The coronavirus pandemic threatens to push many nations’ health systems and economies to the brink of collapse. Imagine the challenge of combating the virus in a place where those things have already collapsed. While other countries worry about their supply of ventilators and masks, Venezuelan hospitals struggle to keep the lights on.

The shortages of basic goods like food, home appliances, cooking oil and even toilet paper that stores in many countries are now experiencing have been a fact of life in Venezuela for years thanks to the economic crisis and hyperinflation that began in the final years of the presidency of Hugo Chavez, and continued after his successor Nicolas Maduro. The crisis has also gutted the country’s health system. Basic drugs and equipment have been scarce for years. As the Guardian reports, “A survey of doctors across the country carried out by the local NGO Médicos Unidos found that only 25 percent of respondents had reliable running water in their hospitals and clinics. Two-thirds said they did not have gloves, masks, soap, goggles or scrubs.” Another survey found that 164 people died in 2019 as a result of complications linked to Venezuela’s frequent electricity cuts. Women who arrive at hospitals to give birth are generally expected to bring supplies including scrubs, gloves, and disinfectant for the doctors along with them.

“You have a health system that was broken down beforehand,” Marianne Menjivar, the International Rescue Committee’s country director for Colombia and Venezuela, told me by phone. “You don’t have even basic medicines and supplies in the hospitals. They’re unable to cope with normal illnesses, never mind a pandemic. People feel like they’re in the hands of fate.”

So far, the country has 42 confirmed cases, and no deaths—but there’s little in the way of testing going on. The Venezuelan government did recognize the severity of the threat posed by COVID-19 faster than many countries. Maduro ordered the closing of business and set up roadblocks to limit citizens’ movements last Friday.

Maduro, who considers most foreign aid as part of a U.S.-led plot to overthrow him, has refused international assistance for the country’s medical system in the past. So it’s a sign of the gravity of this crisis that Maduro this week requested $5 billion in emergency aid from the International Monetary Fund. The IMF rejected his request given that there is “no clarity” on international recognition of the country’s government. (While Maduro is the de facto leader of the country, most western governments have recognized opposition leader Juan Guaidó as the country’s legitimate president since early last year. Guaidó, meanwhile, is issuing his own dueling statements on the crisis and organizing his own crisis response.) As with Iran, U.S. sanctions are not helping either.

More than 5 million Venezuelans have fled the country in recent years, creating a sizable diaspora throughout the region, but neighboring countries Brazil and Colombia have responded to the coronavirus crisis by closing their borders with Venezuela. Menjivar worries this could make the situation worse, prompting people to flee through illegal crossings.

Once in Colombia, the situation is not much better. “In the border regions with Venezuela, the soup kitchens are all closed,” she told me, meaning that many Venezuelan migrants are now going without food. “Basic hygiene conditions for halting the spread of this virus is not available to them. If they get sick—and I don’t mean COVID-19, just if they get sick normally—they don’t have access to the healthcare system.”

She also notes that the “majority of Venezuelans in Colombia subsist by selling things on the street in the informal economy. But the streets have gradually emptied as people have heeded the calls to self-isolate and people won’t go near them.”

Still, even with the borders closed and prospects grim in neighboring countries, more Venezuelans may take their chances abroad rather than stick around to see if their home can survive yet another existential crisis.