As her 3-month-old daughter was recovering from heart surgery at one of the leading public hospitals in Caracas, Venezuela, doctors told Yamila she needed to go out and buy basic medical supplies for her baby that the hospital had run out of. They gave her a list that included catheters, needles for administering IV fluids, antibiotics and other medications, the mother told a Human Rights Watch researcher in November.
Leaving her daughter’s side, Yamila went on a frantic search for medical supplies so basic that no hospital — let alone one of the country’s largest teaching hospitals — should ever run out of them. But none of the hospitals or pharmacies she visited had them in stock. In the end, despite concerns about the quality of the supplies, and unsure whether she had the correct catheters and needles for a newborn, Yamila had no option but to buy whatever she could find on the black market — with no quality guarantees.
Venezuela’s health care system, long a source of pride for the government, is in deep crisis. Thousands of patients cannot get essential medical treatments, and thousands more have been wait-listed for potentially life-saving surgery because doctors don’t have the materials they need to operate.
The government has been trying to deflect blame, going after directors from a leading pharmacy chain and detaining and questioning doctors who have criticized the shortages. But the government itself has failed to ensure that essential medicines and medical supplies are available in the health care system, while its currency exchange restrictions and price controls interfere with the ability of pharmaceutical companies to sell them. The crash of oil prices, a key source of revenue for the country, has dramatically worsened an already bad situation.
On recent visits to Venezuela, Human Rights Watch found shortages of medications to treat pain, asthma, hypertension, diabetes and heart diseases, among others. Syringes, gauze and needles were in short supply, and even basic lab tests couldn’t be performed.
In March, Doctors for Health, a network of medical residents working in public hospitals all over the country, reported results from a survey of 130 public hospitals in 19 states that found that 44 percent of operating rooms were not operational and 94 percent of labs didn’t have the materials they needed to operate properly. They also found that 60 percent of routinely stocked medicines or medical supplies were entirely or partially unavailable in the hospitals, and that a majority of medicines included in the World Health Organization’s Model List of Essential Medicines were not available in pharmacies.
Under international human rights law, governments have a core obligation to ensure that these medicines are available and accessible to all without discrimination. But as we document these problems in countries around the world, we have rarely seen access to essential medicines deteriorate as quickly as it has in Venezuela except in war zones.
Many countries in the region have long had obstacles to access to basic medicines and services, especially in rural areas. But the current shortages in Venezuela affect major hospitals and private pharmacies as well. And the government’s policies are making it harder to get these basic medicines anywhere.
At the end of 2014, public hospitals were wait-listing approximately 20,000 patients for surgery, including 4,000 at the University Hospital of Caracas, according to Doctors for Health. In January, after more than 10 patients waiting for surgery reportedly died there, the hospital closed its cardiology unit and sent the remaining patients home. The unit briefly reopened in February after media coverage of the deaths led health authorities to provide some new supplies of medications, doctors told us. But it closed again two weeks later.
At the pediatrics area of the University Hospital, doctors told us they sterilize and reuse masks for treatment of children with respiratory conditions. At the J.M. de los Ríos Hospital, the main children’s hospital in Caracas, physicians said they face significant diagnostic challenges because they lack supplies like lab tubes or test kits.
As in other countries in the region, Venezuela has had sharp increases in mosquito-transmitted viral diseases, with more than 34,000 suspected cases of chikungunya and 75,000 suspected cases of dengue estimated in 2014, according to Pan American Health Organization statistics. Independent experts suspect there may be many more cases, given the many patients with fever who lack a proper diagnosis. Doctors and patients told us that despite government pledges to import medicines to treat these illnesses, Venezuelans were often unable to get the drugs, particularly during peak demand.
Not surprisingly, this situation has caused significant discontent. Since February 2014, Venezuelans have been holding street protests over a range of issues, including the shortages of medicines and other goods. Security forces have repeatedly used unlawful force against demonstrators and bystanders — including arbitrary arrests, beatings and torture.
The Venezuelan government routinely attempts to divert attention from crises by putting forward conspiracy theories or finding scapegoats. In this case, it has tried to divert popular anger by blaming doctors, pharmacies and pharmaceutical companies for the shortages.
In early February, President Nicolás Maduro accused a pharmacy chain of “carrying out an economic war against the people” after it closed several cash registers at one store, causing a long line. It’s not uncommon to see lines of upset Venezuelans who stand on the street for hours waiting to buy goods when they appear in the market at pharmacies or elsewhere. Instead of addressing the root causes of the shortages, the government detained two of the pharmacy chain’s directors for 45 days. The men were finally released on their own recognizance, facing charges of “boycott to destabilize the economy,” a crime created over a year ago by presidential decree.
Police have detained and interrogated several doctors who had either publicly complained about shortages of medicines and medical supplies or provided care to injured demonstrators.
In February, authorities detained Carlos Rosales, the president of the Venezuelan Association of Clinics and Hospitals in the state of Carabobo, after he complained in a TV interview about the scarcity of medicines.Media reports said Rosales was taken away from the medical center where he works and interrogated for three hours before his release.
A few weeks later, police told two doctors from Táchira to accompany them to give a statement about the treatment they had provided to injured demonstrators the day before, according to press accounts. The doctors told a local news outlet that the officials did not show them anything in writing about the need to provide a statement, but said that failing to provide the information could constitute “concealment or provision of false information.” They were held for five hours, then released.
In reality, however, the government largely has itself to blame.
Venezuela does not have a strong pharmaceutical industry, so the country has to import most medications and medical supplies. Even for medications that are made locally, the raw materials often come from abroad. The government procures some medicines and supplies directly from other countries through bilateral agreements, including Argentina,Cuba, Uruguay and China, but it has not ensured that the public health care system has what it needs.
Several recent reports by Venezuela’s own Comptroller General’s Office criticized poor planning and storage conditions, and found that many medicines had to be thrown away because they had gone bad. In its 2011 report, for example, the office reported that it found medicines and surgical supplies in public hospitals that had expired up to six years earlier. In 2013, the office’s report found that the Health Ministry had failed to release pharmaceutical products promptly from customs, leading to delays of up to 168 days. By September, the ministry had only been able to obtain 0.84 percent of medicines planned for the year; 74 percent should have been available by then. Similarly, a 2014 report on the children’s hospital in Caracas stated that 10 out of 11 areas were not providing adequate services due to “lack of medical personnel, equipment, supplies, as well as a deteriorating infrastructure.”
But for most medical supplies, Venezuela depends on commercial pharmaceutical suppliers. And the currency exchange rules and price controls the government has imposed are interfering with the process.
Foreign suppliers demand payment in hard currency, but dollars are hard to get since the government keeps tight control over the limited amount it appears to have. Private pharmaceutical companies in Venezuela need government authorization to purchase dollars to pay foreign vendors. Once that authorization is granted, they must request the Central Bank of Venezuela to actually deliver them. This is often riddled with long delays, resulting in late payments, our research shows. And foreign suppliers refuse to send new shipments to Venezuela until the debt is paid.
As the law prohibits buying dollars outside this system, pharmaceutical companies cannot legally purchase hard currency elsewhere. But even if it were legal, it wouldn’t be economically viable. Venezuelan law imposes amaximum price for medicines sold there based on the official exchange rate, which is about 3 percent of the black market price. If companies were to buy dollars outside of the official procedure, they would end up paying much more for medicines and supplies than they could charge for them.
And so hospitals and pharmacies routinely run out of the basics, making it increasingly difficult for doctors to do their job. As one doctor told us, “It is incredibly frustrating not being able to do what we are trained to do, which is cure an illness, or at the very least alleviate pain.” The end result is tens of thousands of people whose health or lives are at risk.
Diederik Lohman is associate health and human rights director at Human Rights Watch.