The Caribbean nation of 11 million people reported nearly 4,000 confirmed cases per million residents over the last week, nine times more than the world average and more than any other country in the Americas for its size.

The outbreak, fueled by the arrival of the more contagious Delta variant first identified in India, has pushed hospitals at the virus epicenter in the province of Matanzas to the brink. State media has shown rare images of patients in beds in corridors and doctors complaining of a lack of oxygen, ventilators and medicines.

Cuba’s handling of the pandemic was one of the issues that propelled thousands to take to the streets nationwide last Sunday in unprecedented anti-government demonstrations in a country where public spaces are tightly controlled. Demonstrators also protested shortages of food and medicines and curbs on civil liberties.

Cuba is not alone in struggling under new waves of the pandemic. But the political implications of such a crisis are greater in a country where healthcare is considered one of the pillars of legitimacy of its “revolutionary” one-party system.