The Exiles

Never have I seen this more clearly than when I witnessed first-hand Venezuelans fleeing the devastating human rights, humanitarian, political, and economic crisis their government has created.

Last July, I stood on the Simon Bolivar bridge that connects Cúcuta in Colombia with Táchira state in Venezuela and watched hundreds of people walk by in both directions all day long, under the blazing sun. A suitcase or two, the clothes on their back — other than that, many of those pouring over the border had nothing but memories of a life left behind.

The faces were grim, for good reason. Venezuelans are being driven from their country by many things — severe food and medicine shortages, a ruthless government crackdown, violent crime, and hyperinflation. More than 2.6 million people have left since 2014, according to the United Nations, generating an unprecedented migration crisis in the Americas. This number does not include many who have not registered with authorities.

To assess the extent of the humanitarian crisis these people are fleeing — in a country where the government stopped releasing health and nutrition data and denies the reality on the ground — I traveled to the Colombian and Brazilian borders with Venezuela with a team of public health and medical professionals from Johns Hopkins University’s Center for Public Health and Human Rights and Center for Humanitarian Health. We found desperation and stories that illustrate a devastating health crisis that includes outbreaks of preventable diseases and failure to treat life-threatening health conditions.

Venezuela was once a land of refuge that sheltered many people fleeing repressive regimes in South America, including my family, who fled the military dictatorship in Argentina in 1976 and lived several years in Caracas, where I was born. It has also received tens of thousands of refugees fleeing Colombia’s internal armed conflict. Today, instead, we’re seeing a massive exodus of Venezuelans.

Those who fled the humanitarian crisis include some who not only escaped the food and medicine shortages but also political persecution. Talking to members of security forces who were threatened with arbitrary prosecution for opposing the government in a country without judicial independence, or to teachers in public schools who feared reprisals for speaking out, was a stark reminder that, while the repression is no longer making international headlines, it is still very much a problem across many different segments of society in today’s Venezuela.

But most Venezuelans crossing the borders today aren’t fleeing political persecution. Most will tell you they had no choice but to leave because of severe shortages of food and medicines — many even leaving part of their families behind, making family separation a sadly common characteristic of Venezuelan emigration. Whether they are considered refugees under international law or not (and under the broader refugee definition accepted in many countries in the region, many would likely qualify), they are in urgent need of protection and humanitarian assistance.

The Walkers in Colombia

More than 35,000 people cross the border from Venezuela daily through the seven official checkpoints with Colombia, Colombian government officials told us. Many cross to eat, buy food, or get health care, and return; at least 3,000 stay in Colombia every day. Many others cross irregularly through approximately 270 unofficial crossings along the border.

For many, the temporary relief of slipping over the border is short-lived. More than 1,000 Venezuelans — the so-called “walkers” — leave on foot every day from Cúcuta to travel hundreds of kilometers to other cities in Colombia, Ecuador or Peru in search of jobs and a place to start over.

A survey conducted in July by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) found that the Venezuelans who leave Cúcuta on foot are walking an average of 16 hours per day and expected to walk for about 13 days. Few have enough resources to cover their journeys: many are not getting enough to eat, and more than 90 percent have to sleep in the streets.

The Refugee Shelters in Brazil

On average, 650 Venezuelans cross the border to stay in Brazil each day, according to Brazilian authorities at the border. Most find themselves unable to move out of Roraima, a remote state in Northern Brazil with little connection to the rest of the country, let alone other places in the region.

 

In Roraima state, the United Nations High Commissioner for Refugees (UNHCR) has set up 13 refugee shelters that house more than 5,500 Venezuelans. It is the first time ever the UN refugee agency has launched this type of response in Latin America.

In two of the shelters, hundreds of members of the Warao indigenous community sleep on hammocks and get food to cook their own meals. In others, Venezuelans from all over the country get three meals per day, and sleep in white UNHCR tents or special refugee units, a small plastic house with little ventilation for the extremely hot and humid Roraima weather. Children struggle to study and adults to find a job. Hygienic conditions are difficult, particularly for those with health problems.

One of the people I met during a visit to the shelters in August was Brenyer Caballero González, a 10-year-old who played on the soccer team for Anzoátegui state in northeastern Venezuela before being diagnosed with cancer in March. His parents struggled to find food to provide him with a balanced diet and treatment for his cancer. They purchased chemotherapy on the black market, which they could only afford thanks to donations from a group abroad. Twice, they used expired chemotherapy drugs because it was all they could get. In August, the three fled to Brazil in search of treatment for Brenyer. They spent weeks living in a shelter. In October, with UNHCR support, Brenyer was transferred to Brasilia to obtain medical care. Brenyer’s dream is to feel better to play soccer.

Even though she struggled to protect Brenyer from the heat and get the medical care he needed, his mother was one of the many people who said that, despite the very difficult circumstances they faced, they were better off there than in Venezuela.

That’s because Venezuelans are fleeing a very real crisis.

Vaccination

Dozens of Venezuelans cross the border every day to Colombia and Brazil to get vaccines they cannot find at home. The Colombian government says it provided Venezuelans with more than a half million doses of vaccines between August 2017 and August 2018. Many return to Venezuela after getting their vaccines at the border. Brazilian authorities offer vaccination to every Venezuelan who seeks asylum or temporary residence at the border; in August a Brazilian general at the border told us they were reaching between 200 and 300 people per day.

Venezuela is now routinely experiencing outbreaks of diseases that are preventable through vaccination and had been previously 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.
• 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, which is easily preventable by vaccine, was reported in Venezuela.

Malaria

Gregory Martínez, 10, crossed the Colombian border in July with his mother Mary Gelvez to visit Cúcuta’s main hospital after three weeks with fever, diarrhea, and feeling dizzy. Gelvez, said they had tried to obtain treatment back home, but she had not found a doctor at the local health center. At a health center near her brother’s home, in another city closer to the border, she did find a physician but there were no the medical supplies to do a malaria test on her son. After Gregory fainted on a bus, his mother took him to the hospital in Colombia. Doctors there suspected he had malaria and were waiting for confirmation of test results when we interviewed them. Gelvez said she had difficulty finding food to feed her family; Gregory weighed 23 kgs at the time of the interview — the average weight of a seven-year-old.

The number of presumed 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, which health experts attribute 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.

Tuberculosis

Mariana de la Luz, 15, is a Warao indigenous girl who was diagnosed with tuberculosis 8 years ago in her native Delta Amacuro state, Venezuela. Since her initial diagnosis, the hospital has been able to offer only incomplete courses of treatment, which she received several times. In 2017, doctors told her mother, Yuri Magdalena Silva Rivero, that she was no longer responding to treatment and there was no hope of curing her. When Silva Rivero’s sister died of malaria in February 2018 after being told there were no medicines to treat her, Silva Rivero and her husband took Mariana de la Luz to Brazil. She weighed 15 kilos when she arrived. When she got to the hospital, doctors found she was profoundly malnourished and anemic. She was also diagnosed with multi-drug resistant tuberculosis, which requires lengthy and complex treatment. She started receiving treatment three times a week at Roraima’s main hospital and was gaining weight when I spoke with her.

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, according to the Pan American Health Organization. The 2017 tuberculosis incidence rate (32.4 per 100,000) was the highest seen in Venezuela in 40 years.

HIV

Nilsa Hernández, 61, tested positive for HIV 13 years ago. She began taking antiretroviral medications nine years later and received treatment without interruptions until the medicines suddenly became unavailable in Venezuela. She spent nearly two years without access to antiretroviral treatment and became increasingly fearful for her life. In January 2018, she moved from Bolivar State to Brazil. “I want to live,” she said, and explained she would have left Venezuela earlier to get treatment but could not afford it. Hernández now gets treatment in Brazil and has created a project called “Brave People For Life,” which provides support to other Venezuelans living with HIV who move to Brazil to obtain the medical treatment they cannot find at home. To fund her project, Hernández sells ice-cream on the street and receives support, including financial support to rent her home, from a Brazilian journalist who interviewed her when she first arrived in Boa Vista and was living on the street.

A report by the Pan American Health Organization, UNAIDs, and the Venezuelan health ministry says that 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.

According to official statistics cited by the Pan American Health Organization, 87 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. Fifteen of the 25 antiretroviral medicines that the government previously purchased have been out of stock for over 9 months, and supplies of medicines to treat opportunistic infections are limited, according to a June Pan American Health Organization report.

Crossing the Border to Give Birth

Many women cross the border to give birth in Colombia or Brazil. Doctors in receiving hospitals say many arrive with complications and most did not receive adequate, if any, prenatal care in Venezuela.

Ariana González, 20, lives in Táchira State, a few hours away from the border. During her pregnancy in Venezuela, she only had a few prenatal checks, which she had to pay for in a private clinic. When she was seven months pregnant, she visited a hospital in Venezuela because she had suffered from severe headaches for several days, a potential sign of serious complications. But doctors could not measure her blood pressure because they did not have a functioning blood pressure cuff. As the headache persisted, she crossed to Colombia, where a doctor immediately diagnosed her with life-threatening hypertension and performed an emergency C-section. Her baby was born weighing just 1.6 kgs and spent six days in intensive care; González herself also spent three days in intensive care. As we interviewed her in mid-July, 11 days after she had been admitted to the hospital, she was getting ready to be released, but the baby remained hospitalized in an incubator.

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 health minister who made these statistics public in early 2017 was fired a few days later.

Malnutrition

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 we interviewed 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.

Luis Alejandro Vergara Suárez, 16, was rushed into the Emergency Room of Cúcuta’s main hospital with his older brother, Agustín, by his side. They had crossed the border with their mother and six other siblings a day earlier with the purpose of reaching a rural town in Colombia where their grandparents live. As they were crossing, local officials and doctors spotted Luis Alejandro, who looked severely malnourished, and took him to a health post near the border run by the Argentine White Helmets. From there, Luis Alejandro was transferred to a small nearby hospital before he was taken to Cúcuta’s main hospital.

Luis Alejandro has epilepsy and for years had been able to manage his condition with medication. When the medications disappeared from Venezuelan pharmacies, his family began buying them in Colombia, until they could no longer afford it. He spent several months without treatment before crossing to Colombia, where Agustín and their parents had been born. The whole family had trouble finding food, were eating one meal per day, and had lost weight, but the impact of the shortages was greater on Luis Alejandro because of his epilepsy, his convulsions often making it harder for him to eat the limited food they were able to obtain. When we interviewed him, Alejandro weighed just 16 kgs, the typical weight of a four-year-old. Agustín told us he had also lost weight—more than 20 kgs—in Venezuela.

The Venezuelan government does not publish nationwide malnutrition data, but the available evidence suggests malnutrition is increasing:

• Cáritas Venezuela, a Catholic humanitarian organization that monitors the nutritional situation in the country 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 five years old increased from 10 percent in February 2017 to 17 percent in March-2018 — a level which is indicative of a crisis according to World Health Organization standards. In July 2018 Cáritas Venezuela reported the average had dipped to 13.5 percent, but figures were significantly higher 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 different locations across the country are reporting increases in the number of pediatric admissions with moderate or severe acute malnutrition, and the proportion of children being admitted to hospitals that are acutely malnourished is high, ranging from 18 to 40 percent.
• A nationally representative survey by three prestigious universities in Venezuela concluded that 80 percent of Venezuelan households are food insecure and that people surveyed had lost an average of 11kgs in 2017.

In desperation, hundreds of Venezuelans cross the border just to eat. In July in Cúcuta, a soup kitchen operated by the Catholic Church with the support of UN agencies fed 2,500 Venezuelans per day, including many children and older people.

Fernando Arvelo (pseudonym), 74, moved to Táchira state from his home state – a 20-hour drive – soon after his wife, children, and grandchildren went abroad fleeing the crisis. He did not want to be a burden for his family and felt he could not start over elsewhere at this point in his life. Fernando crosses the border every day, walking in stifling heat of up to 40 degrees Celsius, to eat at the soup kitchen in Cúcuta. Fernando said he used to weigh 85 kilograms, and now weighs less than 50. He struggles to find medicines for heart and respiratory problems, glaucoma, and cataracts in Venezuela. At times, he’s had to purchase and take expired medication, because that was all he could find.

Most of the Venezuelans I met at the border, and throughout Latin America, want to go home to Venezuela, but they don’t know when — or if — that will be possible. The countries where they are seeking refuge should welcome them, while working to help bring about the day they can return to a democratic Venezuela.

Read more on Human Rights Watch's work in Venezuela »