Little Joniel Briceño is much too small and too light for life. He's eight months old and weighs 5 kilograms (11 pounds), little more than many newborns. His mother has carried him here from their small village. It involved two hours of walking to the bus stop with her son in her arm and then a two-hour ride with the bus. Now, Joniel is here, in bed number two, under a Donald Duck decal that someone adhered to the wall.
Joniel isn't the only kid with an emaciated face, swollen legs and distended belly in the emergency room of the children's department of the Dr. Luis Razetti de Barcelona University Hospital in Barcelona, a large city located about 300 kilometers (200 miles) east of the capital of Caracas. The doctors and nurses call the department "Africa." Nowhere is the desperate situation the country finds itself in more clearly visible than in its hospitals.
Venezuela, the country with the largest known oil reserves in the world, is bankrupt. It once was one of the richest nations on the continent, but now the people are starving, especially in the interior of the country. The economy collapsed in 2014, and now there are regular protests and riots because stores lack food and everyday items like toilet paper and detergent. Armed guards stand at the entryways of supermarkets, and the annual inflation rate of 42,000 percent is eating up people's incomes. The poor are starving, the weak and the sick are dying, youths are joining criminal gangs. Anyone who can afford to is leaving the country.
An Existential Crisis
Former president Hugo Chavez, who died in 2013, once made himself popular with the poor by using oil income to finance social programs. The state oil company, however, didn't have enough money for investment. Corruption and mismanagement thrived. Under Chavez's successor, Nicolas Maduro, the country fell into an existential crisis.
The government provides little money to the hospitals, but won't allow any aid into the country either. Doing so would make it clear that Maduro's autocratic government has failed. According to UNICEF, 15 percent of all children in Venezuela are undernourished.
Several of the worst cases come here, to the Razetti university hospital in Barcelona, with 10 beds in the children's emergency ward. Up to three children are kept in some beds. There are dead cockroaches on the floor, and at night a cat saunters through the rundown rooms, which lack everything -- blood glucose test strips, nutrient solutions, antibiotics and anesthetics.
In earlier days, the hospital had been an exemplary clinic, responsible for the entire eastern part of the country. Patients even come here from the Amazon region and the capital. The main building is nine stories high, an imposing red brick structure. "Africa" is located next door, in the children's hospital. Every day, a dozen children are brought here, and one child dies almost daily. It's here where little Jionel is now fighting for his life.
His mother, Yeriyoli Pérez, 25, a young woman with eyes that make her look much older and who weighs 39 kilograms (85 pounds) after losing 16 kilograms in the last six months, stands next to his bed. Her T-shirt flaps around her gaunt body. She mostly feeds herself and her son with corn. Her breastmilk has run dry. "We eat what we can get," she says quietly. The doctors have recommended meat and milk products, but who can afford them?
Pérez only has 1 million bolívars per month at her disposal, the equivalent of one euro. She has no work and no money for anything, including baby food. One can of it costs 2 million bolívars -- that is, if you can even find it in the supermarket in the first place.
A Clinic That Lacks Everything
They haven't had any baby formula at Razetti university hospital since January. Sometimes the doctors have even bought food for the patients, one nurse says. "But they barely earn anything themselves," she says. So, there's little they can do for Joniel other than hope. And fan away the flies circling above him with a piece of cardboard.
There is nothing left at Razetti university hospital -- no medication, no toilet paper, no diapers, nothing for cleaning or disinfecting, no bed linens, not even a pen and paper for the doctors. Loose cables hang from the ceiling in the bathroom, the color is crumbling from the wall, there hasn't been any water for washing hands for weeks. The X-ray machine is broken, oxygen for the respirators is lacking and the air conditioning can't be operated. The intensive care unit is out of commission, just like the operating room, because of missing instruments and equipment. Only a monitor that communicates the most important vital signs still works, quietly peeping. One last sign of civilization.
In the bed next to Joniel there are two twins thrashing about, one month old, who have been here for two weeks with diarrhea and vomiting. They need blood transfusions, but there are no blood reserves and the lab has been closed for months. Their mother could theoretically buy blood at a private hospital, but where would she get the money?
A Dramatic Increase in Child Mortality
The child mortality rate in the country has risen dramatically in the past few years. The government is trying to cover up the crisis and has been keeping most of the health statistics secret for years. The most recent annual figures publicly released by the Health Ministry, from 2015, show that the mortality rate for children under the age of four weeks had increased by 100 percent in three years -- from 0.02 percent in 2012 to more than 2 percent. In early May of last year, the Health Ministry suddenly released reports showing that the deaths among children under 12 months had risen by almost one-third within one year, to 11,446. Since then, the economic crisis has only gotten much worse.
"The children are dying because corrupt government officials steal or misappropriate the money earmarked for the hospitals," says Oscar Navas, a doctor. He's 28 years old, and wears a five-o'clock shadow and a blue smock. He's actually still in the middle of his training to become an orthopedist, but he's working the same shifts as everyone else because of the shortage of doctors. He's been on duty since the morning and, at nighttime, he will be responsible for the entire hospital. These days, weeks and months, though, his work doesn't go far beyond managing the lack of supplies.
"We're having to look on as patients die because we can't treat them," says Navas, who is the son of a gynecologist and the grandson of an internist, both of whom told him not to study medicine. They said he should go abroad, but he stayed.
Over 60 patients are lying or sitting in the corridor of the emergency room in the main building, and each day the numbers are growing. Before, only poor people came into the state-run hospitals, but now the patients come from all social strata. A single nurse is working, and the place smells of urine and vomit. Because the elevators are broken, many of the sick wait for hours for someone to carry them up the stairs to the wards, but there are no cots available there. Instead, there are handwritten notes on the walls:
"There are no supplies."
"There is no medication."
"There is no blood."
There also aren't enough doctors or nurses. Hundreds of hospital employees have left the country. "Anyone who leaves is supporting the dictatorship," says Oscar Navas. "The people need us here." He walks tirelessly between patients, who ask him questions: When will I finally get my operation? When will I be able to walk again? He answers each of them patiently, and strokes some of them on the head. "Affection is the only thing we can give our patients," he says.
A Hard Life for Doctors
Navas is wearing running shoes, jeans and a T-shirt. His smock is smeared with blood. In earlier times, the doctors wore white shirts and ties, but they don't have any money for that anymore. The doctors are also suffering under the hyperinflation. Navas earns the equivalent of 2 euros per month, and he doubles that by working night shifts. But the bus ride to the hospital alone is eating up his earnings.
Navas' girlfriend is an architect. Her parents live in the United States and provide the couple with financial assistance, which has become a necessity. "Every doctor needs a sponsor, because he can't live from his work," he says. He pokes around in a plastic container with rice and beans, his lunch. A sandwich at the fast-food joint in front of the hospital would cost about one-third of his monthly salary. Most of the time, Navas doesn't eat until he gets home. "I don't have an appetite in the hospital, because I'm seeing the patients die of hunger." Some doctors, he says, work 48 hours without eating anything.
Navas wants to provide a tour of the entire hospital, but there are militiamen in olive-green uniforms posted at the entrance, sent there by the government in order to keep out any undesired visitors, like journalists. "There are more militiamen here than doctors," Navas whispers, covering his mouth with his hand.
One of the men blocks the path of Navas and the DER SPIEGEL journalist. His breath smells of alcohol. Navas speaks to him: "You also have family members who sometimes need to go to the hospital, right? I want to show the world what is really happening here, so that something finally happens." The militiamen call their commander, who speaks with the doctor and then the armed men cede the way.
The article you are reading originally appeared in German in issue 30/2018 (July 21st, 2018) of DER SPIEGEL.
Navas climbs a dark, half-rundown staircase to the ninth floor, the newborn ward. On the way, he points to an abandoned hallway: "This was the coronary care unit. We had to shut it down. The cardiologists all left the country." Premature babies are dozing in the three functioning incubators. The hoses leading into the machines are attached with tape. A note hangs on one of the boxes: "Dayana, b. 29.3.30. Week of pregnancy, 45 cm, 1,700 grams. Abandoned by mother." The child was born by caesarian section, but the mother then left the hospital and disappeared. Now the baby receives milk from another breastfeeding mother once a week, always on Fridays. But it's not enough. Dayana needs formula, "otherwise she will die," says a nurse who is taking care of the newborn.
The next morning, Navas explains that his nightshift went as usual. He says there were two new arrivals. A severely undernourished child was brought in, dead on arrival. "Otherwise, it was calm," he says, and begins his morning visit to the accident ward. A doctor needs to be creative in Venezuela. Navas shows how he has stabilized the leg and pelvis of an injured man with a construction made of metal pipes and thread, and how he perforated a shin bone with a borrowed drill from a home-hardware store.
"For a year now, we've been seeing a lot of patients who fell from trees because they were picking mangos or coconuts in order to quell their hunger," Navas says. He places a piece of cardboard between a boy's teeth. He needs to set the boy's broken leg, and there is no anesthetic available. He starts, the boy bites down on the cardboard, and lets out muffled cries because of the pain.
Treatment Without Anesthetic
Navas treats young Erick Guevara, 24, lying next to the door, last. "How's it going, champ?" the doctor asks. No patient, he says, is as stoic as Guevara. When Navas sets his broken leg, Guevara doesn't place the piece of wood between his teeth, even though beads of sweat appear on his forehead because of the pain.
The patient actually wanted to leave the country because of the crisis, and had a bus ticket to Chile in his pocket. Three days before his departure, he was seriously injured in a car accident: A triple fracture of his pelvis, and his left foot was removed. Because they couldn't treat him in the local hospital, they sent him to Barcelona three hours away. When the ambulance arrived, the doctor realized that something was missing: the foot.
Navas called the hospital in El Tigre and asked where the patient's foot was. One of the employees answered that it had been incinerated, because the cold storage had failed. "If they had cooled the foot and brought it here, we might have been able to reattach it," says Navas. Now, he says, they can only treat the stump. They operated on the pelvis using local anesthetic, with a hammer and some thread. He hopes it will grow back together. "We would like to operate the break, but we don't have the supplies." If Guevara is operated on some day, he would initially need to use a wheelchair. Later, he would be able to walk using crutches, and with some luck he would later be able to obtain a prosthesis.
Navas finishes his rounds, having visited 48 patients in a single day. It's noon, and his shift should theoretically be over in an hour, but he still needs to do his charts. He has created a file for every patient. He sits in the doctor's room and takes note of the state of his patients in pencil on the back of used pieces of paper. The only computer is broken and the printer has no ink. He keeps the pieces of paper with writing in an old-fashioned hanging file rack.
A growing number of assaults are taking place, because patients feel poorly treated. Recently, a mother went off on a doctor because she lost her baby -- the doctors had had to induce a miscarriage.
But the doctors are suffering as much under the extreme conditions as the patients. Recently, a doctor was attacked on hospital grounds by a gang member wielding a knife. "We couldn't even do an X-ray of our colleague," Navas says, "because not a single machine worked."
When hospital staff speak publicly about the conditions, the government responds with repression. In Caracas, a "colectivo," as gangs loyal to Marudo are called, stormed a hospital because doctors and nurses had called for protests. "If he doesn't want help from the West, Maduro could at least ask Russia or China for medication and medical equipment," says Navas. "Instead, he is simply denying the suffering."
A Grim Political Outlook
Navas is the president of Venezuela's association of resident doctors and works on health policy. He doesn't hide the fact that he does not support the president. Several of his friends are in jail for being part of the opposition.
Like almost all opposition supporters, Navas boycotted the presidential election in May. "Every vote strengthens the dictator," he says. Almost two-thirds of potential voters stayed away from the polling stations that day, according to independent observers. The election's legitimacy is only recognized internationally by states like China, Cuba, North Korea and Russia.
Unlike his predecessor Chavez, Madura isn't popular. He is compensating for his lack of support among the populace by becoming increasingly authoritarian. The most important opposition politicians are in exile or in jail.
And so, with the disputed May election, the country presumably missed its last chance for a democratic course correction. But as long as the army remains loyal to him, Madura has little to fear, despite his starving population. He has now officially been re-elected until 2024, and is trying to simply ignore the catastrophic state of the population.
A few days after the election, the deputy health minister claimed that there was enough medication for the hospitals. But in Barcelona, none of it has arrived. Dayana, the little girl in the incubator, is now doing better, because an aunt had a baby and is now nursing both of them.
Erick Guevara, the young man who lost his foot, is still waiting for his operation. He says he now no longer wants to become an engineer, but a doctor. "I owe that to Dr. Navas and his colleagues. What they are doing here is almost magic."
Joniel, the baby in the emergency room, died of malnourishment the day after the presidential election.