Political unrest in Venezuela is presenting challenges for the country's health services, which were already struggling with shortages of drugs and medical equipment. Ewan Robertson reports.

Protests began in early February after Venezuela's hard-line opposition leader Leopoldo Lopez called on supporters to take to the streets against the government of President Nicolas Maduro. Some protests have been peaceful, demanding that the government resolve high crime, goods shortages, and a 56% annual inflation rate in the oil rich nation of almost 30 million people.

Meanwhile, a radical wing within the opposition has commenced a strategy of riots and burning street barricades to try to force the government's outright resignation. With the government coalition winning 54% of the popular vote nationwide in local elections only 3 months ago, there seems little indication of a resignation occurring.

At least 22 people have been killed and more than 300 have been wounded in the unrest. Those killed include opposition activists, government supporters, other civilians, and two National Guard officers. Although many parts of the country remain calm, in some cities street barricades have been constructed in the middle or upper-class zones, which form the opposition's base of support.

Venezuela's health minister, Francisco Armada, said recently that the unrest had “significantly” affected health services. Health authorities warn that the barricades and those manning them are creating an adverse physical, environmental, and psychological effect on public health.

The Department of Health says that the burning tyres and rubbish on the barricades produce dangerous levels of toxic substances, and that the forced closure of road access to communities provokes a range of negative psychological emotions for residents trapped inside.

Outside of the capital Caracas' east side, the areas most affected by the barricades are the main cities of the Andean region in the west. In Mérida, a student town with a population of 300 000, one of the city's three hospitals has been entirely blocked off by the barricades.

In a visit to the hospital, a nurse explained to The Lancet that patients had to be hauled over knee-length barbed wire to reach the entrance. Staff and patients seemed to be using the quiet morning period to leave and enter while barricaders slept.

The director of the Mérida state regional health authority, Denis Gomez, denounced the situation of the Social Security Hospital: “In other countries this doesn't even happen in times of war. When the symbol of the Red Cross is seen, it can pass through in the midst of a conflict. Here not even the staff or an ambulance have been able to get through. This can't be called a peaceful protest.”

Nationally, there are several reported cases of people in critical conditions dying because they were prevented by barricaders from reaching hospital. In February, there were also at least four politically motivated attacks against free public health clinics staffed by Cuban doctors, who work in Venezuela under a bilateral agreement.

Meanwhile, some Venezuelan doctors and medical students have joined the peaceful protests to demand that shortages in drugs, medical supplies, and equipment are resolved. They describe the situation as a crisis, which is affecting surgical capacity, patient care, and on occasion, emergency attention.

At the end of 2013, the biggest private clinics in Caracas reported shortages in 25% of medical materials. The Venezuelan Association of Hospitals and Clinics, which represents the country's private medical centres, blames bottlenecks in government currency exchange controls for the problem, saying that they delay clinics from paying distributors to import supplies and parts.

Although it is difficult to judge the exact level of shortages in the public sector, doctors consulted in Mérida's public hospitals reported that these are not at a critical level.

“There aren't supplies and medicines in excess, but there is what is necessary if it is administrated well”, general physician Griseida Briceño told The Lancet. She added that a deficit exists in osteosynthetic surgical material, meaning that patients have to buy the expensive materials themselves. Briceño, who has rotated through each of the city's public hospitals over the past 2 years, also said that shortages of some hospital machines and other equipment was a problem.

In mid-February the health minister admitted that “real challenges” existed for the government in the distribution of medical supplies. Actions taken since then include creating a new state-run company to import and distribute more medical supplies, and holding fresh meetings with the private sector in which the ministry promised to review the mechanisms under which medical supplies are imported and distributed.

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Copyright © 2014 Ewan Robertson