Imagine being a health worker trying to keep covid-19 at bay in a country where the health system has collapsed. “It’s Dantesque, as though we are in a war but not a single bomb has fallen,” one doctor in Venezuela told us in December, before the pandemic even hit.
Long before Venezuela confirmed its first case of covid-19, the country was facing a humanitarian emergency: Malnutrition was on the rise; vaccine-preventable diseases that had been eradicated, like measles and diphtheria, returned; and infectious diseases such as malaria and tuberculosis spiked. Health professionals struggled, as basic utilities blinked on and off at health-care facilities and many colleagues emigrated, driving a steady decline in health-care operational capacity.
And then the novel coronavirus arrived.
As of July 2, Venezuela was reporting more than 6,000 confirmed cases of covid-19, with 54 deaths. But the statistics coming out of Venezuela are not reliable. The real numbers are almost certainly much higher, our recent research has revealed, given the limited availability of reliable testing, a lack of transparency and the persecution of medical professionals and journalists who report on problems. Overcrowding in low-income areas and prisons, as well as limited access to water and sanitation in hospitals and homes, make prime conditions for the virus to spread rapidly.
Venezuelan doctors and nurses, true to their professional and ethical commitment to medicine, keep showing up for work because, as one of them said, “If we don’t care for these patients, who will?” They do this at their own risk, often lacking even basic protective equipment. Some use half their monthly salary to buy a single bottle of hand sanitizer. They told us about nauseating smells, rodent infestations and broken-down bathrooms. One doctor said he washed his hands with water dripping from an air conditioner.
The collapse of Venezuela’s health system is not the consequence of a natural disaster. It is largely due to irresponsible and repressive measures by the government of Nicolás Maduro. The authorities have made heavy-handed attempts to deny and conceal epidemiological data and the severity of a years-long humanitarian emergency. They have also persecuted those who question the government, including health workers.
Venezuelan authorities typically put all the blame for the humanitarian emergency on U.S. financial and oil sanctions. Despite an exception for humanitarian transactions, U.S. financial and oil sanctions could indeed be exacerbating the crisis, both due to the risk of overcompliance and because the sanctions reduce the resources available to the government to address the crisis.
But the collapse of Venezuela’s health system predates 2017, when the U.S. imposed stricter sanctions, and several factors — including mismanagement and the drastic drop in global oil prices — have contributed to the country’s decline.
Now the only hope for curbing the spread of covid-19 is to ensure a large-scale humanitarian response that puts the Venezuelan people first. Our May 26 report urged the United States to ensure that sanctions do not contribute to the crisis or hinder humanitarian efforts and that foreign governments in general depoliticize aid and fund a United Nations-led response.
June 1 brought good news. The Venezuelan health minister, Carlos Alvarado, and the opposition-led National Assembly — through its health adviser, Julio Castro — signed an agreement to coordinate efforts to obtain international funding to strengthen Venezuela’s response to the pandemic. The agreement obliges them to prioritize detecting covid-19 cases, provide adequate and timely treatment of confirmed cases, isolate symptomatic people and quarantine those with whom they were in contact, and protect health workers.
In addition, it prioritizes instituting preventive and infection-control measures in health facilities; providing genuine epidemiological monitoring, information analysis and situation reports; and communicating risks to the public to ensure that citizens adopt preventive measures.
The agreement also requests “technical and administrative support” from the Pan American Health Organization (PAHO), a branch of the United Nations. National Assembly representatives have indicated that a fund consisting of $20 million that the U.S. government had frozen — to prevent its use by the Maduro administration — will now be sent to Venezuela through PAHO. The fund will also help provide Venezuelan health workers with $100 a month for three months, and it will support various independent humanitarian groups. The Spanish government has also announced a transfer of previously frozen funds to PAHO.
The agreement could make a huge difference in Venezuela’s response to the pandemic, but only if it is sufficiently funded, properly carried out and adequately supervised by an independent third party. The agreement does not specify how the delivery of aid will be carried out or monitored. Since PAHO and other U.N. agencies now based in Venezuela will be unable to provide complete monitoring of aid delivery across Venezuela’s vast territory, the Venezuelan authorities should allow all U.N. agencies and nongovernmental organizations — both local and international — to monitor the deal without interference. It is also critical to allow full access to the World Food Program and its partners, which have the logistical capacity to provide a significant amount of humanitarian aid nationwide.
The agreement is unlikely to reflect a deeper change of direction from Maduro and his government, given the reckless disregard they have shown for the life and health of the Venezuelan people. It took sustained international pressure to get them to turn to the outside world for help. That is why the pressure needs to continue and monitoring needs to be meaningful.
If the world can’t quickly bring sufficient aid to Venezuela and ensure it reaches the people who need it, we will find ourselves mourning countless, avoidable deaths.
Kathleen Page is a physician and associate professor of medicine at Johns Hopkins University. Tamara Taraciuk Broner is Americas acting deputy director for Human Rights Watch.