As in other countries, frontline health workers in the region are the most vulnerable to deadly outbreaks. Between 40 and 50 health workers have died in Dagestan since the beginning of the pandemic, according to estimates from Gadzhiibragimov and head of the region’s mufti. Dagestan has a population of around 3 million people. According to the Russian health ministry, the region has 635 ICU beds and ventilators.

Civil rights activist Ziyautdin Uvaisov, who is chairman of Patient Monitor, a non-profit organization that collects money to buy protective equipment for Dagestan doctors, told CNN that the health care system in the region is in very bad shape.

“We have been talking about it since 2017 but unfortunately there is a habit of sweeping everything under the rug,” Uvaisov said.

He added that most doctors in his organization interacted by saying about half of their colleagues were sick because there was no one to replace them when the hospital ward overflowed.

Dagestan’s dire situation has put the republic in the spotlight of Russia’s top officials. On Monday, Putin took the unusual step of leading a special government session with Dagestan leaders.

“The situation in Dagestan is difficult and demands immediate action,” Putin said in a video conference, which ordered the military to build a 200-bed hospital to help ease a crowded emergency room.

Much of the Russian government’s response to the pandemic has been hampered by bureaucracy and mismanagement of regional funds. In poorer regions such as Dagestan, where the average monthly wage is twice as low as national, according to the Russian state statistics agency, dragging feet like that is one of the main reasons behind the severe outbreak.

The additional payment promised by Putin to compensate for the difficulties of front-line work is another complaint for health professionals.

“We have been working since the beginning of the pandemic and we are faithfully doing our job – now many of our colleagues [confined] inside a medical institution, fighting for their lives, “a paramedic from the city of Buinaksk in Dagestan said in a video posted by a local outlet.

“Only a few of us are left at the forefront. We have 151 employees, but only 41 receive payment. The others don’t get anything.”

Similar videos and open letters has appeared in at least 20 of 85 Russian regions in the past week, according to CNN calculations. In public outrage, health workers complained that they did not receive any additional payment or get a small portion of it, calculated on the basis of hours and even minutes spent working directly with Covid-19 patients.

“If the government’s decision is initially declared clear, understandable, transparent and easy to control the principles and ways to bring this presidential payment [to health workers] “to work in special conditions, there will be fewer questions for the head doctors who work from morning to night, and to the governor as well,” Putin said on Tuesday.

The federal government changed the relevant regulations, removed the bureaucratic loophole which resulted in some doctors receiving less than 50 cents of additional salary, and promised to facilitate all payments that should be.

In a special meeting held by Putin on Monday, officials acknowledged the situation in Dagestan was more serious than reflected in official statistics. Russian Health Minister Mikhail Murashko said that 7,000 people had been hospitalized. In a video conference on Monday, Republican Head Mufti Ahmad Abdulaev told Putin many Covid-19 deaths were not recorded because people died in their homes without ever being taken to the hospital and buried according to local traditions – and without an autopsy that could confirm the cause of death.

Vladimir Vasilyev, head of the republic, linked the level of infection in part with the Dagestan tradition, which involved mass gatherings to mark important events such as weddings and funerals as well as unwillingness to delay Friday prayers in the early stages of the outbreak. He also discussed the difference in numbers between pneumonia and coronavirus.

“We are not hiding anything,” Vasilyev said, citing high respiratory-related mortality rates in 2018 and 2019, before coronavirus. “But here it is [is] it’s not so easy to distinguish the two. “

The Kremlin has promised to help Dagestan with additional resources to help him fight the pandemic, including more test kits because the republic is still testing at a daily rate twice the recommended, according to federal health and welfare agency Rospotrebnadzor. The agency’s head, Anna Popova, told Putin that Dagestan maintained “a very fragile balance,” because the authorities were worried that the Eid holiday and mass Muslim celebrations could trigger a new outbreak.

Victims of Russia’s overall coronavirus virus remain low with 2,837 deaths reported on Tuesday and the death rate is 7.4 lower than the global average, according to Deputy Prime Minister Tatiana Golikova. The method of calculating the country has been investigated by observers who show that deaths are often ascribed to other causes.

Russian demographers and epidemiologists hope that national statistics for all-cause deaths in April, which are expected to be released by authorities in late May, will help to get a clearer picture of the number of pandemic victims in Russia – both for deaths from coronavirus that may missed and for people who cannot get medical help for other conditions because the hospital is overwhelmed.