"SOS!! We want supplies. Patients are dying!!"
In the past 10 years, the severe economic crisis in Venezuela has had a dire effect on the country’s public health system. According to the 2018 report The health system in Venezuela: a patient without medication?, funding for the Venezuelan health system has been substantially reduced since 2007. The impact was exacerbated by exchange rate controls, which led to a shortage of the foreign currency needed to import medical equipment, food, and medicines.
According to The Lancet Global Health, patient-to-doctor ratios have decreased from 1·7 to 1·2 per 1,000, and hospital bed ratios (hospital bed per population) have fallen from 1·3 to 0·73 per 1,000. Additionally, vaccination campaigns have ceased in many parts of the country. For example, between 2007 and 2009 the Venezuelan Ministry of Health did not provide vaccines against polio, diphtheria, tetanus, pertussis, hepatitis B, and haemophilus influenzae type B to children under 5 years, and did not vaccinate nearly 20% of children in 2010.
In addition, shortages of basic medicines, surgical supplies, and infant formula have increased health-care costs, making it unaffordable for most of the population. In 2017, 61.2 percent of the Venezuelan population was in extreme poverty, and 89.4 percent of households said they didn’t have enough money to buy food. Today, nearly 90 percent of Venezuelans live in poverty. According to estimates by the United Nations Economic Commission for Latin America and the Caribbean, this is a dramatic increase from 2014 when 48 percent of Venezuelans lived in poverty.
Since the beginning of 2016, the lack of basic necessities inside Venezuela in the health sector have caused the spread of preventable diseases. The figures increased in 2017 and are higher now. Secondary and tertiary care have also been greatly affected, due to declining investment, emigration of providers, and a hyperinflation rate that has driven the country and its people into poverty -10,000,000 percent projected by the International Monetary Fund (IMF) in 2019.
As a consequence, the public health situation previously described as a crisis is now categorized as an emergency. Today, Venezuela is submerged in a complex humanitarian emergency. According to the World Health Organization (WHO), complex emergencies are situations of disrupted livelihoods and threats to life produced by warfare, civil disturbance and large-scale movements of people, in which any emergency response has to be conducted in a difficult political and security environment.
In 2016, the Venezuelan National Assembly declared a humanitarian crisis in the country and requested international humanitarian aid to facilitate the importation of medical supplies and medicines into the country. The Pharmaceutical Federation of Venezuela estimates the country is suffering from an 85 percent shortage of medicine.
A national survey by the National Assembly and the Venezuelan non-governmental organization Médicos por la Salud (Doctors for Health), Encuesta Nacional de Hospitales 2018 (available in Spanish only), revealed that Venezuela's health crisis is worse than expected. The survey, conducted from March 1st through March 10, 2018, assessed the performance of 104 public and 33 private hospitals in Venezuela. According to the figures, most laboratory services and hospital nutrition services are only available intermittently or are completely inoperative. Shortages of items such as basic medicines, catheters, surgical supplies, and infant formula are highlighted in the survey; 14% of intensive care units have been shut down because they are unable to operate and 79% of the facilities analyzed have no water at all. 76% of hospitals suffer from scarcity of medicines, 81% lack surgical materials.
The most affected populations by the crisis are the most vulnerable: children, their mothers, the poor (now the great majority of the population), and indigenous people.
In addition, shortages of basic medicines, surgical supplies, and infant formula have increased health-care costs, making it unaffordable for most of the population. In 2017, 61.2 percent of the Venezuelan population was in extreme poverty, and 89.4 percent of households said they didn’t have enough money to buy food. Today, nearly 90 percent of Venezuelans live in poverty. According to estimates by the United Nations Economic Commission for Latin America and the Caribbean, this is a dramatic increase from 2014 when 48 percent of Venezuelans lived in poverty.
Since the beginning of 2016, the lack of basic necessities inside Venezuela in the health sector have caused the spread of preventable diseases. The figures increased in 2017 and are higher now. Secondary and tertiary care have also been greatly affected, due to declining investment, emigration of providers, and a hyperinflation rate that has driven the country and its people into poverty -10,000,000 percent projected by the International Monetary Fund (IMF) in 2019.
As a consequence, the public health situation previously described as a crisis is now categorized as an emergency. Today, Venezuela is submerged in a complex humanitarian emergency. According to the World Health Organization (WHO), complex emergencies are situations of disrupted livelihoods and threats to life produced by warfare, civil disturbance and large-scale movements of people, in which any emergency response has to be conducted in a difficult political and security environment.
In 2016, the Venezuelan National Assembly declared a humanitarian crisis in the country and requested international humanitarian aid to facilitate the importation of medical supplies and medicines into the country. The Pharmaceutical Federation of Venezuela estimates the country is suffering from an 85 percent shortage of medicine.
A national survey by the National Assembly and the Venezuelan non-governmental organization Médicos por la Salud (Doctors for Health), Encuesta Nacional de Hospitales 2018 (available in Spanish only), revealed that Venezuela's health crisis is worse than expected. The survey, conducted from March 1st through March 10, 2018, assessed the performance of 104 public and 33 private hospitals in Venezuela. According to the figures, most laboratory services and hospital nutrition services are only available intermittently or are completely inoperative. Shortages of items such as basic medicines, catheters, surgical supplies, and infant formula are highlighted in the survey; 14% of intensive care units have been shut down because they are unable to operate and 79% of the facilities analyzed have no water at all. 76% of hospitals suffer from scarcity of medicines, 81% lack surgical materials.
The most affected populations by the crisis are the most vulnerable: children, their mothers, the poor (now the great majority of the population), and indigenous people.
Infant Mortality
Between the 1950s and 2000, Venezuela made one of the largest improvements in infant mortality reduction in Latin America. But around 2009, the long-term decline in infant mortality rate stopped, and a new pattern of increase was observed. The last available official data by the Venezuelan Ministry of Health (2016) showed a rate increase of 30.12% (11,466 cases) due to neonatal sepsis, pneumonia, respiratory distress syndrome, and prematurity as the main causes. In six states, the numbers were up by over 50%.
According to The Lancet Global Health, in 2016 the infant mortality rate was 21.1 deaths per 1,000 live births—nearly 1.4 times the rate in 2008 (15 deaths per 1,000 live births). The increase in infant mortality rate takes the country back to the level observed at the end of the 1990s, wiping out 18 years of expected progress, and left the Venezuelan government far from achieving the target of nine deaths per 1,000 live births stated in the UN Millennium Development Goals.
According to The Lancet Global Health, in 2016 the infant mortality rate was 21.1 deaths per 1,000 live births—nearly 1.4 times the rate in 2008 (15 deaths per 1,000 live births). The increase in infant mortality rate takes the country back to the level observed at the end of the 1990s, wiping out 18 years of expected progress, and left the Venezuelan government far from achieving the target of nine deaths per 1,000 live births stated in the UN Millennium Development Goals.
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Source: The Lancet Global Health
Maternal Mortality
According to the last official nationwide epidemiologic bulletin, published in 2016, maternal deaths rose 66% nationwide, and even doubled in many Venezuelan states. Furthermore, 64% more women died during pregnancy or within 42 days after giving birth in 2016 compared to 2015. In addition, contraceptives are nowhere to be found in about 90% of pharmacies.
In 2018, the British Medical Journal reported on an acute contraceptive shortage in Venezuela "that contributes to peaks in unwanted pregnancies, unsafe abortions, maternal and infant mortality, and sexually transmitted diseases."
In 2018, the British Medical Journal reported on an acute contraceptive shortage in Venezuela "that contributes to peaks in unwanted pregnancies, unsafe abortions, maternal and infant mortality, and sexually transmitted diseases."
Malnutrition
By August 2017, 15 in 100 children were severely undernourished. At least 60% of these children were lactating babies, according to NGO Cáritas of Venezuela. The organization also reported that during 2017 at least six children died weekly from malnutrition throughout the country, and estimated that by 2018 some 280,000 would die from the same cause.
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Source: Financial Times
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An article by the non-profit Victims of Communism assures that “children in Venezuela also are turning to gangs to get enough food to eat. Social workers and police estimate that there are at least 10 different child gangs in Caracas. These child gangs fight with sticks, clubs, knives and machetes. The prize they are battling for is garbage. In order to get enough to eat, child gangs rummage through the trash for scraps, especially in affluent neighborhoods.” The report also estimates these conditions threaten to have long-term consequences as studies show that adolescents exposed to gang violence are likely to suffer from poor mental and physical health well into adulthood.”
In February 2019, a World Health Organization (WHO) spokesperson confirmed that “Venezuela had indeed experienced an increase in the number of undernourished persons,” based on a joint report by FAO, PAHO, UNICEF, and the World Food Program (WFP). The newest data included in a United Nations Office for Human Rights’ September 2019 report speaks of 35% chronic malnutrition in children under five years old.
In February 2019, a World Health Organization (WHO) spokesperson confirmed that “Venezuela had indeed experienced an increase in the number of undernourished persons,” based on a joint report by FAO, PAHO, UNICEF, and the World Food Program (WFP). The newest data included in a United Nations Office for Human Rights’ September 2019 report speaks of 35% chronic malnutrition in children under five years old.
Diseases
As of October 2019, 4.5 million Venezuelans have fled the country due to lack of food and medicines. As more Venezuelans escape the humanitarian crisis, the risk of spillover diseases increases. According to the journal Lancet Infectious Diseases, “these diseases have already extended into neighboring Brazil and Colombia, and with increasing air travel and human migration, most of the Latin American and Caribbean region (as well as some US cities hosting the Venezuelan diaspora, including Miami, FL, and Houston, TX) is at heightened risk for disease re-emergence.”
1. HIV/AIDS
A report by Human Rights Watch states that “HIV testing has been greatly reduced because of a lack of test kits.” Since 2010, new HIV infections have increased by 24%, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). Despite the lack of official data published by the Venezuelan government since 2016, the Pan American Health Organization (PAHO) assures that nearly 9 out of 10 Venezuelans known to be living with HIV are not receiving antiretroviral treatments.The situation makes this crisis a regional health and security concern, affirms the Lancet Global Health.
2. Tubercolosis (TB)
“Tuberculosis is the shadow of misery,” sentenced Md. José Félix Oletta, a former Venezuelan Health Minister. During an interview with the New York Times in 2018, Oletta also said that “if there’s a disease that is a marker of poverty, it’s tuberculosis.” The number of reported TB cases in Venezuela increased from 6,000 in 2014 to 7,800 in 2016 to more than 13,000 cases in 2017, meaning that the incidence has constantly increased since 2014 soon after Nicolás Maduro took office, reaching 42 per 100,000 in 2017 -the highest seen in Venezuela in 40 years.
According to the report by The New York Times, from 2013 to 2015, about 5% of adult patients evaluated each year in the outpatient center at Dr. José Ignacio Baldó Hospital in Caracas were found to have tuberculosis. By the last quarter of 2017, that rate had risen to about 9%, and then climbed even further in January, 2018 to about 14%. Nationwide, tuberculosis infection rate increased by 40% between 2017 and 2018 due to severe shortages of medical supplies and pharmaceuticals.
3. Vector-borne Diseases
The most comprehensive assessment of the impact of the crisis in Venezuela, published in The Lancet Infectious Diseases journal, assures that “the ongoing humanitarian crisis in Venezuela is accelerating the re-emergence of vector-borne diseases such as malaria, Chagas disease, dengue, and Zika virus, and threatens to jeopardise public health gains in the country over the past two decades.”
The combination of poverty-related socioeconomic factors, such as increasingly crowded living conditions, growing population density, precarious homes, and long-lasting deficits in public services, including frequent and prolonged interruptions in water supply and electricity, have contributed to the re-emergence of these diseases, especially dengue says a report by the National Institutes of Health (US National Library of Medicine).
Furthermore, the inability of vector control programmes to do proper surveillance and timely application of vector control measures have exacerbated the crisis. “The stark reality is that in the absence of surveillance, diagnostic, and preventive measures, these figures most likely represent an underestimate of the true situation," assures Dr. Martin Llewellyn from the University of Glasgow, UK, who led The Lancet Infectious Diseases’ research along with colleagues from Venezuela, Colombia, Brazil, and Ecuador.
Malaria: Venezuela was the first WHO-certified country to eradicate malaria in 1961. But between 2000 and 2015, the country witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411.586 cases) compared with 2016 (240.613). This is potentially the largest malaria increase reported worldwide. Among the factors fueling malaria’s rise are reductions in mosquito-control activities, shortages in medication to treat the disease, and illegal mining operations (especially gold mining) in the southern part of the country, with an influx of migrant workers living in overcrowded and unhealthful conditions. As a consequence, Venezuela has become the epicenter of an increasing number of malaria cases spreading to other countries.
Dengue: The incidence increased with an average of 211 cases per 100,000 people between 2010 and 2016. There have also been “six increasingly large epidemics recorded nationally between 2007 and 2016, compared with four in the previous 16 years,” according to The Lancet Infectious Diseases report on Venezuela. Additionally, there are favorable breeding conditions for Aedes mosquitoes due to interruptions of water supply and the need to store it in receptacles, and an increased possibility of severe dengue cases due to co-circulation of four dengue virus serotypes (DENV 1–4).
Chikungunya and Zika: Since October 2014, cases of chikungunya exceeded 2 million, resulting in an incidence of 6,975 cases per 100,000 population, more than 12 times higher than official national estimates. Regarding Zika, the frequency of outbreaks with epidemic potential appear to be increasing as experts found 2,057 cases of Zika virus per 100,000 people.
Chagas: The surveillance and control of Chagas disease transmission in Venezuela was abandoned in 2012. From 2007 through 2018, 16 outbreaks of oral Chagas disease have been recorded nationwide: 321 cases and 23 deaths in 10 years, 40 of them confirmed only between October 2017 and April 2018. According to Dr. Martin Llewellyn, 15 percent of the rural population is infected with Chagas disease. Based on samples collected by The Lancet Infectious Diseases’ researchers between 2008 and 2018, seroprevalence among children under 10 years was estimated at 12.5% in some communities, compared to an all-time low of 0.5% in 1998 (right before Hugo Chávez took office).
Other Vector-borne diseases: According to a May 2019 article by the National Institutes of Health on communicable diseases in Venezuela: “Leishmaniasis is widespread in the human and animal population, outbreaks of Mayaro virus have been reported in the past decade, Oropouche virus in the Amazonas state and the occurrence of epizootic strains of Venezuelan equine encephalitis.”
4. Vaccine-preventable Diseases
According to an April 2019 report by Human Rights Watch (HRW), Venezuela is now routinely experiencing outbreaks of vaccine-preventable diseases. “There are some of them in epidemic situation persisting for over four years, e.g., diphtheria… Measles, mumps, pertussis, tetanus, also, have been reported on raise.”
A report by Human Rights Watch states that “HIV testing has been greatly reduced because of a lack of test kits.” Since 2010, new HIV infections have increased by 24%, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). Despite the lack of official data published by the Venezuelan government since 2016, the Pan American Health Organization (PAHO) assures that nearly 9 out of 10 Venezuelans known to be living with HIV are not receiving antiretroviral treatments.The situation makes this crisis a regional health and security concern, affirms the Lancet Global Health.
2. Tubercolosis (TB)
“Tuberculosis is the shadow of misery,” sentenced Md. José Félix Oletta, a former Venezuelan Health Minister. During an interview with the New York Times in 2018, Oletta also said that “if there’s a disease that is a marker of poverty, it’s tuberculosis.” The number of reported TB cases in Venezuela increased from 6,000 in 2014 to 7,800 in 2016 to more than 13,000 cases in 2017, meaning that the incidence has constantly increased since 2014 soon after Nicolás Maduro took office, reaching 42 per 100,000 in 2017 -the highest seen in Venezuela in 40 years.
According to the report by The New York Times, from 2013 to 2015, about 5% of adult patients evaluated each year in the outpatient center at Dr. José Ignacio Baldó Hospital in Caracas were found to have tuberculosis. By the last quarter of 2017, that rate had risen to about 9%, and then climbed even further in January, 2018 to about 14%. Nationwide, tuberculosis infection rate increased by 40% between 2017 and 2018 due to severe shortages of medical supplies and pharmaceuticals.
3. Vector-borne Diseases
The most comprehensive assessment of the impact of the crisis in Venezuela, published in The Lancet Infectious Diseases journal, assures that “the ongoing humanitarian crisis in Venezuela is accelerating the re-emergence of vector-borne diseases such as malaria, Chagas disease, dengue, and Zika virus, and threatens to jeopardise public health gains in the country over the past two decades.”
The combination of poverty-related socioeconomic factors, such as increasingly crowded living conditions, growing population density, precarious homes, and long-lasting deficits in public services, including frequent and prolonged interruptions in water supply and electricity, have contributed to the re-emergence of these diseases, especially dengue says a report by the National Institutes of Health (US National Library of Medicine).
Furthermore, the inability of vector control programmes to do proper surveillance and timely application of vector control measures have exacerbated the crisis. “The stark reality is that in the absence of surveillance, diagnostic, and preventive measures, these figures most likely represent an underestimate of the true situation," assures Dr. Martin Llewellyn from the University of Glasgow, UK, who led The Lancet Infectious Diseases’ research along with colleagues from Venezuela, Colombia, Brazil, and Ecuador.
Malaria: Venezuela was the first WHO-certified country to eradicate malaria in 1961. But between 2000 and 2015, the country witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411.586 cases) compared with 2016 (240.613). This is potentially the largest malaria increase reported worldwide. Among the factors fueling malaria’s rise are reductions in mosquito-control activities, shortages in medication to treat the disease, and illegal mining operations (especially gold mining) in the southern part of the country, with an influx of migrant workers living in overcrowded and unhealthful conditions. As a consequence, Venezuela has become the epicenter of an increasing number of malaria cases spreading to other countries.
Dengue: The incidence increased with an average of 211 cases per 100,000 people between 2010 and 2016. There have also been “six increasingly large epidemics recorded nationally between 2007 and 2016, compared with four in the previous 16 years,” according to The Lancet Infectious Diseases report on Venezuela. Additionally, there are favorable breeding conditions for Aedes mosquitoes due to interruptions of water supply and the need to store it in receptacles, and an increased possibility of severe dengue cases due to co-circulation of four dengue virus serotypes (DENV 1–4).
Chikungunya and Zika: Since October 2014, cases of chikungunya exceeded 2 million, resulting in an incidence of 6,975 cases per 100,000 population, more than 12 times higher than official national estimates. Regarding Zika, the frequency of outbreaks with epidemic potential appear to be increasing as experts found 2,057 cases of Zika virus per 100,000 people.
Chagas: The surveillance and control of Chagas disease transmission in Venezuela was abandoned in 2012. From 2007 through 2018, 16 outbreaks of oral Chagas disease have been recorded nationwide: 321 cases and 23 deaths in 10 years, 40 of them confirmed only between October 2017 and April 2018. According to Dr. Martin Llewellyn, 15 percent of the rural population is infected with Chagas disease. Based on samples collected by The Lancet Infectious Diseases’ researchers between 2008 and 2018, seroprevalence among children under 10 years was estimated at 12.5% in some communities, compared to an all-time low of 0.5% in 1998 (right before Hugo Chávez took office).
Other Vector-borne diseases: According to a May 2019 article by the National Institutes of Health on communicable diseases in Venezuela: “Leishmaniasis is widespread in the human and animal population, outbreaks of Mayaro virus have been reported in the past decade, Oropouche virus in the Amazonas state and the occurrence of epizootic strains of Venezuelan equine encephalitis.”
4. Vaccine-preventable Diseases
According to an April 2019 report by Human Rights Watch (HRW), Venezuela is now routinely experiencing outbreaks of vaccine-preventable diseases. “There are some of them in epidemic situation persisting for over four years, e.g., diphtheria… Measles, mumps, pertussis, tetanus, also, have been reported on raise.”
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Source: World Health Organization (WHO)
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Measles: Between 2008 and 2015, only a single case of measles was recorded in 2012, but the disease has reemerged in Venezuela since 2017, particularly within vulnerable indigenous populations, and has subsequently reached neighboring countries. The September 2019 PAHO update on measles states that between 2017 and 2019 a total of 10,495 suspected cases were reported (1,307 in 2017, 8,005 in 2018, and 1,183 in 2019); 6,955 were confirmed. No deaths have been reported in 2019, whereas 81 deaths were reported during 2017-2018. The average national incidence rate during 2017-2019 is 22 cases per 100,000 population. As of October 23, 2018, Venezuela had contributed 68% (5,525 out of 8,091 cases) of the measles cases reported in the Americas and most of the measles-related deaths (73 out of 85).
Diphtheria: Venezuela did not experience a single case of diphtheria between 2006 and 2015, says a report by HRW. By 2016, coverage with three doses of diphtheria-tetanus-pertussis vaccine was close to 84%, dropping to an estimate of less than 50% by 2018. The decrease of vaccination led to a total of 2,956 cases of diphtheria from 2016 through August 2019 (324 cases in 2016, 1,040 in 2017, 1,208 in 2018, and 384 in 2019). Of these, 1,726 were confirmed, according to the October 2019 update by the PAHO. The report also indicates that a total of 287 deaths were reported, yielding to a case-fatality rate of 23%, which affected mostly children and teens in 2019 (7% of fatalities among 5 to 9-year-olds, followed by a 4% incidence among 10 to 15-year-olds).
Poliomyelitis: According to the PanAmerican Health Organization, Venezuela’s vaccination coverage with the third dose of polio vaccine has dropped from 87% in 2015 to 79% in 2017. The minimum recommended is 80%, which indicates the establishment of conditions in Venezuela for the potential emergence of vaccine-derived polioviruses (VDPVs).
Diphtheria: Venezuela did not experience a single case of diphtheria between 2006 and 2015, says a report by HRW. By 2016, coverage with three doses of diphtheria-tetanus-pertussis vaccine was close to 84%, dropping to an estimate of less than 50% by 2018. The decrease of vaccination led to a total of 2,956 cases of diphtheria from 2016 through August 2019 (324 cases in 2016, 1,040 in 2017, 1,208 in 2018, and 384 in 2019). Of these, 1,726 were confirmed, according to the October 2019 update by the PAHO. The report also indicates that a total of 287 deaths were reported, yielding to a case-fatality rate of 23%, which affected mostly children and teens in 2019 (7% of fatalities among 5 to 9-year-olds, followed by a 4% incidence among 10 to 15-year-olds).
Poliomyelitis: According to the PanAmerican Health Organization, Venezuela’s vaccination coverage with the third dose of polio vaccine has dropped from 87% in 2015 to 79% in 2017. The minimum recommended is 80%, which indicates the establishment of conditions in Venezuela for the potential emergence of vaccine-derived polioviruses (VDPVs).
