Venezuela: violence, human rights, and health-care realities

Ewan Robertson’s recent World Report outlines the pressure on the Venezuelan health services exerted by the social unrest that our country is experiencing. However, the report fails to grasp the reality of the sociopolitical situation as well as that of our health system. The report states that the roots of the troubles lie in a radical wing of the Venezuelan opposition, but omits to mention that most of the deaths have been caused by governmentarmed individuals, so-called colectivos, trained and contracted to intimidate the population. Moreover, the brutal and violent response of the National Guard against peaceful students and demonstrators has fuelled anger internally and externally—human rights abuses, including torture against dissidents, have been reported. The conditions of the Venezuelan health system are deplorable. We expected a more objective perspective from The Lancet. We previously contacted The Lancet, without success, to request verifi cation of Venezuelan data included in Frenk and colleagues’ report. Nowadays, what the country is enduring is very diff erent from the picture given in Robertson’s report. It is worse, by far. First, most of the units of the Venezuelan health mission Barrio Adentro (a parallel health delivery programme) have been abandoned or are currently not functioning. Second, supplies in public hospitals are at a minimum since the government ceased to honour its debts to pharmaceuticals manufacturers and other providers of medical material and equipment. Third, regarding medical training and education, the conventional 6-year programme has been under continuous attack from the government who is restricting facilities and funding, while a short parallel programme supervised by Cuban authorities to train so-called community medical doctors is thriving with official support. Harassment against dedicated, well-educated health professionals is fuelling a brain drain of talented professionals. Venezuelan physicians and medical staff do not feel respected by the President and the Ministers of Health and Education, and their salaries and opportunities are low, which contrast with those of the Cuban personnel. Perhaps what illustrates best the profound crisis in the Venezuelan public health sector (in addition to well known failures in the control of diseases such as malaria and dengue that are linked to inefficient health services delivery) is that in the past 15 years the government has been incapable of implementing a coherent plan to address the health needs of its people.