IGNORING THE ILLNESS, IMPEDING THE CURE

Venezuela is experiencing a serious human rights crisis, with massive violations of fundamental rights including the right to health, resulting from the lack of essential medicines, medical treatments, diagnostic systems and a deterioration in the hospital infrastructure.

The last official Epidemiological Bulletin, dated December 20161 and published some months later, has been removed from the Ministry of Health website2. Since then, Venezuela has maintained an "epidemiologic silence"; that is, no official figures on public health issues have been made public3.

The lack of available up-to-date information makes it impossible to assess the full extent of the health care problems faced by the population and also poses a risk to public health in other countries in the region. The last bulletin, referred to above, collated the epidemiological figures for 2016 and compared them with those of the previous year, noting a drastic increase in maternal deaths and in the mortality rate among infants under one year of age compared with the previous year4. It also showed a considerable increase in diseases such as malaria, Zika and diphtheria5. Civil society organizations in the country reported that these figures were a reflection of the dramatic deterioration in the Venezuelan health system in the short period of just one year6.

Suppressing official figures has been of little avail to the government given the ever more starkly evident reality. According to civil society organizations and medical associations, the shortage of medicines in the country stands at between 80% and 90%7; more than 50% of hospitals are in a state of collapse8; and the number of medical personnel in public health centres, which account for 90% of the facilities providing health services, has also fallen by 50%9.

The Epidemiological Bulletin was suspended for 18 months in 2007 and again for more than a year in 2014. This publication, however, had been periodically disseminated and updated since 1938. For more information, see the PROVEA-CODEVIDA report, Situación del derecho a la salud en Venezuela 2016, (The right to health in Venezuela 2016) Ver en http://www.oas.org/fpdb/press/informe-codevida--provea-marzo-2016.pdf [available in Spanish only].
After almost two years of epidemiological silence, the Ministry of the People's Power for Health published all the Epidemiological Bulletins up to December 2016. Three days later, Health Minister Antonieta Caporale was dismissed. The last bulletin of 2016 showed worrying increases in the number of cases of malaria, Zika and diphtheria and in maternal and infant mortality. For more information, see CNN, “Destituyen a ministra de Salud de Venezuela días después de difundir las primeras cifras de salud en casi dos años”, (“Venezuelan Minister of Health sacked days after publishing the first health statistics for nearly two years”) at: http://cnnespanol.cnn.com/2017/05/12/destituyen-a-ministra-de-salud-de-venezuela-dias-despues-de-difundir-las-primeras-cifras-de-salud-en-casi-dos-anos/ [in Spanish only]
This Bulletin contains information gathered from mandatory reporting on the number of people who have contracted preventable diseases and epidemics, as these can have a great impact on the population unless properly monitored, and the number of maternal and infant deaths. For more information see, PROVEA, “El silencio epidemiológico” (“The epidemological silence”)https://www.derechos.org.ve/opinion/el-silencio-epidemiologico-oficial [in Spanish only]. See also, the Venezuelan Health Observatory, “El Boletín Epidemiológico Venezolano: ¿Por qué ahora y no antes?” (“The Venezuela Epidemological Bulletin: Why now and not before?”)https://www.ovsalud.org/noticias/2017/el-boletin-epidemiologico-venezolano-por-que-ahora-y-no-antes/ [in Spanish only].
Venezuelan Ministry of People's Power for Health, Epidemiological Bulletin, epidemiological week no. 52, 2016.
For example, the December 2015 Epidemiological Bulletin indicated an increase in maternal mortality of 9% over 2014. The December 2016 Bulletin indicated an increase of more than 65% over 2015. Venezuelan Ministry of People's Power for Health, Epidemiological Bulletin, epidemiological week no. 52, 2015.
PROVEA and CODEVIDA, Venezuela: Informe sobre el desarrollo a la salud 2014-2017, en un contexto humanitario de privación prolongada de medicinas y servicios sanitarios (Venezuela: Report on health development, 2014-2017, in the humanitarian context of prolonged deprivation of medicines and health services)http://www.codevida.org/codevida/wp-content/uploads/Provea-y-Codevida-Informe-Derecho-a-la-Salud-CIDH-2017.doc [in Spanish only]. See also, BBC, “Lo que dicen y lo que no las últimas cifras oficiales publicadas por el gobierno” (“What the the lastest published government figures say (and don't say) about heath in Venezuela”)http://www.bbc.com/mundo/noticias-america-latina-39866691 [in Spanish only].
PROVEA, Informe Anual enero-diciembre 2016, Derecho a la salud, (Annual Report, January – December 2016, Right to health, p.47 [in Spanish only].
Venezuelan Society for Childcare and Paediatrics, Letter to the Secretary-General of the OAS, 20 June 2017. Figures from the IACHR report, Situation of Human Rights in Venezuela, 2017.
PROVEA and CODEVIDA, Venezuela: Informe sobre el desarrollo a la salud 2014-2017, en un contexto humanitario de privación prolongada de medicinas y servicios sanitarios (Venezuela: Report on health development, 2014-2017, in the humanitarian context of prolonged deprivation of medicines and health services) at: http://www.codevida.org/codevida/wp-content/uploads/Provea-y-Codevida-Informe-Derecho-a-la-Salud-CIDH-2017.doc. [in Spanish only]

The UN Food and Agriculture Organization (FAO) in collaboration with the Pan American Health Organization (PAHO) highlighted in a recent report that between 2016 and 2014 malnutrition had risen by 3.9 percentage points in Venezuela compared with the preceding three years. This means that 1.3 million more people were suffering from malnutrition in 2016 10. The United Nations Children's Fund (UNICEF) warned in January 2018 of a worrying increase in child malnutrition in the country and complained about the lack of official data on the issue 11.

One of the most striking aspects of the situation is that Venezuela was not always like this12. For approximately 10 years, the country made great strides in ensuring the rights to housing, health, education and food of its people13. According to official and UN information, poverty was progressively and consistently reduced between 1997 and 201114. Between 1998 and 2011, the percentage of the population living below the poverty line decreased from 49.0% to 27.4%, and the percentage living in extreme poverty decreased from 21.0% to 7.3%15. This had a substantive impact on greater enjoyment of and access to other social rights, as several UN agencies with offices in the country acknowledged16.

However, in 2013 poverty levels increased to 32.1% and extreme poverty rose to 9.8%. In other words, since 2013 Venezuela has been experiencing a process of regression as regards social indicators17. Following a sharp decline in the price of oil on the international market (96% of Venezuela's exports are dependent on the hydrocarbon sector), and certain public policies implemented at both the micro and macro levels, Venezuela began to experience a serious and complex economic crisis with inflation levels calculated at over 2,600% by the end of 201718.

In terms of health, the current level of government investment in the public health system is not known19. Between 1998 and 2010 Venezuela almost doubled the proportion of its GDP earmarked for health and investment grew from the very low level of 1.4% to 2.3%. However, for a number of years this very limited increase in funding has stalled and in 2014 it plummeted to 1.5%20.

For the year 2014, the last date for which data was recorded, Venezuela came second from last in the list of countries for investment in the public health sector in Latin America and the Caribbean; the only country to spend less was Haiti21.

The emergence in the last two years, of diseases that had been eradicated in Venezuela, has been seen as an indicator of the deterioration in the system. Venezuela was seen as a model for the eradication of malaria in the Americas, with its northern region declared malaria free by the World Health Organization (WHO) in 1961. However, in 2008 a slight increase began to be registered and by 2015/2016, the number of notified cases had increased by more than 76% (from 136,000 to 240,000), overtaking Brazil as the country with the highest incidence of malaria in the Americas and recording the highest figures in the entire epidemiological history of the country22.

FAO, PAHO and WHO, 2017 Panorama of food and nutrition security in Latin America and the Caribbean.
UNICEF. Press release, 26 January 2018: Prevalence of malnutrition among children in Venezuela growing as economic crisis deepens at: https://www.unicef.org.uk/press-releases/prevalence-malnutrition-among-children-venezuela-growing-economic-crisis-deepens/
Venezuela experienced significant progress in terms of access to health, housing, education, among other social rights, for more than 10 years.
ECLAC (Economic Commission for Latin America and the Caribbean) Social Panorama of Latin America 2017 at: https://www.cepal.org/en/publicaciones/ps
WHO Estrategia de Cooperación, Resumen Venezuela (Cooperation Strategy at a glance: Venezuela) at: http://apps.who.int/iris/bitstream/10665/136983/2/ccsbrief_ven_es.pdf?ua=1 [in Spanish only]. See also, PAHO and WHO, Health in the Americas, Country Report: Venezuela (Bolivarian Republic of) at: http://www.paho.org/salud-en-las-americas-2017/?page_id=163&lang=en
National Institute of Statistics (INE), Síntesis Estadística de Pobreza e Indicadores de Desigualdad 1er semestre 1997 – 2do semestre 2011 de la República Bolivariana de Venezuela (Summary of poverty statistics and indicators of inequality 1st semester 1997 – 2nd semester 2011 of the Bolivarian Republic of Venezuela) at: http://www.ine.gov.ve/documentos/Boletines_Electronicos/Estadisticas_Sociales_y_Ambientales/Sintesis_Pobreza_e_Indicadores/pdf/2011Semestre2.pdf [in Spanish only].
See also, FAO, Reconocimiento de la FAO a Venezuela (FAO Survey on Venezuela),http://www.fao.org/americas/noticias/ver/en/c/230150/ [in Spanish only]. See also PAHO, Country Report: Venezuela (Bolivarian Republic of)http://www.paho.org/salud-en-las-americas-2017/?page_t_es=informes%20de%20pais/venezuela&lang=en
ECLAC (Economic Commission for Latin America and the Caribbean) Social Panorama of Latin America 2014 at: https://www.cepal.org/en/publications/37627-social-panorama-latin-america-2014
World Bank, The World Bank in Venezuela: Overview, At: http://www.worldbank.org/en/country/venezuela/overview
PROVEA, Situación de los Derechos Humanos en Venezuela, Informe anual 2016 (Situation of human rights in Venezuela: Annual Report 2016 at: https://www.derechos.org.ve/informe-anual/informe-anual-enero-diciembre-2016 [in Spanish only]
World Bank, Health expenditure, public (% of GDP), Venezuela at: https://data.worldbank.org/indicator/SH.XPD.PUBL.ZS?locations=VE
WHO-PAHO, 2017 Edition, Health in the Americas – Summary: Regional Outlook and Country Profiles, at: http://www.paho.org/salud-en-las-americas-2017/wp-content/uploads/2017/09/Print-Version-ENGLISH.pdf
WHO, World Malaria Report 2017 at: http://apps.who.int/iris/bitstream/10665/259492/1/9789241565523-eng.pdf?ua=1

In recent years, civil society 23 and international organizations have repeatedly called on the government to request and accept international assistance24, given the state's inability to cope with the crisis.

In August 2016, Ban Ki-Moon, former UN Secretary-General, referred to the Venezuelan situation as a humanitarian crisis because of the lack of the basics such as food, water, health care and clothing25, and offered the country UN support26. The UN High Commissioner for Human Rights, Zeid Ra'ad Al-Hussein, has expressed concern on numerous occasions about the dramatic decline in the enjoyment of economic and social rights, and has offered the support of his office in facing the challenges27. Although at the beginning of 2017 the Venezuelan government made a brief announcement asking for international help from UN agencies in the country, no more information was forthcoming on the nature or scope of the assistance requested28. In its most recent report on Venezuela the Inter-American Commission on Human Rights (IACHR), called on the state to guarantee the right to health by mobilizing the necessary resources available, "including those of international cooperation"29.

El Nacional, “CODEVIDA insiste en apertura de canal humanitario” (“CODEVIDA demands the opening of a humanitarian channel”) at: http://www.el-nacional.com/noticias/sociedad/codevida-insiste-apertura-canal-humanitario-tras-rechazo-del-gobierno_215912 [in Spanish only].
Although the UN system in Venezuela has been providing technical assistance and cooperation to the country for years, requesting and accepting international assistance would entail a more extensive cooperation and coordination scheme, capable of ensuring the basic health rights of the entire population.
BBC, “Venezuela envoys disputes UN chief´s humanitarian crisis remarks” at: http://www.bbc.com/news/world-latin-america-37082927
La Nación, “Ban Ki Moon: en Venezuela hay una crisis humanitarian” (“Ban Ki-moon: there is a humanitarian crisis in Venezuela”) at: https://www.lanacion.com.ar/1926563-ban-ki-moon-en-venezuela-hay-una-crisis-humanitaria [in Spanish only].
2nd Cycle – UPR Venezuela 2016: Contributions of the Venezuelan Civil Society, Speech by Zeid Ra'ad al Hussein, at: https://www.upr-info.org/sites/default/files/document/venezuela_bolivarian_republic_of/session_26_-_november_2016/factsheets_upr_venezuela_en.pdf. A year later, Zeid Ra'ad al-Hussein reiterated his criticism of Venezuela's refusal to accept there is crisis. For more information, see UN Web TV, Zeid Ra’ad al Hussein (OHCHR) on the situation in Venezuela – Security Council, Arria formula meeting at: http://webtv.un.org/watch/zeid-ra%E2%80%99ad-al-hussein-ohchr-on-the-situation-in-venezuela-security-council-arria-formula-meeting/5643399460001/
United Nations System in Venezuela, Press release on the request for support from the Government of the Bolivarian Republic of Venezuela to the United Nations to regularize the supply of medicines in the country, March 2017, at: http://venezuela.unfpa.org/id/node/23020 [in Spanish only].
IACHR, Report, Situation of Human Rights in Venezuela, 2017, at: http://www.oas.org/en/iachr/reports/pdfs/Venezuela2018-en.pdf
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A person carries a poster denouncing the lack of supplies for dialysis in Venezuela in the protest "We do not want to die" on February 8, 2018 in Caracas.

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Patients and people with medication needs show their posters at the "We Do not Want to Die" protest on February 8, 2018 in Caracas, Venezuela. It is estimated that some 3 million people with chronic diseases in need of treatment were at least a year without access to their medications

In addition to these human rights bodies, representatives of different countries, for example the President of Colombia30, have offered to provide assistance to Venezuela. However, both the Venezuelan President and many government ministers31 have made public statements denying that there is a crisis and rejecting the international cooperation offered as "an imperialist attack" and a tactic on the part of opposition parties to intervene in the politics of the country. 32

At the end of 2017 the Health Minister reiterated the official position, stating "none of us will kneel before the empire" and rejecting so-called humanitarian aid33. In January 2018, President Nicolás Maduro stated once again that the only intention behind the offer of international aid was to facilitate a US 34 invasion of the country to seize Venezuela's oil and wealth35. Various human rights organizations have characterized the current situation as a "complex humanitarian emergency" in view of the severe collapse of the formal economy, social conflict, the inability of the authorities to address the deterioration and dismantling of the health and food systems and the large migratory flows to other countries in the region36.

Although Venezuela is experiencing a serious and complex financial situation, with spectacular levels of inflation and stagnation, this does not absolve the state from fulfilling its obligation to ensure the right of everyone to the enjoyment of the highest attainable standard of physical and mental health and to implement all the measures necessary to guarantee this37, including requesting international cooperation. Financial restrictions do not excuse states from fulfilling their fundamental obligations and must not affect the minimum content of economic, social and cultural rights, as established by the UN Committee on Economic, Social and Cultural Rights (CESCR), the body responsible for interpreting the provisions of the International Covenant on Economic, Social and Cultural Rights (ICESCR).

Part of the minimum content that Venezuela must fulfil is ensuring the provision to all its population of essential medicines, according to the list of the WHO's Action Programme on Essential Drugs38. This is a non-derogable obligation under international law. Venezuela has an obligation to ensure that essential medicines are available and accessible to all its citizens, both in terms of physical and economic availability, culturally appropriate and of good quality39.

In addition, the Committee on ESCR has established that reproductive, maternal (prenatal and postnatal) and child health care equates to the above (a minimum and non-derogable obligation)40, and that where a country cannot guarantee these basic obligations, it must demonstrate that every effort has been made to comply with this duty both using existing resources within the state as well as those available from the international community through international assistance and cooperation41. By refusing this aid, Venezuela is breaching its international obligations.

Amnesty International has received information consistent with the allegations made by human rights organizations in Venezuela that the public health services are unable in virtually all cases to provide prescribed medication and that patients are obliged to obtain this through their own means. The statements obtained indicate that the lack of medicines in pharmacies means that most people are forced to resort to the black market, where, on the rare occasions medicines can be found, people often have to travel great distances to acquire them, pay disproportionately high prices and have no guarantee of their quality.

EFE, “Santos pide a Maduro aceptar el apoyo humanitario de la comunidad internacional” (“Santos asks Maduro to accept humanitarian support from the international community”) at: https://www.efe.com/efe/america/politica/santos-pide-a-maduro-aceptar-el-apoyo-humanitario-de-la-comunidad-internacional/20000035-3451984 [in Spanish only].
El Nacional, “Ministro de Salud dice que no permitirá canal humanitario en Venezuela” (“Minister of Health says he will not allow humanitarian channel in Venezuela”) at: http://www.el-nacional.com/noticias/gobierno/ministro-salud-dice-que-permitira-apertura-canal-humanitario_213888 [in Spanish only].
Excélsior, “Niega Maduro que haya crisis en Venezuela” (“Maduro denies there is a crisis in Venezuela”), 8 January 2018, at: http://www.excelsior.com.mx/global/2018/01/08/1212339 (last visited 14 February 2018).
El Nacional, “Ministro de Salud dice que no permitirá canal humanitario en Venezuela” (“Minister of Health says he will not allow humanitarian channel in Venezuela”) at: http://www.el-nacional.com/noticias/gobierno/ministro-salud-dice-que-permitira-apertura-canal-humanitario_213888 [in Spanish only].
In August 2017, US President Donald Trump mentioned the possibility of a military intervention in Venezuela if necessary. However, this was resoundingly and immediately rejected by most countries in the region. For more information, see Correo del Orinoco, “Países de la región, rechazan la amenaza de intervención militar de Estados Unidos contra Venezuela” (“Countries in the region reject the threat of US military intervention against Venezuela”) at: http://www.correodelorinoco.gob.ve/paises-de-la-region-rechazan-amenaza-de-intervencion-militar-de-eeuu-contra-venezuela/ [in Spanish only].
Excélsior, “Niega Maduro que haya crisis en Venezuela” (“Maduro denies there is a crisis in Venezuela”) at: http://www.excelsior.com.mx/global/2018/01/08/1212339 (last visited 14 February 2018).
CEPAZ (Centro de Justicia y Paz), Complex Humanitarian Emergency in Venezuela, at: https://cepaz.org.ve/noticias/emergencia-humanitaria-compleja-venezuela/
Venezuela is a state party to the International Covenant on Economic, Social and Cultural Rights (ICESCR) of 1966, Article 12 of which states: 1 The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 2 The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: (a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; (b) The improvement of all aspects of environmental and industrial hygiene; (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.
Essential medicines are those that satisfy the priority health care needs of the population, They are selected with due regard to the prevalence of the illness and their safety, efficacy and safety, and comparative cost-effectiveness. WHO Model List of Essential Medicines at: http://www.who.int/medicines/publications/essentialmedicines/en/
According to the CESCR, medication must meet the essential requirements of availability, accessibility, acceptability and quality. Availability refers to the need to have a sufficient quantity of health-care facilities, goods, medical personnel and public health services and programs; Accessibility means that all services must be accessible to everyone without discrimination some, including its economic affordability; acceptability means that they must be respectful and culturally appropriate; and quality means that they must be appropriate from a scientific and medical point of view and be of good quality. CESCR General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12), E/C.12/2000/4, 11 August 2000.
CESCR General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12), E/C.12/2000/4, 11 August 2000.
CESCR General Comment No. 3: The Nature of States Parties’ Obligations (Art. 2, Para. 1, of the Covenant), E/1991/23, 14 December 1990

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