Title: From Health to Humanitarian Crisis in Venezuela: Options for the International Community

Recent reports by international and national agencies, along with global news organizations, have documented dire public health conditions in Venezuela. Health services lack supplies and equipment, while hospitals and pharmacies frequently face shortages of basic medicines. As primary care infrastructure has collapsed, it is increasingly common that patients with diabetes, cancer, hypertension, HIV/AIDS, and tuberculosis face notorious deficits in treatment and services. Many patients often bring their own medicine and supplies or go on never-ending searches to receive drugs or care in clinics and pharmacies. Epidemiological surveillance has suffered amid the general deterioration of the health system. Worsening conditions are evidenced by an increase in transmissible diseases such as measles, the return of illnesses such as malaria and diphtheria, and belated or insufficient responses to grave challenges posed by the Dengue and Zika Fevers. Appalling labor conditions not only make it difficult for healthcare personnel to deliver services, but also breed further frustration, contributing to the “brain drain” of approximately Venezuelan 13,000 doctors in recent years.

Child and maternal health conditions are particularly worrisome, as upticks in mortality have been recorded in recent years. Primary care services for children suffer from acute deficiencies, particularly in poor and low-income communities. A 2017 Caritas reportshows an increase from eight to thirteen percent in malnutrition among children under five in the past year alone. This increase is largely due to significant decreases in caloric consumption, as families suffer from unemployment and rising levels of poverty. Regular water and food shortages further compound this bleak situation. Venezuela’s food crisis is dangerously close to a state of emergency with devastating consequences for children and mothers.

As conditions continue to deteriorate, the government has used partisan calculations to assign healthcare resources, rewarding pro-Chavista officials and punishing districts ruled by the opposition. Some clinics now request the government-issued “carnet de la patria,” or “the motherland’s identification card,” as a prerequisite for services and medicine. Partisanship also plays a role in allocating government-subsidized food boxes that deliver basic necessities to families. Such politicized practices are contrary to international human rights legislation, which states that governments should provide services to all persons without any form of discrimination.

Overall, Venezuela’s national health system – once praised as the jewel of revolutionary social policies achieved by the current regime during its eighteen-year rule – is in a state of collapse. A toxic combination of mismanagement, corruption, and inefficiency has spawned abysmal health conditions in a polarized political environment with strong authoritarian elements, including state censorship of health data. The manipulation of health statistics and general opacity in public administration complicates the production of reliable data, making it hard to understand the specifics of the problem and to determine appropriate responses.

Until recently, experts believed that targeted actions by the government and civil society organizations could ameliorate this complex situation; yet it has since evolved into a humanitarian crisis. In recent months, conditions have worsened at a rate typically seen in countries devastated by war. Continuous migration outflows attest to rapidly untenable living conditions for large segments of the population. Expectedly, low-income citizens face even greater challenges to emigrate as many do not have the financial resources to apply for visas nor the social networks that would facilitate the process.

Given the current circumstances, the international community must step up its efforts. Venezuela also needs a two-pronged action plan to attend to its internal health situation, as well as to address the growing diaspora of Venezuelans to neighboring countries – particularly Brazil and Colombia.

At the domestic level, NGOs should develop and lead community-level responses immediately, so citizens can access basic services, such as medications, vaccines, and food; and frontline health workers can adequately do their jobs. International donors and technical agencies need to find creative ways to offer citizens access to healthcare centers, given official refusal to recognize the gravity of the situation and the mounting financial impediments to supporting programs and purchasing medical goods. At the regional level, they need to support neighboring countries in providing assistance to the swelling numbers of migrants. Border towns and cities in Northern Brazil and Colombia are not equipped to provide sufficient healthcare, food, shelter, and jobs to such a large number of foreign nationals. Inaction puts additional pressure on these municipalities—as their limited resources are already strained by the crisis—thus further exacerbating current tensions between the Maduro administration and neighboring governments.

Longstanding political conflict between the government and the opposition—as well as current diplomatic tensions between Venezuela and several countries in the Americas—hobbles effective action. Unfortunately, there are no obvious levers to pull that would lead the government to introduce drastic reforms in the healthcare system in order to expedite changes and deliver effective results. No one-shot, rapid action is likely to succeed amid such extremely difficult political circumstances; nor is it evident that sanctions would impact public health positively.

Thus, as long as the government denies the problem, it is unlikely to cooperate fully with international agencies, donors, and implementing organizations. The Venezuelan National Assembly, as well as human rights and medical organizations, has reported the conditions in international fora such as the European Commission and the Organization of American States. Regrettably, however, the Maduro administration continues to deny the current plight of millions of its citizens and blames foreign powers and the pharmaceutical industry, making it difficult for international organizations to take action or create measures of accountability.

Effectively addressing and remedying this humanitarian crisis will require a mix of political incentives to promote and reward responsible actions, as well as logistical ingenuity. Rebuilding a dilapidated health system will take a long time; but rapid, targeted actions are essential to alleviate the health conditions of millions of citizens in desperate need in the short term.

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Silvio Waisbord is Professor in the School of Media and Public Affairs at George Washington University. He is Editor-in-Chief of the Journal of Communication. He has published on communication, journalism, development, and public health in academic journals and books, as well as in the New York Times (Spanish edition), Project Syndicate, and various newspapers in Latin America. His recent books include Routledge Companion to Media and Human Rights (edited with Howard Tumber, Routledge, 2017) and Global Health Communication (edited with Rafael Obregon, Wiley 2014).