Venezuelans'
right to health crumbles amid political crisis
The rising
prosperity of Venezuela during the 20th century helped to consolidate gains in
health outcomes made over decades. Now, a country rich in natural resources is
submerged in a complex humanitarian emergency due to the politico-economic
crisis that started in 2008, progressively destroying the health-care system.
In this
issue, Page and colleagues discuss the current situation in Venezuela and
explain how the crisis has threatened the nation's public health, resulting in
increases in morbidity and mortality. The authors also report on the
observations they made when visiting the Venezuelan borders with Colombia and
Brazil, where the movement of Venezuelan migrants has already resulted in a
strain on both countries' health-care systems. Another worrying implication of
the movement of migrants into neighbouring countries is the quick dissemination
of infectious diseases, such as malaria and Chagas. A Review in The
Lancet Infectious Diseases analysed the return of vector-borne
diseases and the implications for spillover in the region. For example, the
number of malaria cases increased by 359% between 2000 and 2015, and by a
further 71% in 2017 (411 586 cases). Dengue incidence increased by more than
four times between 1990 and 2016. These epidemics are exacerbated by the
decline in public health programmes, such as childhood immunisation,
insufficient potable water, and poor sanitation conditions.
In 2018, 82%
of people in Venezuela (about 28·5 million people) and 75% of health centres
around the country did not have a continuous supply of water, according to
a report on
the right to water published by five Venezuelan non-governmental organisations
(NGOs). Running water is provided sporadically (in some areas this can be once
every 20 days) and the water that does reach the population is of poor quality
or not potable. To aggravate the situation, shortages of electricity have been
recurrently reported over more than 3 months and have culminated in a
widespread blackout between March 7 and March 11, leaving homes and hospitals
in the dark. Failures in the electricity supply system were reported as causing
the death of 79 patients between Nov 16, 2018, and Feb 9, 2019, in the 40 main
hospitals of the country. These data are from a national
survey, Encuesta Nacional de los Hospitales
2019 which also notes that 1557 patients died because of insufficient
hospital supplies. The medical NGO that published these data explained that these
are conservative estimates as many deaths are not reported.
In the
meantime, hyperinflation (estimated by the International Monetary Fund to be at
10 million % in 2019) puts the cost of daily food out of reach for nine in ten
Venezuelans, according to the ENCOVI (Living Conditions survey) 2017. The food
crisis is further exacerbated by absence of food diversity and collapse of food
infrastructure (production, distribution, and access to food). As a result,
between 2016 and 2018, the proportion of the population that is undernourished
increased from 5% to 12%, according to a report on
the right to food published by three Venezuelan NGOs. Poor nutrition between
conception and 2 years of age is threatening the physical, mental, and social
development of new generations. Venezuela is the only country in Latin America
showing a deterioration in child survival back to the levels of the 1990s.
According to estimates in a recent study in The
Lancet Global Health, the infant mortality rate reached 21·1 deaths per
1000 livebirths in 2016, almost 40% higher than in 2008.
Vowing to
improve the situation, on March 1, the UN security council voted on two
resolutions related to Venezuela but failed to pass either of them because the
USA, Russia, and China clashed over the issue. The USA recognises Juan Guaido,
leader of the National Assembly, as the country's president, whereas China and
Russia continue to recognise Nicolás Maduro as leader of the country. While the
divisive debate regarding last year's disputed presidential elections continues
to rage, Venezuela is struggling with hunger and preventable diseases.
As we went to
press, a UN team was visiting the country on an official human rights mission
following a surprising invitation from Maduro, who has been reluctant to accept
humanitarian aid. There is hope that Maduro will be transparent with the UN
team and allow them to observe the true complexity of the situation. The UN
human rights team is also scheduled to speak with members of Guaido's party.
Whatever the outcome of the UN's mission, the urgent implementation of
effective measures to facilitate the coordinated international response to the
Venezuelans' plight cannot come soon enough. The right to health and to food
cannot be politicised and the international community is failing if these
universal rights are not restored in Venezuela.
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