When Juan Guaido raised his nation’s tricolour flag in January and swore himself in as interim president to the rapturous cheers of thousands in Caracas, many hoped – and believed – President Nicolas Maduro was finally on his way out.

A long-fractured opposition had reorganised, mass protests returned to the capital, and within minutes the US – followed by 50 other nations – officially recognised the national assembly head as the country’s legitimate leader.

The successor of Hugo Chavez’s failed socialist project, Maduro had long been in the White House’s diplomatic crosshairs. The country’s economy was now collapsing and an international consensus was forming that his latest elections were fraudulent.

“Both the Venezuelan opposition and the US government thought this was going to be a quick win,” says David Smilde, a Venezuela expert and senior fellow at the Washington Office on Latin America.

But seven months on, political change has proved more elusive: despite the US’s best efforts to pressure Maduro with bellicose rhetoric and waves of economic sanctions, the embattled leader holds on to power.

In crisis-hit Venezuela, terminally ill children struggle for survival Show all 22 1 /22 In crisis-hit Venezuela, terminally ill children struggle for survival In crisis-hit Venezuela, terminally ill children struggle for survival Yelitza Parra poses with her 7-year-old son Alyeiner Moises in Caracas, Venezuela. Alyeiner has been diagnosed with severe bone marrow aplasia and needs constant treatment and transplants, especially of platelets. Derived from his low defenses, he also suffers from Hepatitis C and Cushing's syndrome Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Alyeiner was diagnosed at the age of four after routine exams at school. "I had to buy the needles to do the hematology for my son," Yelitza said. She wants the government to pay more attention to the precarious situation of children with terminal illnesses Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Ines Zarza poses with her 7-year-old daughter Maria Elena. Maria Elena was diagnosed with severe sickle cell disease after a cerebrovascular accident in 2016 Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Maria Elena has to take medicine, which Ines usually gets through donations. They need $2,600 for another test. "I don't even have money to eat, where I am going to find that amount?" Ines says Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Rosa Colina poses with her 17-year-old daughter Cristina. Cristina has been diagnosed with major thalassemia, systemic lupus erythematosus and Hepatitis C Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival "It is not easy to stand the criticism of people on the street," Cristina says. "In December last year we were walking and a group of young people approached. I heard one say to the other: 'Look, she has AIDS'. That was devastating for me because I don't have AIDS and I'm not going to give it to anyone," Cristina said Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Jacqueline Sulbarn poses with her 10-year-old son Carlos. Carlos is a survivor of acute lymphoblastic leukemia (ALL), but must complete two years of treatment to prevent relapse. ALL is a type of blood and bone marrow cancer that leaves the child unprotected from infections Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Carlos' treatment has had to be interrupted due to his parent's economic problems. "Sometimes he asks me why he does not have hair, and I tell him it's because his dad wants to see him with the same haircut as him. My husband cut off all his hair too," Jaqueline says. According to the US National Library of Medicine, genetic disorders such as Down syndrome are a high risk factor which can lead to developing ALL. Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Elsa Murillo poses with her 16-year-old son Miguel Alejandro. Miguel was diagnosed with beta thalassemia in 2007, a genetic severe anemia that forces the adolescent to undergo red blood cell transfusions every three weeks. His illness could be solved with a bone marrow transplant, for which he is on an emergency waiting list that's not going down Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Despite the added difficulty of living two hours from the capital, the worst part for Elsa is to see her son lose hope: "I get sad when I see that he loses his temper. Sometimes he tells me that he does not want this anymore" Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Evelline Fernandez poses with her 15-year-old daughter Edenny. Edenny was diagnosed with major thalassemia at the age of one. She hes been receiving blood transfusions since she was seven months old Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival For Eddeny, the most difficult thing is to miss class and her classmates calling her 'chameleon' or 'zombie' because of her skin color, which sometimes changes from her natural tone to yellow. "When she grows up she wants to be a lawyer," says her mother Evelline Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Verioska Martinez poses with her 14-year-old son Jerson. Jerson has severe bone marrow aplasia, and he is one of the children on the list for an urgent transplant Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival "Here in Venezuela he does not have any chances, and his brother is not compatible [for a transplant]. The government told us that they cannot do anything because they owe so much money," says Martinez. She adds: "My children are my life. They know they are my everything. It's not only me, there are lots of mums who need help" Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Norlisa Aparicio poses with her 16-year-old son Oscar, who has beta thalassemia. "My son's disease manifested at four months old. His bone marrow does not produce red blood cells," Norlisa says. "The illness is more or less manageable but he has been seeking a transplant for 14 years. It is hereditary. I took the risk to have another child in case they could be compatible, but they aren't. My 10-year-old daughter is also a carrier" Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival "The hardest part for me has been learning how the be a mother under this circumstances," says Norlisa. "We started bringing him to he hospital every 21 days thanks to much sacrifice. He has had severe dengue two times, at nine and at eleven years old. I feel helpless lots of times when I don't know what to do. There is no day that I don't speak about my son's need to get a transplant" Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Zulema Gonzalez poses with her 9-year-old son Juan Manuel. Juan Manuel was diagnosed with anemia when he was six months old, but it turned severe in January 2017 when he suffered a cerebrovascular accident. He suffered another last February. Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival 'My son needs a transplant because he has blood transfusions every 21 days," Zulema says. "His blood is B+ and this is the only type he can receive. I have had to buy blood but sometimes I just can't get it and he spends a month without a transfusion. There's no congenital blood here because there are no reagents, and the government has not done anything to solve the problem for children with this condition. Untreated blood means they vomit and get diarrhea. I'd do anything for my child's life, I'd go anywhere. I'm not going to let him die; he is my son" Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Adriana Avariano poses with her 6-year-old daughter Mariana. Mariana has been diagnosed with Acute lymphoblastic leukemia (ALL) and is in the first phase of chemotherapy. The protocol, that should last two years, has been extended due to the suspension of chemotherapy sessions - meanwhile, her cancer cells are reproducing Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival "Thank God we do not need a bone marrow transplant," Adriana said. "The day they tell us that it is necessary we are going to have to leave the country, because it is a lie that they are going to help us here. Many children have already died waiting for that transplant" Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival Geraldine Labrador holds a photo of her late son Robert. Robert died at the age of seven of acute Acute lymphoblastic leukemia (ALL), a few days before this picture was taken Miguel Gutierrez/EPA In crisis-hit Venezuela, terminally ill children struggle for survival '"Doctors told me he was very sick; one of them said that they had to put tubes in him because if he had respiratory failure they did not have the tools to help him. They stabilized his tension, but he went into a respiratory failure at 5am. For 40 minutes doctors were assisting him, until one came up to me and said: 'I do not want to be the last person to see the last breath of your son; you are the one who deserves to be there.' I went in there willing to give my son strength to resist, but in the midst of despair I told the doctors to leave him alone. I was with him, I kissed him a lot, and I decided to take all the tubes off. He did not deserve to suffer any longer" Miguel Gutierrez/EPA

“They completely underestimated the sociology of authoritarian governments, which are often more resilient than you think,” Smilde says.

Last week, the US took centre stage at a Lima Group meeting to announce its latest efforts to turn the screw on Maduro. In the company of 14 other nations allied in seeking a resolution to the Venezuela crisis, it spelled out its boldest, most sweeping economic sanctions on the country to date.

The executive order froze Venezuela’s assets in the United States, banned entry to Venezuelan citizens aiding the dictator, and pledged to sanction foreign companies – or governments – dealing with Maduro’s government.

Guaido swiftly welcomed the news. The wiry leader stressed to reporters in Caracas that the “sanctions are against Maduro, not the Venezuelan people”; items that alleviate human suffering – clothes, food and medicine – are exempt.

The measures would “protect Venezuelans” from the government plundering the nation’s assets, he tweeted.

Predictably, Venezuela’s foreign office blasted the sanctions, describing the order as “economic terrorism against the Venezuelan people” and the formalisation of “a criminal economic, financial and commercial blockade that has already started”.

While the US has already imposed targeted sanctions on individuals (figures close to Maduro), specific companies and industries, the latest measures cast the net wider. For the first time they include secondary sanctions (targeting those outside the US), threatening to cut off foreign businesses with America and its financial system should they not comply.

“Do you want to do business in Venezuela, or do you want to do business with the United States?” US national security adviser John Bolton said to reporters in a message to foreign businesses around the world.

“That includes any foreign entity, government, corporation, person, who contributes to keeping the Maduro regime in power”.

Although both the US and Guaido deny that the measures are an embargo, experts in international law, international relations and NGOs operating in the country told The Independent they will still exacerbate an already dire humanitarian crisis – and hinder efforts to restore democracy.

The new US sanctions worsen the suffering of Venezuelans, they should be personally targeting members of the state Rodolfo Montes de Oca, Venezuelan human rights lawyer

“Although it is not technically an embargo ... the order will have a chilling effect on any transactions with Venezuelans,” predicts Mary Ellen O’Connell, international law expert at the Kroc Institute for International Peace Studies. The academic adds that the move is “unlawful”, violating World Trade Organisation Standards.

Mismanagement of the most oil-rich nation in the world – and once the wealthiest of Latin American nations – has caused widespread food and medicine shortages, a spike in crime and rampant hyperinflation, predicted by the IMF to reach 10 million per cent.

Over 4 million have fled the crisis, according to the UN Agency for Refugees, and nine out of 10 Venezuelans now say they go hungry, according to local polls.

The new sanctions are, according to the US, intended to alleviate that suffering by strangling Maduro’s finances and forcing him out of power. But some fear that the Venezuelan people will hurt more than its leaders.

“The new US sanctions worsen the suffering of Venezuelans, they should be personally targeting members of the state,” says Rodolfo Montes de Oca, lawyer at leading Venezuelan human rights organisation, Provea.

As many as 40,000 people have already died in Venezuela as a result of US sanctions since 2017 that made it harder for ordinary citizens to access food, medicine and medical equipment, according to a report released by the Washington-based think tank, the Centre for Economic and Policy Research.

Bolton boasted that Venezuela now joins Cuba, Iran, Syria and North Korea in the “club of rogue states” exiled from the US market.

Academics researching the impact of US sanctions on those countries say none offer a positive case study in restoring democracy; more likely, they weaken resistance to authoritarian governments as local populations are ground down by suffering.

“This tends to hurt ordinary people far more than it hurts governments, as governments have control of hard currency,’’ says Barbara Slavin, an Iran expert at the Atlantic Council think tank.

“This is cruel and counterproductive. The sanctions look tough but how is this tough if it’s killing innocent people?”

Several NGOs told The Independent that they are already facing banking difficulties due to over-compliance with previous sanctions. As Slavin says, financial institutions commonly avoid working with organisations – even if exempt – due to fear of draconian measures from the US.

Four activists staging protest inside Venezuelan embassy in Washington are arrested

More salient than the potential exacerbation of the already grave humanitarian crisis, Smilde says, is that the announcement could have torpedoed ongoing talks between Maduro and Guaido.

As the crisis drags on but Guaido’s opposition loses momentum, international observers have increasingly looked to ongoing negotiations in Barbados, now in their third round, as the most likely peaceful way out.

Late on Wednesday, the government announced in an official statement that it would not be sending delegations this week “due to the grave and brutal aggression” being “carried out by the Trump administration against Venezuela”.

It is not known if they will return to the table.

“The ramping up of sanctions by the US provided the perfect excuse for Nicolas Maduro to withdraw from this round of negotiations,” Smilde says.