A. SITUATION ANALYSIS
Description of the context
Venezuela continues to face a complex situation in which access to basic services, especially health services remain critical. Prior to the COVID-19 pandemic, health challenges remained especially acute in promotion and prevention of communicable and non-communicable diseases, diagnosis and treatment, mental health, and the related area of water, sanitation and hygiene. With the outbreak of COVID-19, the Venezuelan health system is on alert with focused efforts to reduce the sudden appearance of cases through timely preventive measures.
In 2019, the Pan American Health Organization (PAHO) reported outbreaks of preventable diseases, such as diphtheria, measles and malaria, as well as an increase in tuberculosis in Venezuela. To reduce the spread of the diseases, vaccination campaigns were launched, which effective reduced the number of new cases by 91%. In the midst of the COVID-19 pandemic, in April 2020 the PAHO director encouraged all countries in the Americas to continue vaccination efforts, stating: “History has shown us that after wars or epidemics, if we allow large gaps in immunization coverage, vaccine preventable diseases like polio and measles can reemerge.” 3 Constant and prolonged actions to support State-run vaccination campaigns remain more necessary than ever.
With seasonal changes, such as the start of the rainy season in May and its continuation through November, mosquito-borne diseases will continue to increase the demand on the challenged health system. Additionally, WASH activities remain essential when some of the symptoms of dengue, such as fever, headaches, muscle and joint pains, and tiredness, overlap with those of COVID-19.
The current context of the COVID-19 pandemic has had an impact on the hospital network of the Venezuelan Red Cross (VRC). As part of the health system and the provision of services, the VRC’s 8 hospitals and 33 outpatient clinics continue to contribute to respond to health needs in the country. To do so, these centres now focus their activities exclusively on emergency care, referral of suspected cases of COVID-19, and obstetrics and gynaecology consultations. Planned health days, in which the VRC provides health care in different settings outside the facilities of the hospital and clinics, have been reduced. Health information is provided through digital means and a reduced number of home consultations are conducted.
The Government of Venezuela declared a state of emergency on 15 March 2020, which has been extended to 12 June 2020. This measure aimed to reduce the spread of the virus by suspending activities, except in essential areas (basic services, essential products and security). Combined with the intermittent electricity service, which reached an extremely critical period during the March 2019 nationwide power cuts, medical centres and healthcare are challenged to provide needed services, particular emergency care and the use of required equipment (from refrigeration and dialysis machines to lighting). The declaration of the quarantine in the country has exacerbated the capacities of the health system.
Violence is one of the social determinants of health in the country, which not only entails deaths, as well as the sequalae experienced by their surviving loved ones. The Venezuelan Observatory of Violence (OVV), with data for 2019, reported the death of at least 1,120 children and adolescents in 4 categories: homicides (425 people), deaths due to “resistance to authority" (68 people), suicides (88 people) and deaths in Investigation (539 people). Adolescents between 12 and 17 years of age are the most affected population; however, there are a considerable number of cases in the population of children from 0 to 11 years of age whose deaths are under investigation. These figures indicate that three children and adolescents died in violent deaths daily in 2019.
The World Health Organization (WHO) recognizes suicide as a global health problem. In Venezuela, suicide has been made more visible in recent years, with an increase measured by the OVV of 160% in the past 8 years. According to this source, there are 9 to 10 suicides per 100,000 inhabitants in the country, with the highest figures in Mérida. It is estimated that 40 per cent of the cases are due to mental health conditions, which highlights the need for mental health and psychosocial support (MHPSS).
As mentioned above, the provision of electricity has had a domino effect on other services. With power outages, the supply and quality of water is affected since pumping stations and water treatment plants cannot function, affecting the most vulnerable people and having an impact on other crucial services like health and education. About 25 per cent of the population are unable to access to clean and safe water, according to the World Food Programme’s January 2020 report. The incidence of vector-borne diseases has risen; this situation is linked to delays or suspension of garbage collection and/or the lack of personnel to maintain the already deteriorated water and sanitation infrastructure.
The current situation, already burdened by fluctuating services and fuel shortages, has been aggravated by cases of COVID-19 in the country. The Venezuelan economy with its reliance on oil export has been affected by the radical fall in oil prices and decreased global demand, as well as the reduction of remittances from Venezuelans abroad. While the society aims to avoid contagion, the ability to maintain livelihoods and access essential services and food is not only complicated, but represents an additional burden in already fragile coping mechanisms in the country.
The Documentation and Analysis Centre for Workers (CENDA) in its December 2019 report, indicates that an average family requires 101.7 minimum wages (BS. 150,000.00) to purchase the monthly basic food basket. Although the inflation rate fell in 2020, according with the Central Bank of Venezuela, the national consumer price index continues to rise.4 Although food may be available in markets, many people, especially those with lower incomes and those in situations of vulnerability, are unable to purchase it due to high prices due to a significant depreciation of the currency and import difficulties. Despite the efforts from the government to establish a new price control on food products, the local inflation of the US dollar has contributed to the food insecurity (IPC Phase 45) of approximately 2.3 people in the country, according to the United Nations Global Humanitarian Response Plan 2020.
At the same time, 60,000 of the 5 million Venezuelans that had migrated abroad, have attempted to return to the country related to the economic hardships due to social immobilization measures in the receiving countries. This situation adds more pressure to the deteriorating situation, especially for those living on a day-to-day basis. Based on a WFP food security assessment done between July and September 2019, approximately 37 per cent of the population has experienced a total loss of their income.6 The Economic Commission for Latin America and the Caribbean (ECLAC) indicates that while containing the spread of the virus through quarantine and social distancing is of central importance, the slowdown in production or even total interruption have an impact on economic activities; it recommends (i) a commensurate fiscal stimulus to support health services and protect incomes and jobs; (ii) strengthening social protection systems to support vulnerable populations; and; (iii) lifting sanctions on countries so they can access food, medical assistance and supplies.
The extension of the timeframe for this Appeal operation will enable the continuation of the assistance to the VRC in its supporting of the access to integrated health attention. The National Society conducts this work by fulfilling its mandate and ensuring that all actors understand the Fundamental Principles of the International Movement of the Red Cross7, particularly in this context the principles of impartiality, neutrality and independence. The IFRC will continue to mobilize financial support for the purchase and distribution of medicines and medical supplies to ensure the availability of services at primary and specialized levels.