CAIRO (AP) — Reza Khandan got the word from friends jailed in Iran’s most feared prison, Evin. A prisoner and a guard in their cell block had been removed because they were suspected of having coronavirus, and two guards in the women’s ward had shown symptoms.

It was frightening news. Khandan’s wife, Nasrin Sotoudeh, one of Iran’s most prominent human rights lawyers, is imprisoned in that ward in close quarters with 40 other women. Only days earlier, the 56-year-old Sotoudeh — known for defending activists, opposition politicians and women prosecuted for removing their headscarves — held a five-day hunger strike demanding prisoners be released to protect them from the virus.

“The virus has entered the jail, but we don't know the extent of it,” Khandan, who had until recently been imprisoned in Evin as well, told The Associated Press by phone from Tehran.

“It will be impossible to control," Khandan warned.

Iran, where thousands have been infected and hundreds died, has not confirmed any coronavirus cases in its prisons. But Khandan’s is one of several reports of cases that have leaked from inside Evin and elsewhere.

Tens of thousands of political prisoners are jailed in Iran, Syria and other countries around the Middle East, punished for anything from advocating for greater rights to holding protests or simply criticizing autocratic leaders on Facebook or YouTube.

Alarm is growing that they and other prisoners are in danger: If one guard, visitor or new inmate introduces the infection, the coronavirus could race rampant through a captive population unable to protect itself.

Prisons across the region are notorious for overcrowding, with inmates packed sometimes by the dozens in each filthy cell. Torture, poor nutrition and other abuses leave prisoners weaker and more vulnerable.

The vast majority of those infected by the new coronavirus recover, but for many, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia and death.

“The consequences of neglecting (prisoners) are potentially catastrophic,” warned the U.N. high commissioner on human rights, Michelle Bachelet.

The International Committee of the Red Cross is working with authorities in several places around the Middle East to boost prevention measures in detention facilities, said Fabrizio Carboni, the ICRC’s Near and Middle East regional director.

It has requested permission from Syria to do the same in its facilities, he said.

Syria is the darkest black hole. In the long civil war, tens of thousands of activists, protesters and others have been swallowed up with hardly a trace into prisons run by the government of President Bashar Assad.

Conditions inside are perhaps the most terrifying across the region. Rights groups and former detainees describe Syria's prisons as slaughterhouses where detainees undergo torture, including beatings, electric shocks, mutilations and rapes.

As many as 50 people are locked in each 4-by-6-meter cell for weeks, month and years — sleeping on top of each other, almost never allowed to bathe. Amnesty International estimated 17,723 people were killed in custody across Syria between 2011 and 2015, with the actual number likely higher. Thousands more certainly died since.

Syria has confirmed nine cases of coronavirus and one death, none of them in prisons.

Dr. Amani Ballour, who previously ran a hospital in a rebel-held enclave in Syria, said she doubted the outside world would find out if coronavirus were spreading behind prison walls.

“If there is (an outbreak), they won’t declare it because they’re killing detainees anyway — or trying to,” said Ballour who has searched in vain for her brother and brother-in-law in Syrian prisons for nine years. “I don’t imagine anyone surviving the regime prisons.”

The U.S. State Department has warned that an outbreak in Syria’s prisons would be devastating and demanded Damascus free all arbitrarily detained civilians — including Americans.

One of those Americans is Majd Kamalmaz, who vanished a day after entering Syria in February 2017 to visit family for first time in six years. The 62-year-old clinical psychologist from Virginia was not involved in politics and was engaged in international humanitarian work.

“To this day we don’t know why they detained him,” his daughter Maryam said, speaking from her home outside Dallas, Texas, where she and her family have been isolating themselves amid the pandemic.

She fears her father is deeply vulnerable. He is diabetic and had a stroke and a heart attack.

“We know that the Syrian regime doesn’t care much about human life and the idea of them saying oh yes he might have passed with the coronavirus and not really caring much is very worrisome to us,” she said.

In Iran, authorities say they have temporarily freed some 100,000 inmates to ease overcrowding — around half the prison population — a sign of their alarm amid the biggest coronavirus outbreak in the Middle East.

Siamak Namazi, an Iranian-American businessman who was not among those released, has reported “multiple cases (of the virus) on his hallway” in Evin Prison, his Washington-based lawyer, Jared Genser, has said.

In Egypt, families are desperate for information on loved ones in prisons that rights groups say are plagued by overcrowding, abuses and poor hygiene. Tens of thousands have been jailed in crackdowns against government opponents since 2013.

Security forces briefly detained four women — including the mother, sister and aunt of prominent activist Alaa Abdel Fattah — for staging a protest calling for his and other prisoners' release for fear of coronavirus. Authorities released only a handful of detainees recently.

Iyad Dawoud said he was deeply worried over his brother, Khaled Dawoud, a prominent journalist and former opposition leader detained in September and held at Cairo’s Torah Prison.

"Torah complex has thousands of prisoners,” Iyad Dawoud said. "God forbid, one infected person among thousands means the end.”

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El Deeb reported from Beirut. Associated Press correspondents Jon Gambrell in Dubai, United Arab Emirates; Mohammed Daraghmeh in Ramallah, West Bank; Ilan Ben Zion in Jerusalem; Zarar Khan in Islamabad and Rahim Faiez in Kabul contributed to this report