The only road to St Theresa Point in north-eastern Manitoba is made of ice and lasts just two months. The remote community's 3,200 people, most of them Cree Indians, are squeezed into 530 homes, more than half of them without running water. Until June, a doctor flew in once a week for three days. But since an outbreak of swine flu left more than 200 people ill and sent 12 by air ambulance to Winnipeg, 600km (375 miles) away, Health Canada has been ferrying in more doctors. This autumn, in preparation for the flu season, it is also delivering something else: a supply of body bags.
In Australia, a similar scenario played out in July. An estimated 400 people out of a population of 3,400, more than 90 per cent of them Aboriginal, caught H1N1 influenza on Palm Island off the Queensland coast. In Brazil, a conference on indigenous education was cancelled in September after seven members of the Matsigenka, a tribe living along the Urubamba river in the Peruvian Amazon, tested positive for swine flu.
As health authorities gear up for the northern hemisphere's flu season, the new strain of influenza is expected to hit indigenous peoples far harder than it will healthy, wealthy, urban Westerners. If the outbreaks in Canada and Australia are any guide, native communities could find a tenth of their populations sick, and untold numbers dead.
The World Health Organisation warned in its August briefing note on the pandemic that minorities and indigenous peoples face a far higher risk of hospitalisation and death. "In some studies, the risk in these groups is four to five times higher than in the general population," it said.
Survival International, a London-based charity that tries to protect indigenous peoples, has called on the government of the Andaman Islands to close the Andaman Trunk Road because it runs through land populated by a nomadic tribe. The Jarawa came into contact with outsiders only in 1998; within a year, half of them had suffered respiratory problems after an outbreak of measles.
Glenn Shepard, an anthropologist who works closely with Peru's Matsigenka, said they are not the only tribe he is concerned about. "The arrival of swine flu among the Matsigenka is especially worrying as they are known to have intermittent contact with quite isolated Indian groups living near by," he said.
Scientists and medical researchers have two hypotheses to explain the vulnerability of tribal peoples. The first is that those, like the Jarawa, who have had little contact with the global community simply have immune systems that have never been primed. Kevin Paterson, a Canadian doctor, notes that during the 1918 Spanish flu, 8.5 per cent of American Indians died, but among the more isolated Inuit in Nome, Alaska, the toll was 55 per cent. In Hebron, Labrador, 5,000km to the east, 150 out of 220 Innu were killed. Yet the global fatality rate for Spanish flu was just 2.5 per cent.
The other hypothesis applies to those indigenous populations that live on the fringes of Western society, such as the Cree of St Theresa Point and the Aborigines on Palm Island. For them, the problem is poverty, poor general health and crowded living conditions. "We have in excess of 15 people living in a three-bedroom home, which you wouldn't find in mainstream communities," said Alf Lacey, the mayor of Palm Island. Although Tamiflu was available, many islanders were unaware of it because they are unable to read.
"Influenza has a cure," said Dr Paterson. "It's called affluence."