Monitoring of Access to Health in Venezuela Newsletter N. 20 March

NEWSLETTER

20

2019

MARCH

MONITOREO DEL DERECHO A LA SALUD EN VENEZUELA: MEDICIÓN DEL DESABASTECIMIENTO DE MEDICINAS Y LA SITUACIÓN DE LAS ENTIDADES DE ATENCIÓN DE PERSONAS MAYORES. CONVITE, A.C. 2018 LUIS FRANCISCO CABEZAS DIRECTOR GENERAL FRANCELIA RUIZ DIRECTORA DEL PROYECTO INVESTIGACIÓN Y REDACCIÓN: YANIRETH FERNÁNDEZ, FRANCELIA RUIZ. REVISIÓN Y EDICIÓN: LUIS FRANCISCO CABEZAS, WENDY RACINES. DIAGRAMACIÓN Y DISEÑO: CAMILO ESCOBAR. EQUIPO DE LEVANTAMIENTO: DISEÑO MUESTRAL Y PROCESAMIENTO ESTADÍSTICO: MIGUEL PADRÓN EQUIPOS LOCALES DE LEVANTAMIENTO: ÁREA METROPOLITANA DE CARACAS: ALEXANDER MONSALVE SANDRA PEPE DIEGO RAMÍREZ KELLYN RUIZ BARQUISIMETO: JOSÉ RAMÓN QUERO LISSETTY PÉREZ ISABEL BRAVO AQUILES QUERO CARMEN QUIÑONES MARACAIBO: ORGANIZACIÓN MULIER ESTEFANÍA MENDOZA MAYERLING GUERRERO ALEXANDRA NAVA JHULIANA TORRES LENIN ALVAREZ MÉRIDA: ORGANIZACIÓN PROMEDEHUM RIGOBERTO LOBO FRANCISCO DE JESÚS SEGOVIA JUAN CARLOS LIENDO ELVIS RIVAS

CIUDAD BOLÍVAR: ORGANIZACIÓN KAPÉ KAPÉ RAIZA GUAIPO MARY CARMEN SALAZAR ALCALA JOEL A OBDOLA FIGUEROA CARLOS R TORRES FLORES RANIER RAFAEL RICCIARDI PÁEZ PUERTO LA CRUZ: ORGANIZACIÓN DEFENSA EN ACCIÓN ALEJANDRA OLIVARES LUZ GUERRERO SUSANA DÍAZ MERCEDES CURIEL ZEZARINA GUEVARA VALENCIA: ORGANIZACIÓN FUNCAMAMA SOLEIR VALECILLOS YANIRA SUAREZ CARMEN BUENO ARACELYS COLMENAREZ MARIA ISABEL ALVARADO

PUERTO ORDAZ: ORGANIZACIÓN CODEHCIU MAIRIS BALZA NORKIS SALAZAR ROXANA MATHEUS ALEJANDRO HERNANDEZ ANGÉLICA SALAZAR

T A B L E

O F

C O N T E N T S

ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS MEDICINE SHORTAGE INDEX – MARCH, 2019

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AN INTRODUCTORY STATEMENT, NOW THAT IS WORLD WATER DAY

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INDICATOR BEHAVIOR AND EVOLUTION

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BEHAVIOR AND EVOLUTION OF THE GENERAL SHORTAGE INDEX BY MORBIDITY.

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DIABETES: HYPERTENSION: ACUTE RESPIRATORY INFECTIONS (ARIS): DIARRHEAL DISEASES: DEPRESSION OR PERSONALITY DISORDERS: SEIZURES:

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ON CONTRACEPTIVES SEXUAL AND REPRODUCTIVE HEALTH AT RISK

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#CONVITEDENOUNCES MARCH 2019VENEZUELA EMERGENCY FOR BLACKOUTS NATIONWIDE

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ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS

MEDICINE SHORTAGE INDEX MARCH, 2019

CHRONOLOGICAL DETAILS OF THE SURVEY Period and Frequency of Data Collection: The survey consisted of two measurements conducted in the month of March of 2019, from the 21st to the 22nd and from the 28th to the 29th —which dates fall on the second and fourth weeks of the month, respectively—, in order to detect variations that could be quantified and circulated regarding medicine supply protocols in pharmaceutical establishments. It should be noted that in the cities of Mérida and Maracaibo, due to the nationwide blackout and for reasons inherent in the current context of social conflict, the second leg of the survey (March 28 – March 29) had to be cancelled; accordingly, for the purposes hereof, the GSI was calculated for those cities based only on the measurements taken on March 21 and March 22. It is also worth noting that seven of the pharmacies surveyed in the city of Maracaibo were looted.

For further information on the technical data sheet of the survey and other methodological details, please refer to Newsletter No. 1, September 2017, available at https://conviteblog.wordpress.com/2017/10/17/informes-de-septiembre-del-proyectomonitoreo-del-derecho-a-la-salud-en-venezuela/

AN INTRODUCTORY STATEMENT, NOW THAT IS WORLD WATER DAY Water: the vital fluid. This is how it is known all over the world, for it is an invaluable resource that is vital for the survival of all living creatures. And it is precisely because of water is so important that a day is annually observed (March 22) in order to raise awareness among citizens and promote public policies for water conservation and sanitation.

In Venezuela, there is the Venezuelan Observatory of Public Services, which is promoted by civil organization Entorno, Sociedad, Desarrollo y Ambiente (ESDA). The VOPS has been evaluating public services at the national level via measurements based on a survey of 5,200 inhabitants of eight of the major Venezuelan cities, namely Caracas, Maracaibo, Valencia, Barcelona, Barquisimeto, San 1

Cristóbal, Punto Fijo and Ciudad Bolívar, covering 22 municipalities .

The most recurring problem in these cities, and so far the most serious one, is the one posed by irregularities in water supply, as reported by 70 percent of the people surveyed, followed by claims by 14 percent of the people surveyed that the water they get is far from being odorless, colorless or tasteless, and next by those made by 35.5 percent of households that they receive water less than two days per week. Julio Cubas, who performs as president of the VOPS, indicated that “62 percent of the people surveyed have reported to have suffered from diarrhea because of the poor quality of the water they get, while 17 percent have reported to have suffered from scabies, other skin diseases and various gastrointestinal ailments.”

In addition to being exposed to diseases associated with a poor water quality, the people affected by the water crisis are forced to spend a substantial part of their monthly income on buying water from cistern trucks and/or oversized returnable water bottles, which in and of themselves are not entirely reliable, judging by the continued complaints that the questionable safety conditions of the water so dispatched have raised.

While much of the world is debating the 17 Sustainable Development Goals (SDSs), which establish priorities such as to “Ensure availability and sustainable management of water and sanitation for all” or to “Ensure access to affordable, safe, sustainable and 2

modern energy...”, in this part of the world called Venezuela we are discussing a “water crisis” and a “health catastrophe” , which are 1. Sinergia, Venezuelan Network of Civil Society Organizations (January 1). Available at: http://sinergia.org.ve/2019/01/09/el-servicio-de-agua-potable-fue-el-peor-valorado-enel-2018-por-las-principales-ciudades-del-pais-segun-el-observatorio-venezolano-de-servicios-publicos/ 2. SOTELDO, Eduardo (April 1, 2019). “Susana Raffalli: Escasez de agua puede convertirse en una catástrofe sanitaria” (Susana Rafalli: Water Shortage May Turn Into A Humanitarian Catastrophe). Available at: https://www.laprensalara.com.ve/2019/04/susana-raffalli-escasez-de-agua-puede-convertirse-en-una-catastrofe-sanitaria/

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the words that Susana Raffalli —a nutritionist, activist and consultant of the Caritas de Venezuela organization— uses to characterize this serious shortage scenario.

The lack of water and the precarious quality thereof lead to huge difficulties for people to meet their basic needs and cause a direct impact on their day-to-day activities, on their physical and mental health and, therefore, on the quality of life of all the country’s inhabitants alike.

INDICATOR BEHAVIOR AND EVOLUTION 3 The shortage indexes reported in our March 2019 survey within the framework of the Monitoring the Right to Health in Venezuela project, which range between 38 percent and 100 percent, are shown below.

Table No. 1: Nationwide Aggregate by City and Morbidity. March 2019.

Table No. 2. Most Scarce Active Ingredients Per City and Morbidity Surveyed. March 2019.

3.For details on the historical data of all the measurements carried out since the beginning of the project, please refer to our Newsletters No. 1 to No. 11, available at: https://conviteblog.wordpress.com/

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Chart No. 1: Behavior of the Medicine Shortage Index Nationwide. March 2019

Chart No. 2: Behavior and Evolution of the General Shortage Index by Morbidity. October 2018 – March 2019

During the month of March, the General Medicine Shortage Index showed a downward trend, which was reflected in a 1 percent reduction (February: 73 percent vs. March: 72 percent). Still suffering the most difficulties in acquiring the medication they need to treat their condition are those Venezuelans who experience convulsive episodes as a consequence of other morbidities or special health conditions, and those afflicted by depression and other personality disorders and by acute respiratory infections. In March, there was a 90 percent shortage of anticonvulsants, an 88 percent shortage of antidepressants and an 86 percent shortage of medications for ARIs. Barquisimeto, the Metropolitan Area of Caracas (MAC), Puerto La Cruz, Puerto Ordaz and MĂŠrida are the places with the most alarming indicators in the entire country, with drug shortage rates of between 60 percent and 100 percent.

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GR APHIC DEPIC TION OF RESULTS BY MORBIDIT Y: DIABETES

Chart No. 3: Behavior of the Medicine Shortage Index by Morbidity: Diabetes. March, 2019.

The inhabitants of the dusk city of Barquisimeto just give up when, having toured every local and national pharmacy chain, they can’t find the diabetes medication that they need, faced with a 98 percent shortage of drugs to manage diabetes in that city.

The inhabitants of the city of MĂŠrida are also affected by the ravages of the medicine shortage, with a shortage index of 88 percent for diabetes medication alone.

In the Metropolitan Area of Caracas, the shortage index is in the order of 81 percent, while in the cities of Puerto Ordaz and Puerto la Cruz it is 73 percent and 70 percent, respectively, for drugs to treat diabetes.

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HYPERTENSION:

Chart No. 4: Behavior of the Medicine Shortage Index by Morbidity: Hypertension. March 2019.

Hypertension is a poorly managed morbidity in Puerto La Cruz. The medicine shortage indicator for hypertension drugs that we derived from our monitoring of the selected pharmacy groups was 84 percent for Puerto La Cruz, followed by Barquisimeto, the Metropolitan Area of Caracas, MĂŠrida and Puerto Ordaz, with shortage indexes of 83 percent, 72 percent, 64 percent and 55 percent, respectively. The remaining cities in the survey had drug shortages below 55 percent.

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ACUTE RESPIRATORY INFECTIONS (ARIS):

Chart No. 5: Behavior of the Medicine Shortage Index by Morbidity: ARIs. March 2019.

Barquisimeto is back at the top of the list of cities with the highest medicine shortage rates; this time around, Barquisimeto is the city with the largest shortage of drugs to treat acute respiratory infections (ARIs) with a 97 percent SI. In the pharmaceutical establishments that we visited, Puerto La Cruz ranks next, with a 95 percent shortage index, followed by the Metropolitan Area of Caracas with 90 percent; Puerto Ordaz with approximately 86 percent, and MĂŠrida with 85 percent. These are the cities with the highest shortage rates for medication to manage ARIs.

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DIARRHEAL DISEASES:

Chart No. 6: Behavior of the Medicine Shortage Index by Morbidity: Diarrheal Diseases. March 2019.

Barquisimetanos have virtually no medicines to treat diarrhea (100 percentage shortage in pharmaceutical chains), and diarrhea is an increasingly frequent pathology in most Venezuelan regions as a result of the serious problems facing the country with the supply and the quality of water for human consumption.

Puerto La Cruz also encounters serious difficulties when it comes to find drugs to control diarrheal diseases (93 percent shortage). It is worth remembering at this point that just one month ago or so, 14 deaths were reported in the state of Anzoรกtegui, mostly children, from severe dehydration (caused by vomiting and diarrhea), the majority in connection with the consumption of contaminated water.

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DEPRESSION OR PERSONALITY DISORDERS:

Chart No. 7: Behavior of the Medicine Shortage Index by Morbidity: Depression. March 2019.

Barquisimeto is again leading the list of the most affected cities, followed by Puerto Ordaz, Puerto La Cruz and the Metropolitan Area of Caracas. These four Venezuelan cities have the most alarming shortage indexes for medication to manage and control the symptoms of depression and other personality disorders: 90 percent.

The remaining cities surveyed have shortage indicators of between 72 percent and 87 percent.

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SEIZURES:

Chart No. 8: Behavior of the Medicine Shortage Index by Morbidity: Seizures. March 2019.

Unfortunately, seizures now add to the list of morbidities that are the most complicated to fight in Barquisimeto: with a shortage index of 100 percent, no drugs can be found in local pharmacies, national pharmacies or private pharmacies to treat the condition.

Valencia comes next. Over the last few months, Valencia’s shortage rates had not been too high, but the situation has changed and the capital city of the state of Carabobo is facing a serious shortage of anticonvulsants. For their part, Puerto La Cruz, the MAC and MÊrida have recorded anticonvulsant shortage rates of above 90 percent.

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ON CONTRACEPTIVES

Sexual and Reproductive Health at Risk

Chart No. 9: Shortage Index Aggregate Nationwide, by City. The Case of Contraceptives. March 2019.

It appears from the data obtained during our monitoring work that the shortage of contraceptives remains unaltered at the national level. Barquisimeto, Puerto La Cruz and the Metropolitan Area of Caracas are still the most critical locations, with shortage indexes of up to 100 percent in products such as injectable contraceptives, oral contraceptives, implantable contraceptive devices, contraceptive patches, vaginal rings and emergency contraceptives.

A shortage index of 100 per cent has also been recorded in the city of Maracaibo for the latter products, although it is easier to find oral contraceptives and condoms there. In MĂŠrida it is almost impossible to find injectable contraceptives, implantable contraceptive devices, contraceptive patches and vaginal rings in pharmacy chains and private pharmacy stores, but there is a chance that people may find condoms and emergency contraceptives.

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#CONVITEDENOUNCES MARCH 2019: VENEZUELA: EMERGENCY FOR BLACKOUTS NATIONWIDE

A NATIONWIDE BLACKOUT TAKES PEOPLE “BY SURPRISE” AND AGGRAVATES THE CRISIS OF THE VENEZUELAN HEALTH SYSTEM On Thursday, March 7, at 4:00 pm, Venezuela was left without electric power. The nationwide blackout went on for more than 100 hours. Power was progressively restored in some areas of the country. However, twenty-four hours into the blackout, the country’s water supply service became intermittent and eventually to a complete stop, which further aggravated the emergency situation. The collapse of two of the most basic services in every country’s life added to the deterioration of healthcare facilities around the country. Just on the first day of the power outage, there were reports of casualties, both officially and extra officially.

As per the NGO Coalition of Organizations for the Right to Health and Life (Codevida), 15 people had died as 4

of Saturday March 3, 2019 because they could not be dialyzed. Most hemodialysis units were inoperative since 5

they lacked power or water. Some of the units were said to be 95 percent inoperative, while some others managed to operate by use of power generators but only to the extent that their supply of fuel allowed them to do so. Most of the reported deaths occurred in the state of Zulia, where the death toll was of nine patients, and there were four related deaths in Caracas’s Pérez Carreño Hospital and two in the state of Trujillo.

According to the NGO Doctors for Health, 21 people had died as of March 11 in the hospitals surveyed by the 6

organization (i.e. 40 type-III and type-IV healthcare facilities) as a consequence of the blackout. Fifteen people died in Maturín’s Núñez Tovar Hospital; four newborns were reported dead in Caracas and Maracaibo combined, and one adult was reported dead in Maracay..

In the meantime, the regime, through its minister of health, claimed that more than 90 percent of the power generators in public hospitals had worked during the contingency. Minister Carlos Alvarado denounced that 7

the media and users of social networks were creating a “fake” and “tendentious” campaign . On the other hand, Carlos Prósperi, president of the Society of Internal and Resident Physicians (Somir) of Hospital Vargas, complained that “only 10 percent of the healthcare facilities in the country had power generators”.

The ‘José Manuel de Los Ríos’ Hospital didn’t spare the headlines during the blackout. The lack of power and water was compounded by a shortage of food to feed its users. Children yelled from their rooms and from the halls that they were hungry.8 The patients’ parents, representatives and caretakers alleged that the food that they received from the hospital was insufficient and that on Sunday, March 10, they were prevented from entering or leaving the premises because the National Bolivarian Police (PNB) and the Special Action Forces (FAES) had taken custody thereof.

4.EFECTO COCUYO (March 10, 2019). “15 pacientes han muerto por no poder dializarse afirma Codevida” (Fifteen Patients Have Died for Lack of Dialysis, Codevida Reports). Available a: http://efectococuyo.com/principales/15-pacientes-han-muerto-por-no-poder-dializarse-afirma-codevida/ 5. AFP newsagency/EL ESTIMULO.COM (March 9). “Peligran vidas de 10.000 pacientes renales por apagones en Venezuela” (The Lives of 10,000 Kidney Patients at Risk for Blackouts in Venezuela). Available at: http://elestimulo.com/blog/peligra-la-vida-de-10-000-pacientes-renales-por-apagones-en-venezuela/ 6. EFECTO COCUYO (11 de marzo de 2019). “Aumenta a 21 la cifra de fallecidos por apagón en Venezuela, según ONG”. Disponible en: http://efectococuyo.com/ principales/aumenta-a-21-la-cifra-de-fallecidos-por-apagon-en-venezuela-segun-ong/ 7. PINEDA, Julett (6 de febrero de 2019). “Ministro de salud dice que información sobre muertes por apagón es falsa y tendenciosa” Disponible en: http://efectococuyo. com/salud/ministro-de-salud-dice-que-informacion-sobre-muertes-por-apagon-es-falsa-y-tendenciosa/ 8. EFECTO COCUYO (10 de marzo de 2019). “¡No hay comida! gritan los niños del J.M de Los Ríos desde las ventanas del hospital”. Disponible en: http://efectococuyo. com/salud/no-hay-comida-gritan-ninos-del-j-m-de-los-rios-desde-las-ventanas-del-hospital/

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#CONVITEDENOUNCES They didn’t have running water to meet their personal hygiene needs nor drinking water to quench the thirst of sick children. The collapse of the power system that affected the entire country could not be swiftly restored; the hospital’s internal power generator didn’t start; a portable generator that was sent but it didn’t work either because it had missing parts that had been stolen. But the director of the J. M. de Los Ríos Hospital, Natalia Martinho, firmly stated that the hospital had never ceased to receive the support of the State’s agencies and that its emergency, intensive care and hemodialysis areas had been operational at all times.

People say that second parts have never been good. And there is your second nationwide blackout in less than 20 days...

While many Venezuelans were just resuming their daily routine after almost a full week without power, a new “mega blackout” came to disrupt —less than one month after the first major power outage— the sense of normalcy that they had barely regained. Work and academic activities were suspended, again, and the health sector was struck another blow that made the situation worse. The entire country was brought to a stop as a consequence of the high instability of such a fundamental service.

There were reports of physicians having to use their mobile phone lights in the middle of a surgical procedure because the generators that had been installed only covered a few areas in the hospitals where they work. The condition of patients with kidney disease got worse because they couldn’t be dialyzed; babies and children couldn’t receive their chemotherapy sessions; medical consultations were suspended... and the list of deaths attributable to the outage kept growing.

Doctors for Health —an ONG that also monitors deaths in hospitals as a consequence of the lack of electricity in contingencies such as this— reported that, up to March 27, three elderly patients had died: two (2) in the Central Hospital of Maracay and one (1) in Caracas’ Carlos Arvelo Hospital; also, two (2) renal patients had died in the state 9

of Zulia , and one (1) person who had been wounded by a firearm and had respiratory complications died because the power generator didn’t start when he needed to be treated.10 NGO Codevida released a statement condemning the silence of the Venezuelan Society of Nephrology (SVN) in the face of the serious situation that renal patients have had to enndure since 2016 and whose lives are dimmed 11

with each interruption in the supply of power and water. However, just one day after Codevida’s statement (March 28), the SVN issued a communication reporting that 22 kidney patients had died as a consequence of the first 12

blackout. Additionally, nephrologists reported both on the exact number of patients affected by organ and/or graft rejection due to the lack of medication and immunosuppressant agents, and on the suspension of organ transplant surgeries and on the discontinuation of the peritoneal dialysis program.

The communication ended with a call to the health authorities to declare an emergency in the national health system, allocate the necessary resources to all healthcare facilities, and reactivate the Venezuelan Dialysis and 9. PINEDA, Julett (March 28, 2019). “Al menos tres fallecidos dejó segundo megaapagón en los hospitales, alerta Médicos por la Salud” (At Least Three Dead from the Second Mega Blackout in Hospitals, Warns Physicians For Health). Available at: http://efectococuyo.com/principales/al-menos-tres-fallecidos-deja-segundomegaapagon-en-los-hospitales-alerta-medicos-por-la-salud/ 10. PINEDA, Julett (March 29, 2019). “Fallece paciente en Hospital Central de San Cristóbal porque la planta eléctrica no respondió” (One Patient Dies at San Cristóbal’s Central Hospital Because the Power Generator Didn’t Work). Available at http://efectococuyo.com/salud/fallece-paciente-en-hospital-central-de-sancristobal-porque-la-planta-electrica-no-respondio/ 11. FERMINKANCEV, María Victoria (March 27, 2019). “Codevida condena silencio de nefrólogos ante crisis que sufren pacientes renales” (Codevida Condemns Silence of Nephrologists on Kidney Patient Crisis). Available at: http://efectococuyo.com/principales/codevida-condena-silencio-de-nefrologos-ante-crisis-que-sufrenpacientes-renales/ 12. PINEDA, Julett (March 28, 2019). “Durante primer megaapagón fallecieron 22 pacientes renales, según Sociedad de Nefrología” (Twenty-Two Kidney Patients Died during the First Mega Blackout, the Venezuelan Society of Nephrology Reports). Available at: http://efectococuyo.com/principales/durante-primer-megaapagonfallecieron-22-pacientes-renales-segun-sociedad-de-nefrologia/

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#CONVITEDENOUNCES Transplant Registry. In this manner, the Venezuelan Society of Nephrology broke its silence and refused to become an accomplice to the government’s wrongdoings.

The violation of the rights to health and life is aggravated by the acts and omissions of the Venezuelan State. The consequences of major power outages, which occur due to the incapacity, ineffectiveness and negligence of a criminal regime, seem endless.

It is not only the mega blackouts, which last several days, and the accompanying ‘aftershocks’ that are programmed to save energy; it is also the chain of ensuing events that affect the whole country: there is no water supply, there is a limited supply of gas in gas stations, the hospital crisis worsens, infectious and viral diseases spread —and there is no medication to fight them—, there is no cash, the industrial and commercial capacity of the country is reduced, public transportation is insufficient, and food becomes more scarce. The list of hardships that further deteriorate the current state of the country doesn’t cease to grow. If Venezuela were a sick person being evaluated by a physician, the prognosis would be “critical”, meaning that the patient is “in a critical condition and in extreme danger”.

Other Important March Events, Besides the Electric Emergency The Controversy over the Entry of Palestinian Physicians Within the framework of bilateral relations between the Maduro government and Palestine, a delegation of 15 Palestinian doctors was given entry to Venezuela. Their purpose is that they assist in surgical procedures in three hospitals in Caracas and one in Vargas.13 The delegation is made up of neurosurgeons, traumatologists, anesthesiologists and obstetrician-gynecologists.

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Twenty-six thousand one hundred and forty (26,140) Venezuelan doctors have left the country since 2004, driven by the meager salaries that they earn, the lack of tools and inputs to practice their profession with dignity and, in general, the political and socioeconomic crisis that is crippling the Venezuelan people.

The kernel of the matter with this cooperation visit is not precisely the origin or nationality of the medical staff.

Instead, many people ask: Why not seek international cooperation to improve the quality of life of the Venezuelan medical professional? Why not provide for a constant supply of equipment and material to the country’s healthcare network? Or, why not tackle several issues simultaneously? In other words: Is it possible to bring foreign professionals to add to the local workforce —whose needs must also be met— and at the same time exhaust all possible resources to recover the human capital that felt forced to emigrate?

Announcements about the arrival of personnel, medicines and miscellaneous supplies from abroad are inconsistent with the discursive line of Maduro’s regime. In addition to the arrival of medical staff from other countries, there

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is the technical assistance that has been offered by Russia through the Pan American Health Organization (PAHO) , an agency attached to the UNO. Since the latter, in turn, is an organization that provides assistance to countries

13. PINEDA, Julett (March 1, 2019). “Arriban a Venezuela médicos palestinos para operar en cuatro hospitales” (Palestinian Physicians Arrive in Venezuela to Perform Surgeries in Four Hospitals). Available at: http://efectococuyo.com/principales/arriban-a-venezuela-medicos-palestinos-para-operar-en-cuatro-hospitales/ 14. PINEDA, Julett (October 28, 2018). “Más de 26.000 médicos se han ido del país en los últimos 14 años según la FMV” (More than 26,000 Physicians Have Left The Country over the Last 14 Years, According to the Venezuelan Medical Federation). Available at: http://efectococuyo.com/principales/mas-26-mil-medicos-se-han-idopais-ultimos-14-anos-segun-fmv/ 15. PINEDA, Julett (March 1, 2019). “Aquí no ha llegado nada, denuncian en hospitales que recibirían medicamentos de Rusia” (We Have Received Nothing Here, Denounce Hospitals that Were to Receive Medications from Russia). Available at: http://efectococuyo.com/salud/aqui-no-ha-llegado-nada-denuncian-en-hospitalesque-recibirian-medicinas-de-rusia/

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#CONVITEDENOUNCES that experience serious difficulties, including those with serious difficulties stemming from their precarious health and hospital systems, it is evident that the regime does recognize (albeit veiledly) the existence of an humanitarian emergency, but that it places conditions on what aid to receive and authorizes the entry of what it considers convenient and from whoever it considers best (the more aligned with its political idiosyncrasy, the better).

Meanwhile, in the Metropolitan Area of Caracas 16

On March 11, the medical staff of the Miguel Perez Carreño Hospital went on an active strike , stating that they would only treat emergencies. This form of protest was not only triggered by the utterly poor state of Venezuela’s healthcare facilities: this time, the step was taken after the dismissal without cause of Neomar Balza, a member of the hospital’s resident staff, who was beaten out of the facilities only because he dared to denounce the crisis that the Perez Carreño is going through.

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On Wednesday, March 13, the medical staff of the J. M. de Los Ríos hospital issued a communication denouncing the acts of aggression and intimidation to which they are constantly subjected and expressing their support to their counterparts in the Pérez Carreño Hospital in their defense of their colleague who had been abused and fired without cause just for raising his voice.

The president of the Venezuelan Medical Federation, Douglas León Natera, condemned the “permanent and 18

continuing aggression” against the country’s healthcare workers, which aggression comes —in most cases— from the hospital directors themselves who, for their part, carry out orders from the high government.

Doctors are not breaking the law, disrespecting the authority or bypassing the regular channels to demand that their concerns or needs be met: they are just asking to be allowed to practice their profession with dignity, including safety for the staff, patients and caregivers alike, and the efficient provision of medical supplies, food and utility services to ensure the operation of all healthcare centers in the country.

In Mérida, the Observatory for Human Rights of Universidad de Los Ándes Makes Its Voice Heard The Observatory for Human Rights of the Universidad de los Andes denounced the deplorable state of the 19

facilities of the Los Ándes University Hospital Autonomous Institute (Iahula), which is located in the state of Mérida.

The list is seemingly endless and includes the closure of 18 medical services, the lack of equipment and supplies, the shortage of medicines, the lack of personnel, long lists of patients waiting for surgery, the deterioration of the hospital’s infrastructure, and the existence of a contamination hazard from the accumulation of uncollected waste (biological, toxic and organic). Not only is its users’ right to health infringed; it is also the occupational safety of its medical, administrative and labor personnel due to the unsuitable conditions in which they have to work.

16. GARCIA, Cristofer (March 11, 2019). “Hospital Pérez Carreño se va a paro indefinido y sector salud se reúnen para organizarse” (Pérez Carreño Hospital to Go to Indefinite Strike While the Health Sector Meets to Organize). Available at: http://efectococuyo.com/salud/hospital-perez-carreno-se-va-a-paro-indefinido-y-sectorsalud-se-reunen-para-organizarse/ 17. PINEDA, Julett (March 13, 2019). “Médicos del J.M. de los Ríos denuncian amedrentamiento y agresiones sistemáticas” (J. M. de Los Ríos Hospital Physicians Denounce Systematic Harassment and Aggressions). Available at: http://efectococuyo.com/principales/medicos-del-j-m-de-los-rios-denuncian-amedrentamiento-yagresiones-sistematicas 18. PINEDA, Julett (March 22, 2019). “Trabajadores de la salud en la mira mientras crisis en los hospitales se agrava” (Health Workers Targeted as Hospital Crisis Aggravates). Available at: http://efectococuyo.com/salud/trabajadores-de-la-salud-en-la-mira-mientras-crisis-en-los-hospitales-se-agrava/ 19. GONZALEZ, Isaac (March 5, 2019). “En el Hospital Iahula de Mérida no funcionan 18 servicios médicos”. (Eighteen Inoperative Services at Mérida’s Iahula Hospital).

Available at: http://efectococuyo.com/la-humanidad/en-el-hospital-iahula-de-merida-no-funcionan-18-servicios/

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#CONVITEDENOUNCES Too Little Too Late, Rotondaro While the visit of the technical commission of the office of the UN High Commissioner for Human Rights was at the center of the public debate, a former official of the ruling party appeared out of the blue with information on acts of political discrimination that had been committed against thousands of Venezuelans. It was the former president of the Venezuelan Institute of Social Security (IVSS), Carlos Rotondaro, who denounced that “some 5,000 patients with kidney disease died in the country because the government of Nicolas Maduro hid the treatments for political reasons.”

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Many wonder how it is possible that a person who performed for 10 years as the head of the IVSS waited so long to publicly declare on the diversion of the resources and medicines that they received at the State-managed agency.

Rotondaro claims that he always denounced the irregularities committed and that he was never involved in acts of corruption, thereby dismissing accusations from the National Assembly (AN) that he embezzled more than 100 million dollars through the IVSS. Protection Measures of the Inter-American Commission on Human Rights (IACHR) The Inter-American Commission on Human Rights (IACHR) granted the request made by Women’s Link Worldwide, an international organization, along with the Venezuelan NGO Center for Justice and Peace (Cepaz), Mujeres en Línea, Avesa, and Freyay Red Equivalencias en Acción.

The IACHR issued precautionary measures to the Concepción Palacios Maternity Hospital, a hospital complex that has been so severely affected by the health system crisis that it is currently working at half capacity due to the lack of medical supplies, medicines, hygiene and cleaning products, medical specialists, and to deficiencies in the electric power and water supply services, thereby putting the lives of pregnant women and newborn children at risk.

The Venezuelan State must comply, from the moment they are granted, with the following protection measures issued in Resolution No. 13 dated March 18, 2019:

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Ensure the provision of adequate medical supplies, medication and medical services to effectively handle emergencies related to women’s sexual and reproductive health (among others, by coordinating appropriate referral mechanisms among various healthcare facilities); Ensure that efforts to protect and grant access to maternal health and any services aimed at beneficiaries’ medical needs incorporate a gender perspective; Ensure the provision of nutrition programs and adequate medical check-ups prior to a pregnancy, during that pregnancy and in the period after childbirth, both for the relevant women and for their newborns; Ensure that beneficiaries are held in adequately sanitary conditions and that facilities have sufficient means— including medical staff, infrastructure, electricity and water—to assist them, in compliance with the applicable standards.

20. PINEDA, Julett (March 18, 2019). “Casi 5 mil pacientes renales han fallecido desde 2017, confirma expresidente del Ivss” (Almost 5,000 Kidney Patients Have Died Since 2017, Confirms the Former President of the IVSS). Available at http://efectococuyo.com/principales/casi-5-mil-pacientes-renales-han-fallecido-desde-2017confirma-expresidente-del-ivss/ 21. Comisión Interamericana de Derechos Humanos. Resolución 13 /2019, Medida cautelar No. 150-19, “Hospital Maternidad Concepción Palacios respecto a Venezuela”, 18 de marzo de 2019. (Inter American Commission for Human Rights. Resolution 13/2019, Precautionary Measure No. 150-19, “Concepción Palacios” Maternity Hospital in Venezuela). Available at: https://cepaz.org.ve/wp-content/uploads/2019/03/resolucion-cidh.pdf

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#CONVITEDENOUNCES Visit of the Technical Commission of the United Nations High Commissioner for Human Rights Put the Venezuelan Government under Pressure Just a few days into the “mega blackout”, health workers continued to denounce the situation of their sector and 22

invited the technical commission sent by the UN High Commissioner for Human Rights to visit the J. M. de Los Ríos Hospital and not the hospitals that had been previously staged by the government, such as the ‘Antonio María Pineda’ Central University Hospital in Valencia, state of Carabobo, whose infrastructure had been repaired and 23

stocked with medicines and supplies in sort of an operation blitz.

To the government’s misfortune, the members of the technical commission of the UN OHCHR did not arrive in the country uninformed because they had been receiving for some time innumerable reports from different Venezuelan human rights organizations, union leaders and the staff of the country’s health sector.

In addition to having a preliminary diagnosis of the situation, the commission was able to verify firsthand the reality in their visits —despite the efforts made by the government agencies to quickly refurbish the places where a visit had been scheduled— and in meetings they held with leaders and nongovernmental organizations, who insisted 24

that what we have in Venezuela is indeed a complex humanitarian emergency and not a mere episodic crisis.

No amount of express makeup can cover up the crisis that engulfs and suffocates all healthcare centers at the national level. Efforts by the government to conceal the reality in Venezuelan will never succeed as long as there are citizens committed to doing their job, supporting the unassisted or the most vulnerable, and willing —despite the risks involved— to denounce the systematic violation of human rights.

“I am deeply concerned by the magnitude and gravity of the human rights impact of Venezuela’s current crisis...”

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This is how the UN High Commissioner for Human Rights, Michelle Bachelet, began her oral update report on the human rights situation in the Bolivarian Republic of Venezuela on March 20, 2019.

From the last report, which was published in June of 2018, the situation in Venezuela has been deteriorating, affecting the most vulnerable sectors of the population: children, pregnant women, the elderly and the indigenous peoples.

Statements by the High Commissioner included:

22. PINEDA, Julett (March 14, 2019). “Gremio de la salud insta a comisión de la ONU a visitar hospitales, pero no a los maquillados”. (Health Unions Urge UN Commission to Visit Hospitals, But Not the Staged Ones). Available at: http://efectococuyo.com/salud/gremio-de-la-salud-insta-a-comision-de-la-onu-a-visitar-hospitales-pero-noa-los-maquillados/ 23. ROMERO, Tibisay (March 14, 2019). “En Valencia las madres de pacientes clamaron ayuda a Misión de la ONU”. (In Valencia, Mothers of Patients Claimed the UN Mission for Help). Available at: http://elestimulo.com/blog/en-valencia-las-madres-de-pacientes-clamaron-ayuda-a-mision-de-la-onu/ 24. RODRIGUEZ, Ronny (March 21, 2019). “Huniades Urbina: La comisión de Bachelet sabe que en Venezuela pasa algo grave” (Huniades Urbina: Bachelet’s Commission Knows that Something Serious is Going On In Venezuela). Available at http://efectococuyo.com/principales/huniades-urbina-la-comision-de-bachelet-sabe-que-envenezuela-pasa-algo-grave-conlaluz/ 25. CEPAZ (March 20, 2019). Publicación del “Informe oral de actualización sobre la situación de derechos humanos en la República Bolivariana de Venezuela.

Declaración de la Alta Comisionada de las Naciones Unidas para los Derechos Humanos, Michelle Bachelet”. (Publication of the “Oral Update Reporto n the Situation of Humar Rights in the Bolivarian Republic of Venezuela. Statement by Michelle Bachelet, UN High Commissioner for Human Rights). Available at https://cepaz. org.ve/documentos_informes/informe-oral-de-actualizacion-sobre-la-situacion-de-derechos-humanos-en-la-republica-bolivariana-de-venezuela-declaracion-de-laalta-comisionada-de-las-naciones-unidas-para-los-derechos-humanos-mich/

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#CONVITEDENOUNCES -The extent and severity of the crises have not been fully acknowledged by the authorities; -The current situation has been exacerbated by the blackouts, the extent of whose damages remains unknown, and people continue to be adversely affected by the constant interruption in the provision of other utility services; -The health system and the educational system continue to deteriorate; -The room for the exercise of democracy has been reduced as a result of the criminalization of protest and dissent; -Human rights have been violated by State security forces and pro-government armed groups; -There have been reports of extrajudicial executions allegedly attributable to the police’s Special Action Forces (FAES): 25 in 2018 and 39 in January of 2019; -Restrictions on freedom of expression and on the right to information in Venezuela have continued to increase, as have the arbitrary use of the Law against Hatred, which was adopted in November 2017, solely for the purpose of prosecuting anyone who express a dissenting opinion; -A massive exodus of Venezuelans, most with urgent humanitarian needs.

Mme. Bachelet ends her report by making the following demand: “I call on the authorities to take steps to demonstrate their real commitment to addressing the many challenging issues reported across the country. And I want to emphasize the continuing commitment of the Office to work with all relevant stakeholders in their efforts to improve the human rights situation in Venezuela.”

In addition to Michelle Bachelet’s statements on March 21, experts from the UN issue a communication where 26

they “condemn widespread rights violations reported during protests”. They voice their concern for the acts of repression, arbitrary detentions, killings and torture during Venezuelans protests between January and February of 2019, who were just exercising their legitimate right to peaceful assembly to make their concerns heard and their needs met.

They end their communication by stating as follows: “We call upon the Venezuelan authorities to conduct an immediate, impartial and effective investigation into all deaths which have occurred during the ongoing protests, and to release all of those who have been detained for legitimately exercising their human rights to freedom of expression and peaceful assembly.” “We urge the Government to take immediate measures to remedy the situation, including by allowing critical and dissenting voices to be heard in Venezuela, without fear of retaliation, threats, violence or other harassment.”

The OAS issues yet another Statement on Venezuela, this time demanding for the entry of humanitarian aid.

On Wednesday, March 27, the Organization of American States (OAS) passed a resolution whereby it urges the government of Nicolás Maduro, and especially the military and law enforcement authorities, to allow the entry of humanitarian aid into Venezuela.

The resolution was approved as follows: of the 35 members of the organization, 19 voted in favor, 5 voted against, 8 abstained, and 2 didn’t take part in the process because they were absent at the time of the voting. Venezuela’s

26. CEPAZ (March 21, 2019). “Venezuela: expertos de la ONU condenan violaciones generalizadas de derechos humanos denunciadas durante protestas”.

(Venezuela: UN Experts Condemn Widespread Violations of Human Rights during Protests, as Denounced). Available at: https://cepaz.org.ve/documentos_informes/ venezuela-expertos-de-la-onu-condenan-violaciones-generalizadas-de-derechos-humanos-denunciadas-durante-protestas/

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#CONVITEDENOUNCES representative to the OAS, Jhon Guerra, insists that the decision is nothing more than a pretext to “justify a foreign 27

military intervention.”

Unfortunately, Guerra failed to explain, as did other officials, the truth behind the presence in the country since Sunday, March 24, of two Russian military planes that allegedly transported military personnel and unidentified equipment. According to the government, the Russians presence is no indication of foreign occupation or interference, but for most neighboring nations it does pose an imminent danger that transcends Venezuelan borders and puts the entire Latin American region at risk.

On the other hand, the Red Cross issued a statement on March 29 where it assumed the responsibility of managing 28

the entry of humanitarian aid into the country , a decision that has no connection with the OAS resolution and is separated from the actions promoted by interim president Juan Guaidó.

Francisco Rocca, president of the Red Cross, claims to have been authorized access by the national executive in meetings whose details he didn’t disclose. Rocca insisted that the process will be conducted under the principles of impartiality and neutrality. The humanitarian aid proposed by the Red Cross is intended to meet the needs of just a sector of the population (650,000 of the country’s most vulnerable people) and only in the health area.

All the aid that has been authorized into Venezuela comes from funds approved by the International Red Cross Committee, but resources from other organizations, the private sector, other states and the civil society could add thereto. The entry of power generators, medical equipment for diagnosis, surgical kits, medicines, and other supplies for 12 hospitals in the public health network is expected, and the recipient selection criteria will be based on their location, number of beds, specialties, number of staff members with postgraduate studies and on whether or not they are considered to be a medical reference in their regions. It will have the support of over 2,500 volunteers amongst their own to start operations within 20 days.

Nicolás Maduro’s regime is expected to comply with what was allegedly agreed with the international organization and refrain from hindering operations by trying to interfere and politicize the entry of humanitarian aid.

27. EFECTO COCUYO (March 27, 2019). “OEA aprueba resolución para exigir ingreso a la ayuda humanitaria al país” (OAS Passes Resolution to Demant Access of Humanitarian Entry into the Country). Available at: http://efectococuyo.com/internacionales/oea-aprueba-resolucion-para-exigir-ingreso-de-la-ayudahumanitaria-al-pais/ 28. PINEDA, Julett (March 29, 2019). “Los riesgos, el ingreso y el alcance: 13 claves de la ayuda humanitaria de la Cruz Roja” (Risks, Entry and Scope: 13 Keys to Red Cross Humanitarian Aid). Available at: http://efectococuyo.com/principales/los-riesgos-el-ingreso-y-el-alcance-13-claves-de-la-ayuda-humanitaria-de-la-cruz-roja/

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