For months and months, Venezuelans have been fleeing the stark conditions in their country, where a political and economic crisis has produced severe shortages of food, medicine, electricity and water.

“Over 3.4 million Venezuelans are living abroad, of whom 2.7 million have left the country since 2015,” said the United Nations’ refugee agency UNHCR. “Colombia is the country most affected by this outflow, with over 1.1 million Venezuelan refugees and migrants.”

But while Colombia has had what UNHCR calls “a generous open border policy and a series of status regularization measures and facilitating access to basic services, the humanitarian needs have overwhelmed the country’s reception capacity.”

And for some migrants, the despair they felt in Venezuela has replaced the hope they had for a better life in Colombia or beyond.

In La Guajira, Colombia’s northernmost department, or province, that despair has manifested itself in a frightening way. In 2018, there were 216 suicide attempts among refugees, many of them single mothers with children.

“Many made the long and dangerous trek across the border to Colombia and are now living on the streets, under tarps, in shacks made from scraps of plastic and metal, and in rooms with upwards of 15 people,” said Jill Watson, a spokeswoman for the Catholic charity Malteser International. “They feel hopeless. No food, no job, no money, no safety. Many think there is no way out. Their mental health is suffering and suicide has been on the rise. This is why we are providing mothers and all Venezuelan refugees with psychosocial support during this traumatic time.”

Malteser, the humanitarian arm of the Order of Malta, came to La Guajira in 2014 to help the indigenous Wayuu and other peoples, who were suffering the effects of the decades-long civil war. La Guajira is the second poorest department in Colombia, and locals lacked access to basic services, including health services. There were very high neonatal and maternal death rates.

When the crisis in Venezuela, to the east, began to lead to increased migration, the Wayuu people, known for their hospitality, were open to the newcomers.

Officially, there are now 130,000 refugees in La Guajira, but that number is based on how many people come through the official border crossing in Maicao and on a census done in two urban centers in Riohacha and Maicao, said Jelena Kaifenheim, Latin American coordinator for Malteser. But, she pointed out, there are 183 “informal” border crossings in rural areas of La Guajira, and there are no numbers for refugees in rural areas.

“So we have to assume that that number is maybe 40 percent or even less of the real figure,” she said in an interview.

Many of the refugees are in poor health, as Venezuela’s health system has broken down. “Many of the children who are coming do not have complete vaccination schemes,” said Kaifenheim, who just returned from a visit to Colombia. “And they are coming to a host community that really has nothing to give, because they are already in need.”

Malteser had a team of two doctors, two nurses and two psychologists in place in La Guajira, but that was planned for one municipality, since other “international health actors” were to step in for other municipalities. Now Malteser’s team is seeing people both at its refugee support center in the public Nuestra Señora de los Remedios hospital in Riohacha and making regular trips all over the department as a mobile medical team. They are the only international humanitarian group that provides mobile medical care in La Guajira

Kaifenheim said the Colombian government decided not to install permanent camps in La Guajira. The two accommodation centers that are there have a capacity of about 200 people. Refugees can stay there for only three days, during which time officials try to find an option for them, such as living with family members.

“In most situations they don’t find other options for them,” Kaifenheim said. “Anyone they accept into these temporary accommodation centers are mainly female heads of household with small children. And they told me that after three days they have nowhere to go. They just put them right back on the streets.”

On top of that, local officials have restricted such refugees from urban centers, in order to maintain order, so refugees end up in peripheral areas around the cities, where they live in unsanitary conditions and typically do not see anyone for medical or other help.

Because it now has to respond to the large influx of refugees, Malteser’s team needs to prioritize who needs healthcare the most. Kaifenheim said single mothers and their children seem to be the most vulnerable. They live by themselves, unprotected and exposed. They feel they are not able to return to Venezuela, and must live in unhygienic conditions. “They make a minimal living by selling sweets, coffee or something, so they manage to feed their children at least once a day, which is an improvement over what they lived in Venezuela,” she said.

Still, she said, “living in a shack, with your children, being displaced, for a year, a year and a half, and there’s really nothing that’s changing and there’s no prospect to make a living—it’s wearing them down. There’s a lot of depression, and ultimately, total despair. You can imagine a young mother with children without any protection, without help, without anywhere to go, and the need to provide for the children, but not really the means of how to provide for them, it’s a lot of stress and a lot of pressure, and there is an increasing rate of suicide attempts.”

Last year, the Malteser team provided 7,000 medical consultations. It is working with national health entities to provide vaccinations to children.

Like many Catholic agencies, Malteser’s work is coordinated with the local Church. In La Guajira, “they are opening soup kitchens for children and mothers so they can come and have a meal. We are targeting those soup kitchens for medical presentations, because they have a strong selection of the most vulnerable, and then we complement what they’re doing. They’re giving food, and we’re providing healthcare at the same time.”

To the south, the Diocese of Cúcuta reported that it has provided 1 million meals to Venezuelan migrants, and groups like Catholic Relief Services and Jesuit Refugee Services are assisting in various aspects of the Venezuela crisis.

And in La Guajira, the U.N. Refugee Agency, UNHCR, together with the Colombian authorities, is opening a reception center to offer support to vulnerable refugees and migrants in the border city of Maicao. The Integrated Assistance Centre, set up at the request of national and local authorities, has an initial capacity of 350.

But, with no end in sight for the crisis in Venezuela, groups like Malteser are facing challenges that are very daunting indeed.

“We are urgently needing donations as we need to increase our medical team and buy more medicines so we can actually cover the full department,” Kaifenheim said. “Right now, with our limited resources, it’s an impossible task.”