Disease Outbreaks; Lives at Risk
As the crisis continues to spiral out of control, Human Rights Watch researchers traveled to the Colombian and Brazilian borders to assess the extent of the humanitarian crisis Venezuelans are fleeing. Human Rights Watch traveled with a team of public health and medical professionals from John Hopkins University’s Center for Humanitarian Health and its Center for Public Health and Human Rights, based at the Johns Hopkins Bloomberg School of Public Health.
“Venezuela’s public health system has collapsed, putting at risk the lives of countless Venezuelans,” said Shannon Doocy, associate professor at Johns Hopkins Bloomberg School of Public Health, who was part of the team that traveled to the Colombia-Venezuela border. “The combination of a failing health system and widespread food shortages has produced a humanitarian catastrophe, and it will only get worse if it’s not addressed urgently.”
In the last few years, the Venezuelan government has sought to suppress data on the country’s epidemiological situation, in an apparent attempt to hide the extent of the health crisis. In 2015, the Health Ministry abruptly stopped publishing its weekly updates on relevant health indicators, a key source of public health information, although it still reports some data to the Pan American Health Organization.
When the health minister at the time briefly resumed their publication in 2017, she was promptly fired. The government has also retaliated against physicians who have publicly expressed concern about the crisis or attempted to report data on it.
Existing data points to a troubling picture of outbreaks of diseases like measles and diphtheria, spikes in malaria and tuberculosis cases, and a nearly absolute unavailability of anti-retroviral treatment for people with HIV. Increasing levels of malnutrition compound this health crisis, making Venezuelans both more susceptible to infectious diseases and more prone to complications when sick.
Venezuela is now routinely experiencing outbreaks of diseases that are preventable through vaccination and had been eliminated in the country. These outbreaks suggest serious problems with vaccination coverage. According to the Pan American Health Organization:
Since June 2017, more than 7,300 measles cases have been reported in Venezuela, including 5,500 confirmed cases and 64 deaths as of September 2018. No cases of measles were recorded in Venezuela between 2008 and 2015, except for a single case in 2012. The outbreak has spread to other countries in the region, with more than 10,000 suspected cases of measles in Brazil related to the Venezuela outbreak.
Between July 2016 and September 2018, more than 2,000 suspected diphtheria cases were reported. More than 1,200 have been confirmed and more than 200 people have died. By contrast, between 2006 and 2015, not a single case of the disease was reported in Venezuela.
The number of suspected and confirmed malaria cases in Venezuela has consistently increased in recent years – from nearly 36,000 in 2009 to more than 406,000 in 2017, according to the World Health Organization. Malaria is currently an ongoing epidemic in nine Venezuelan states, according to an official document by the Pan American Health Organization, UNAIDS, and the Venezuelan Health Ministry. Health experts attribute this to reductions in mosquito-control activities, shortages in medication to treat the disease, and illegal mining activities that promote mosquito breeding by creating pools of water.
The number of reported tuberculosis cases in Venezuela increased from 6,000 in 2014 to 7,800 in 2016, and preliminary reports indicate that there were more than 10,000 cases in 2017. The 2017 tuberculosis incidence rate (32.4 per 100,000) was the highest seen in Venezuela in 40 years.
Venezuela is the only middle-income country in the world where large numbers of patients with HIV are forced to discontinue their treatment as a result of widespread shortages of anti-retroviral medicines. Eighty-seven percent of the more than 79,000 people living with HIV registered to receive anti-retroviral treatment from the Venezuelan government are not getting it. The number of newly identified HIV cases in Venezuela increased 24 percent between 2010 and 2016, with 6,500 new diagnoses in 2016. The real number of new HIV infections is undoubtedly higher, particularly given that many health centers are no longer able to perform HIV tests.
Maternal and Infant Mortality
The latest official statistics available from the Venezuelan Health Ministry indicate that in 2016, maternal mortality rose 65 percent and infant mortality rose 30 percent in just one year.
The medical complications patients in Venezuela experience are further compounded by severe shortages of food and limited access to an adequate nutrition. Many of the dozens of Venezuelans the Human Rights Watch and John Hopkins team interviewed at the border said they had lost weight and were eating one or two meals per day back home, which for some consisted solely of yuca or sardines.
The Venezuelan government has not published nationwide nutrition data since 2007, but available evidence suggests malnutrition is increasing:
A nationally representative survey by three prestigious universities in Venezuela concluded that 80 percent of Venezuelan households are food insecure, meaning they don’t have a reliable source of food, and that people surveyed had lost an average of 11 kilograms in 2017.
Cáritas Venezuela, a Catholic humanitarian organization that monitors the nutritional situation and provides nutritional aid to children in low-income communities in Caracas and several states, reported that moderate and severe acute malnutrition among children under age 5 increased from 10 percent in February 2017 to 17 percent in March-2018 – a level indicative of a crisis, based on World Health Organization standards. In July 2018 Cáritas Venezuela reported the average had dipped to 13.5 percent, but figures exceeded crisis levels in Caracas (16.7 percent) and Vargas state (nearly 20 percent).
A 2018 Cáritas survey found that 48 percent of pregnant women in these low-income communities had moderate or severe acute malnutrition.
Hospitals in various locations across the country are reporting increases in the number of children admitted with moderate or severe acute malnutrition, and the proportion of children being admitted to hospitals who are acutely malnourished is alarmingly high, ranging from 18 to 40 percent, according to information provided by Venezuelan health professionals to Human Rights Watch.
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