infrastructure has been damaged and disrupted by shelling. For example, though it is likely that the territory's largest hospitals have their own small generators, an Azerbaijani attack on Stepanakert's main power station resulted in the city losing electricity on October 3. On October 14, photos emerged showing the bombing of a hospital in the fiercely contested town of Martakert, in what Armenian officials say was a deliberate attack, which their Azerbaijani counterparts denied. This war comes alongside a surge in COVID-19 cases across the entire South Caucasus. Armenia was initially the hardest hit.