Struggling to survive a socialist economy lacking everything from basic maternity goods to cancer drugs, Venezuelans have begun trading at “medical flea markets” outside of the control of the government, where they receive no guarantee the drugs will actually work.

The “medical flea markets” appear to have taken on the same form of the “pop-up” markets that became popular in Venezuela in 2014, when shortages of laundry detergent, deodorant, baby formula, and other goods triggered demand for trade outside of the nation’s strict ration system. The government has vowed to crack down on traders participating in these markets, referred to often as bachaqueros, and dictator Nicolás Maduro has resisted accepting humanitarian aid from neighbors like Colombia.

Speaking to Venezuelans in San Cristobal, on the border with Colombia, and Maracaibo, Reuters found that many are searching for painkillers, birth control, and other common drugs. Bachaqueros told Reuters that anticonvulsants have come into more demand lately, and antibiotics are perennially necessary.

The drugs, Reuters explains, comes partially from hospital employees, who sell them to the merchants to bring in some extra income, and from Colombia. Those smuggled in are often “stacked on top of each other. The packaging is visibly deteriorated: The cases are discolored and some are even dirty.” They are sold alongside food and other goods.

Doctors tell Reuters that the conditions these drugs are kept in are not ideal for preservation, meaning many could have gone bad by the time they are sold.

Previous reports have exposed the unreliable nature of the legal drugs in Venezuela, as well, likely contributing to Venezuelans being comfortable buying the drugs in flea markets rather than waiting for legal supplies. In April, a group of cancer patients complained that the drugs they had received in government hospitals, which Venezuela bought from the communist government of Cuba, were causing side effects that made their health status “worse than when we were first diagnosed with the disease.”

In January 2016, the Venezuelan Pharmaceutical Federation declared a “humanitarian emergency,” noting that the nation was facing a “100 percent shortage” of necessary drugs on a national level and 85 percent of the nation’s pharmacies were on the brink of bankruptcy. The legally acquired drugs began disappearing in mid-2016 from hospitals completely. Hospital staff then began asking patients to bring their own medicine—as well as bandages, gauze, and other necessary tools—to hospitals and not expect to be medicated upon arriving.

The situation has gotten worse since. In an extensive report published this week, Venezuela’s El Nacional newspaper highlighted individual cases of citizens suffering severe medical shortages. One mother explained that she only had money for her necessary kidney medications or her child’s milk, but not both. Another lamented that her child, diagnosed with a highly curable form of leukemia, is likely to die due to lack of treatment.

Venezuelans who have managed to leave the country often send medicine home from abroad, though many have to pay a high price to acquire it. The Miami Herald reports that women, in particular, find themselves in dangerous situations after using their savings to flee Venezuela. Many end up in prostitution, which often generates enough money to buy the drugs their relatives at home need to survive, even if only the suspect black market versions of the drugs they need.

The neighboring government of Colombia has offered Venezuela humanitarian aid, which Maduro has rejected for political reasons. In a speech in November, Maduro condemned Colombian President Juan Manuel Santos, telling him to “swallow your medicine and your drugs and your cocaine, you must be very evil to do that.”

This month, Venezuelan Health Minister Luis López insisted that Venezuela would not allow anyone to “impose” humanitarian aid on the country.

“Nobody here is going to kneel before the empire, nor are we much less going to allow the right wing to impose humanitarian aid on us,” he asserted.

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