Featured Journal Content
Mar 23, 2019 Volume 393Number 10177p1177-1260, e35
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.
Venezuela’s public health crisis: a regional emergency
Kathleen R Page, Shannon Doocy, Feliciano Reyna Ganteaume, Julio S Castro, Paul Spiegel,
The economic crisis in Venezuela has eroded the country’s health-care infrastructure and threatened the public health of its people. Shortages in medications, health supplies, interruptions of basic utilities at health-care facilities, and the emigration of health-care workers have led to a progressive decline in the operational capacity of health care. The effect of the crisis on public health has been difficult to quantify since the Venezuelan Ministry of Health stopped publishing crucial public health statistics in 2016. We prepared a synthesis of health information, beyond what is available from other sources, and scholarly discussion of engagement strategies for the international community. Data were identified through searches in MEDLINE, PubMed, and the grey literature, through references from relevant articles, and governmental and non-governmental reports, and publicly available databases. Articles published in English and Spanish until Dec 1, 2018, were included. Over the past decade, public health measures in Venezuela have substantially declined. From 2012 to 2016, infant deaths increased by 63% and maternal mortality more than doubled. Since 2016, outbreaks of the vaccine-preventable diseases measles and diphtheria have spread throughout the region. From 2016 to 2017, Venezuela had the largest rate of increase of malaria in the world, and in 2015, tuberculosis rates were the highest in the country in 40 years. Between 2017 and 2018, most patients who were infected with HIV interrupted therapy because of a lack of medications. The Venezuelan economic crisis has shattered the health-care system and resulted in rising morbidity and mortality. Outbreaks and expanding epidemics of infectious diseases associated with declines in basic public health services are threatening the health of the country and the region.