At the Locri hospital in southern Italy, patients are often sent elsewhere for lack of doctors, the lifts are endlessly in disrepair and the CT scan works one day, but not the next.
Infiltration by the mafia, severe doctor shortages, and a regional health agency hundreds of millions of euros in debt are just a few of the challenges the hospital confronted in 2019 alone.
And that was before coronavirus.
Now, residents of the community in Italy's southernmost region of Calabria are bracing for what they fear could be an inexorable march south of the disease that has killed over 17,000 people in the country, and wondering how they can possibly cope.
"It's adding a crisis on top of a crisis," Locri's mayor Giovanni Calabrese told AFP.
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The fact that Locri has so far been spared any deaths, he said, was "the only good news we've got".
To date, Italy's devastating coronavirus crisis has been centred in its prosperous, industrial north.
In regions such as Lombardy and Piedmont some hospitals rival the best in Europe, but unrelenting waves of patients, combined with too few doctors, ventilators and supplies, have brought them to breaking point.
Health authorities have warned for weeks that if a similar surge in cases erupts in the south, the consequences could be even more devastating.
"If all these patients start coming in like what's going on in Lombardy, how would we do it?" asked Emanuela Barbuto, regional leader of the Fsi-Usae union which represents public health workers, among others. She said residents felt "abandoned".
"The system can't hold up."
For now, only eight people have been infected with coronavirus in the vicinity of Locri, a beachfront town whose hospital serves an area of 150,000 inhabitants.
But a sharp rise in infections elsewhere in Calabria, the mountainous toe of Italy's boot, has caused authorities to bar access to 14 towns deemed "red zones".
Calabria's death toll has risen to 60 since the first fatality reported on March 14, with an average of four new deaths each day over the past week.
Three days before the first Calabrian died, the region's president, Jole Santelli, activated an emergency plan calling on provincial authorities to decide which hospitals would be designated "COVID-19" centres.
One choice was Locri.
A subsequent announcement by the provincial health authority that manages Locri's hospital specifying that the facility would dedicate 37 beds to coronavirus patients caused disbelief, and panic.
"There aren't conditions to guarantee even minimum standards," said Barbuto.
"How do we handle this if we don't even have the basic things?" The problems at Locri's hospital date back years and are well documented. Nevertheless, locals say promised changes never arrive.
Even before the coronavirus crisis gripped Italy, Locri residents in February formed a citizens' group to save their local hospital.
Built in the 1970s, its concrete edifice is crumbling in places, exposing rusting steel bars. Tall weeds line the driveway.
Inside, things aren't any better, with those who spoke to AFP describing a litany of problems.
An MRI bought three years ago has yet to arrive. Radiology is closed nights and weekends. The lifts, fixed for now, have broken down repeatedly in the past -- any that still worked had to transport patients, medical supplies, food, and corpses.
Last year, when all five lifts were out, staff were forced to carry patients to cardiology on the fifth floor.
The Provincial Health Agency of Reggio Calabria (ASP), which oversees the hospital, has been run since March 2019 by a special commission after being dissolved for the second time in a decade due to infiltration by the 'Ndrangheta, Italy's most powerful organised crime syndicate based in Calabria.
An investigation by prosecutors found a series of anomalies, including invoices paid twice, some in the millions of euros, contracts given without public tenders, and salaries paid to officials banned from public office.
From 2013 until 2018, the ASP operated without a budget.
The agency had a cumulative debt of over 420 million euros ($455 million) by the end of 2017, credit rating agency CRIF Ratings wrote in report last year.
"Normally in an administration that doesn't have a budget, they shut it down or they arrest someone," said Bruna Filippone, a Locri resident who started the Defend the Hospital group.
A decade ago, a parliamentary investigation into healthcare in Calabria uncovered a host of problems at Locri.
Investigators cited purchasing conducted "in systematic violation of the anti-mafia regulations," injunctions related to accrued debt arriving "daily," unreliable data and weak auditing controls, according to the 2011 report, which urged "radical change".
The ASP did not respond to repeated AFP requests for an interview.
In November 2018, just four months before the special commission took the reins of the agency, Prime Minister Giuseppe Conte paid a visit to the Locri hospital, vowing swift action to fix its problems and promising to return. So far, he has not.
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