In the final hours before Covid-19 claimed her life, Cecilio Sangama watched helplessly as his eldest sister Edith gasped for breath.

Hospitals across Peru’s largest Amazon city had run out of oxygen, and the shortage had pushed the black market price of a cylinder well above $1,000 (£810).

“Her body could not hold on. She needed oxygen but we just couldn’t afford it,” said Sangama, 49, a municipal worker, speaking by telephone from Iquitos.

“I had promised her: ‘Don’t worry sister, today I will find you a cylinder,’… but in the end, there was nothing I could do.” His voice broke and he fell silent for a few seconds. “My sister died just a few hours ago, we are trying to find the way to give her a Christian burial.”

Hemmed in by a sea of jungle, plagued by dire poverty and already reeling from a dengue fever outbreak, Iquitos is now the second major Amazon city – after Manaus in Brazil – to take a brutal hit from the coronavirus pandemic.

Iquitos faces an added obstacle in efforts to contain the disease: as the largest city in the world which cannot be reached by road, it depends on intermittent air deliveries for essential supplies of medicine, personal protective equipment and oxygen.

“We are living in a catastrophe,” said Graciela Meza, executive director of the regional health office in Loreto, the vast Amazon region which surrounds the city of half a million inhabitants.

The city’s main public hospital was overflowing with nearly five times the number of patients its 180 beds could hold, said Meza, who herself was recovering from the virus.

“I’ve never seen anything like this in my life, or even in my dreams,” said Meza, a lifelong Iquitos resident, who compared the situation to living in a disaster film.

“Most victims have died from a lack of oxygen; 90% have died because of lack of medical supplies,” Meza added.

She had counted dozens of dead every day over the last three weeks, including two nurses, and three doctors – the latest a junior doctor in his twenties.

Just how bad Loreto’s Covid-19 outbreak is remains unclear, but few in Iquitos doubt it exceeds the official count of 62 dead and 1,595 confirmed cases as of Wednesday.

After more than 50 days under lockdown, Peru’s overall official count of more than 51,000 confirmed coronavirus cases and 1,444 dead places it second only to Brazil in Latin America. Brazil, which has reported nearly 8,000 deaths and has a population nearly seven times that of Peru.

Hundreds of critically-ill patients were seated outside in rocking chairs around the hospital grounds or, in the last few days, in three field hospitals erected in football pitches and stadiums in the city.

“There’s no oxygen in the lungs of the world,” Meza remarked bitterly, referring to the city’s Amazon location. “That should be the headline for your story,” she added.

Her tone switched to anger as she said: “We only have our dreadful authorities to blame for their corruption and decades of chronic under-investment in healthcare.”

The comments reflected growing outrage at the slow response of the regional government amid allegations that private companies were profiteering from a monopoly on oxygen tanks.

The local prosecutor’s office in Iquitos has announced an investigation into reports that the Loreto regional government was paying inflated prices for oxygen cylinders – including alleged purchases from a company owned by the daughter of a councillor.

Growing anger over chronic shortages coincided with a visit by Peru’s health minister, Víctor Zamora, on Monday. The minister pledged to establish daily flights to take medical supplies and oxygen from Lima to Iquitos and replenish the numbers of medical professionals, as more than a dozen doctors infected with Covid-19 were evacuated.

Zamora also promised to build two new oxygen plants in Iquitos, which needs 800 cylinders a day, but warned the construction would take several weeks. The existing plant can produce a maximum of 250 cylinders a day, according to local reports.

Agustina Huilca, president of the local doctor’s federation said it was too little, too late.

“We asked for the medicine more than a month ago,” she said. They desperately need strong antibiotics, anti-coagulants and anti-inflammatory drugs to treat Covid-19, she said.

“There’s no medicine, there’s no oxygen and I’ve got 40 doctors in hospital [with Covid-19], am I supposed to wait for them to die one by one?” she exclaimed on Monday. A total of 128 medics had been infected with the virus in the city, a number second only to that of the capital Lima, a city with a population 20 times the size.

“[As doctors] we feel impotent, frustrated and isolated. We feel abandoned by the government,” Huilca added.

The pandemic could not have arrived at a worse time, said Valerie Paz-Soldan, a Peruvian-American social scientist and director of Tulane Health Offices for Latin America.

Iquitos was already struggling with the tail end of a dengue fever outbreak coupled with a bout of leptospirosis. Asia and the Americas had multiple outbreaks of dengue in 2019 which was the worst year on record for the disease.

Both dengue and Covid-19 cause fevers which have complicated diagnoses, said Paz-Soldan, while Iquitos’ hot climate, crowded living conditions, poverty and geographic isolation were “a perfect storm of deadly factors”.

“I suspect that in Iquitos the situation is already out of control,” she said.