Colombia

"My name is Fredy Flores, I am 62 years old and I have been living in Tibú for a year and a half.  I had many skills: I was a painter, a mason and a driver. But then I had the accident and could no longer get a job. Then one of my sons, who was already in Venezuela, told me to come, and here I am. It hasn’t been easy. I live in a ranch that I take care of, and I eat in the neighbourhood canteen for migrants. I came to MSF to seek treatment for an allergy that I get when it’s hot. They treated me very well and they are even looking for a way to get me a prosthesis. I wish that I could be given the miracle to be able to return to work.”

Fredy Flores, above, is one of the Venezuelan migrants facing numerous barriers to accessing health services in Norte de Santander, Arauca and La Guajira regions. While in theory people are guaranteed access to vaccinations, safe child birth and emergency care, the medical needs of this group are too large for the Colombian system to meet them. These are some of the stories from that unattended crisis.

According to the UN Refugee Agency, nearly three million Venezuelans have fled their country in recent years because of the economic and political crisis. Around 1.5 million have crossed the border to Colombia, with 600,000 settling in the border departments of La Guajira, Norte de Santander and Arauca.

For them, life in these places is not easy. There is a lack of stable employment opportunities and living conditions are poor, with thousands living without access to drinking water and sewerage systems. Added to this is the difficulty of reaching health services, beyond emergencies, deliveries and vaccinations.

Lack of food forces a family to leave

"It was on the third day of eating only mangoes that Poellis Córdoba and her husband realised that it was time to flee Venezuela. After enduring several months of food shortages, which they rationed strictly so that their three small children had something to eat every day, they decided they had to leave the country to survive.

"My husband made a good living as a bricklayer and we lived relatively comfortably. But little by little the situation has worsened to the point that we only had enough money to buy sardines and cornmeal. I remember that in the end we only had enough to feed our children. Then we couldn’t even get that and it was then that my husband arrived with a suitcase full of mangoes. When they were finished, we finally understood that we could not take it anymore," explains Poellis.

"Life here has not been easy"

First, her husband travelled to meet some of his brothers who had migrated a few months earlier to Tibú, a Colombian border town in the regions of Norte de Santander. Seven months later Poellis arrived with her five-year-old son. And it took another year for them to bring their two older children, aged seven and nine. Today, the whole family lives in the informal settlement of Divino Niño, a collection of houses with wooden floors, polyethylene walls and zinc roofs, where Venezuelan migrants who cannot pay rent end up.

"Life here has not been easy," says Poellis. "Sometimes it is really hard for us but at least food is not lacking for the children," she adds. The poor living conditions and the risk of not getting food are just two of the challenges that Poellis and her family face. Recently, her youngest child developed a small inflammation in his stomach. "As it did not seem serious I decided to take him to the Médecins Sans Frontières clinic because they do not treat Venezuelans in the hospital here unless it is an emergency," she explains.

In the border regions of La Guajira, Norte de Santander and Arauca, state-run medical services are not open to Venezuelan migrants, except for emergencies, vaccinations and child birth. As a result of this, between November 2018 and May 2019, over 12,000 Venezuelans used the primary healthcare and mental health services provided by Médecins Sans Frontières/Doctors Without Borders (MSF). Is the case of Marilyn Díaz, who crossed from Venezuela to Tibú a year ago and gave birth to her second daughter a few days ago at a local hospital. After being discharged, she realised she had to go to MSF for drugs and postnatal consultation.

Among the migrant community, women and children are particularly vulnerable to the lack of access to health services. Between November and May, nearly 40 percent of patients see at the MSF clinics were under five years of age and teams conducted almost 2,500 prenatal care and more than 4,600 family planning consultations. The most frequent health concerns in Venezuelans treated by MSF are skin allergies, respiratory and urinary infections and gynaecological conditions. In children under 14, the most common problems were related to diarrhoea and intestinal parasites.

In addition, almost 1,000 people have received mental health consultation. The main symptoms found are anxiety and depression caused by the conditions of migration, difficulties in finding work and family separations.

"The lack of access to basic and specialised health services for Venezuelans in Colombia is a health crisis that needs more attention from the international community," says Ellen Rymshaw, MSF head of mission in Colombia. "The medical needs of this population have overwhelmed the Colombian health system, which at this time does not have the resources or personnel to attend to them. Due to these limitations, many migrant patients have not been able to receive timely attention in hospital emergency rooms, despite being entitled to this by law.”

“We are calling for greater involvement from the international community to facilitate humanitarian assistance and improve access to healthcare for the Venezuelan population through direct support to hospitals. This is a crisis that urgently needs to be addressed," Rymshaw adds.

It is not only the 350,000 Venezuelans who, according to official calculations, reside in these three border regions that require medical services. They are joined by the thousands of people who cross the border every day in search of medical care and medicines, in many cases for diseases that are not considered emergencies, but that require strict treatment which they cannot get inside Venezuela.

Yamileth Gómez travelled more than four hours to reach Colombia from Seboruco, in Táchira state (Venezuela), in search of treatment for hyperthyroidism, which she was diagnosed with in January. "In Venezuela the medicine I need is not available and here it costs me more than what I can afford at the moment. I even had to come asking for a ride because I did not have money for a bus ticket," she says.

Yamileth used to be a teacher but she had to stop working because of voice problems in addition to other symptoms such as headaches, tachycardia, vomiting and diarrhoea. "MSF will help with the medication. I hope to get it so that I can return to a normal life."

The stories of Poellis, Marilyn and Yamileth show the challenges that Venezuelan migrants are forced live through on the Colombian border. After fleeing the crisis in their country that made scarcity routine, they arrived in a country that does not offer them opportunities for safe housing, work or comprehensive healthcare. The limitations imposed by the public health system and the economic vulnerability in which migrants live make access to medical care a distant and uncertain possibility that puts people’s well-being on hold.