Clashes between protesters and security forces have become a deadly cycle and doctors are seeing disturbing patterns in the violence

There is a pattern to the protests that have rocked Venezuela for the past two months. Anti-government demonstrators set off on a march to the government buildings in Caracas’s city centre to protest against a government they consider illegitimate. Halfway to their destination national guards and riot police deter them with gas bombs and water cannons. Clashes ensue and dozens of people are injured. Some die.

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For the doctors at a medical post in Plaza Alfredo Sadel the predictability of the marches means the action starts around 5pm with an influx of wounded protesters. Until then they might have treated a handful of people suffering from tear gas or a few with injuries to their arms and legs from rubber bullets. But at dusk the victims arrive with deeper gashes or even unconscious. These injuries are not from rubber bullets to the limbs but from tear gas canisters shot to the chest and head. On two occasions it was too late.

For Dr Henrique Montbrun, who oversees the triage post in the municipality of Baruta, the violence in Venezuela has reached unprecedented levels. “It’s madness,” he says. “We have gone from an average of 30 wounded people to more than 65 in the last two weeks. We live in a continuous state of emergency.”

As the clashes between the demonstrators and security forces enter their third month, doctors say that they can no longer predict the type of violence to prepare for. Dr Montbrun says injuries were originally superficial, usually buckshot wounds. More recently, protesters have been treated for 5cm-deep holes caused by metal marbles shot at close range.

“Violence doesn’t surprise me but the level of hatred security forces are showing towards average citizens and the use of non-conventional weapons like loading tear gas canisters with nails and marbles does take me aback,” he says.

According to the public defender’s office, 67 people – including minors, students, passersby and national guards – have died during or as a result of the protests. On Wednesday a 17-year-old died of an explosive-related wound to the chest and a national guard was murdered.

Facebook Twitter Pinterest Security forces clashing with demonstrators rallying against Venezuela’s president, Nicolás Maduro. Photograph: Ivan Alvarado/Reuters

Last week demonstrators claimed that police and national guard were stealing their phones and wallets. Journalists too have had their cameras stolen; some have been detained. In a video widely circulated on social media, a handful of police can be seen stealing a protester’s watch as she suffers from tear gas inhalation. Another video shows a national guard firing a gun at the person who is filming him at a distance.

And yet, despite the escalation of violence, protesters remain in the streets. “I am not afraid,” says Rosmery Indare, 19, who arrived barely conscious at the triage post. “They threw several gas bombs and we all ran. I tried to go into a nearby mall but most shops had closed and I was cornered.”

Rosmery described how two national guards clubbed her in the legs and knees while threatening to jail her. “They’re not going to stop me from marching,” she says. “I haven’t had a chance to enjoy my country because they stole it from us but this time, I am sure, we will recover [it].”

In 2014 a similar wave of protests erupted but was quashed by security forces. 42 people died during months of protests and thousands of students were detained. Leopoldo López, a leading opposition figure, was tried on charges that were condemned around the world as politically motivated and has remained in jail since.

This time the protests are different.

Demonstrations erupted on 1 April after the supreme court, widely seen as packed with pro-government judges, ruled that the opposition-led national assembly could no longer legislate. Although the judges backtracked, the government, led by President Nicolás Maduro, a protege of the late president Hugo Chávez, fuelled further protests when it stripped the opposition leader, Henrique Capriles, of his right to run for public office.

Capriles had previously been considered a moderate opposition voice but he too has changed. He has called on his supporters to take to the streets “until democracy is restored”.

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While in 2014 the protests were seen as a middle-class phenomenon restricted to a few cities and towns with opposition mayors, since April people from all walks of life have joined in the almost-daily marches.

Polls show Maduro’s popularity is at 21.9%. His most recent effort to quell the social unrest, by proposing to redraft the constitution, provoked rare criticism from within his own party ranks. Even the country’s general attorney, a long-time Chávez ally, declared the move unconstitutional and a “threat to Chávez’s legacy”.

Meanwhile Venezuela’s economy is in tatters with inflation rising by 800% in 2016 while the economy shrank by 18.6% over the same period, according to the central bank. Crime has soared with over 28,479 homicides in 2016 – one of the highest murder rates in the world. Finding food or medicine has become nearly impossible – except for the very few who can afford black market prices.

The number of women dying in childbirth rose by 65% in 2016 and infant mortality rose by 30% over the same period, according to a ministry of health report leaked by the minister of health after two years of no official data. She was sacked. Malaria, previously eradicated, is on the rise again.

Once the most prosperous and stable democracy in the region, Venezuela teeters on the verge of collapse. “We live in one of the most beautiful countries in the world and yet no one visits,” Rosmery says. “Explain that to me! What happened to us?”

The government’s answer is that the country is defending itself from economic warfare, part of a US-backed effort to remove Maduro and exploit Venezuela’s resources.

Economists argue instead that Venezuela is currently the worst economy in the world because nearly two decades of mismanagement and crippling price-controls destroyed the productive sector and bred corruption.

When security forces defy their leader it generally means you are one step away from a failed state. Unless they listen, we could soon be on the brink of anarchy Dr Henrique Montbrun

At the triage post in Plaza Alfredo Sadel a chronic lack of medical supplies means doctors have to rely on donations from expat Venezuelans. “Gauze is a luxury. Antibiotics are like gold dust,” says Dr Diana Lopez, a 23-year-old doctor who volunteers at the triage post. “We are practising medicine under war conditions, making do with what we have.”

Last week the guard fired tear gas bombs at a clinic where an opposition legislator was getting stitches after being thrown to the ground by a water cannon. Lopez and her colleagues had to flee. “If some one yells ‘code red’ it means the national guards are coming and we need to rush off. It’s happened while we are removing pellets from some guy’s leg,” Dr Lopez says.

Following reports and video evidence of national guard and police robbing protesters, the minister of defence, general Vladimir Padrino López, told his troops to stop mistreating demonstrators.

Two days later there were no signs the soldiers had heeded the order. Dr Montbrun says he had seen at least three people hurt by ball-bearings. One had been hit on the head. “When security forces defy their leader it generally means you are one step away from a failed state,” he says. “Unless they listen, we could soon be on the brink of anarchy.”