Mounting political tensions between the United States and the embattled Venezuelan government of President Nicolás Maduro, including a proliferation of crippling US sanctions, are being played out in the halls of the 72nd World Health Assembly, marred by walkouts and finger-pointing by the two adversaries.

“The World Health Organization is about global health, norms, standards and decision making about health, and politics should not be brought to the WHA. People can do this in the UN Security Council and the UN General Assembly,” a top Europe-based medical delegate, and veteran of WHA meetings, who requested anonymity, told Health Policy Watch, which interviewed more than a dozen health experts and diplomats.

“This forum is about health whatever their government is.”

Similarly, a number of western WHO diplomats and envoys from major developing countries alike, and UN officials, complained in private that the airing of political differences by Washington and Caracas was, as one put it, “deflecting precious time from dealing with many pressing health issues on the WHA agenda.”

Alex Azar II, the US Secretary of Health and Human Services, fired the first salvo in the opening WHA plenary of last Monday, leveling the charge that the Maduro government has destroyed the country’s health sector.

“Measles was once eliminated in the Western Hemisphere, but we now have thousands of cases caused by the collapse of the Venezuelan healthcare system,” Azar declared before representatives of some 194 WHO member states gathered for their annual meeting.

Carlos Alvarado, Venezuela’s Minister of Health, pushed back telling delegates: “Since 2014, the US government increased its attacks against the Venezuelan people through unilateral coercive and illegal measures mainly characterised by the financial and commercial blockade, the attack to our national currency inducing hyperinflation, which brings about dire consequences to both our economy and society.”

These measures, he said, “bring about death and suffering to the Venezuelan people.”

Layers of Political Rhetoric

A top international humanitarian, speaking on the condition of anonymity, told Health Policy Watch, “there are many layers of political rhetoric about aid,” and added that in the case of Venezuela, health and humanitarian aid has been politicised by both Washington and Caracas.

As Alvarado was delivering his opening speech, a group of about 20 delegations, which included the US, Brazil, Chile, Peru and Argentina, walked out in protest. The countries are among more than 50 nations that have recognised Juan Guaidó, the President of the Venezuelan National Assembly, as acting President, following a May 2018 election which observers say was rigged by Nicolás Maduro, president since 2013. Most other Latin American and European countries, along with the USA, Canada and Australia, have recognised Guaidó’s presidency in the wake of the election, in which the main opposition leaders were not allowed to compete.

At the WHA, however, Alvarado declared that the attacks by the US “aim to overthrow” the democratic and legitimate government of President Maduro and control Venezuela’s natural wealth.

“The Venezuelan people’s most profound health problem is that of the US illegal blockade, with its constant threat of invasion, war, and death, that will undoubtfully bring about unfortunate consequences, not only for Venezuela but also for the Latin American and Caribbean region.”

“We request the countries that are part of this prestigious Organization to join our call to cease the blockade against our country.”

He also said, “payments for the purchase of vaccines, medications, and health inputs are blocked and cause severe difficulties to guarantee access for millions of people to health care.”

Similar statements were made to reporters on 16 May by Jorge Valero, Venezuela’s ambassador to the UN in Geneva.

Asked to comment on the claims by the Venezuelan envoy that some bank payments for the procurement of drugs had been blocked because of the US treasury sanctions, Azar told reporters on the sidelines of the WHA meeting on 20 May:

“I wouldn’t be in a position to comment on allegations made by that failed, and former regime’s, representative, regarding this. We believe that we, and the world community, support the public health of the people of Venezuela.”

“Those who remain in Venezuela and those too who have had to flee Venezuela, and we will work, if only the Maduro regime would be out of the way, to stop blocking access to their citizens to have access to medicines and public health. That would be a boon for the people of Venezuela.”

During another WHA side-event on vaccines (on 21 May) Azar again slammed Maduro’s track record on health.

“Addressing vaccine-preventable disease has also been one of the top priorities of the US response to the crisis in South America, caused by the Maduro regime’s destruction of the Venezuelan healthcare system, which has allowed measles and other diseases to return to a region where they had been eliminated.”

According to WHO diplomats and international aid officials, who requested anonymity, a combination of factors – including but not limited to the sanctions – have exacerbated the shortages in food and medicines, severely challenging health services. These include poor governance and mismanagement by the Maduro government, along with the delay by Maduro to formally request international humanitarian assistance.

The deteriorating situation has, in turn, spurred the exodus of 3.7 million people to neighbouring countries.

Funds Blocked for Vital Medical Aid

On Wednesday, 22 May, Alvarado told reporters during a news conference that the country was in an “economic war that has started,” and provided a long list of sanctions, which are impeding the procurement of food, medicines, medical supplies and equipment, and life-saving health services.

These have included, he said, the freezing of almost €5 billion in North American and European banks, which would be “enough to pay for all of the medical needs of Venezuela for six years,” he said. Of that total sum, €600 million of the frozen funds was immediately earmarked “for the purchase of food, medicines and surgical material, for the Ministry of Health.”

He said that the frozen funds included:

• €12 million to buy medicines for chronic diseases, anaesthesia, and antibiotics;
• €2 million for blood banks;
• €2 million designed for payments to the Pan American Health Organization (PAHO), in WHO’s Region of the Americas, for the purchase of medications;
• €197,000 intended for purchase of replacement parts for hospital equipment, needed for operations on 500 children awaiting heart surgery.
• Funds needed to cover the costs of bone transplants for Venezuelan children awaiting treatment in Italy, and for patients awaiting kidney transplants in Argentina.

To overcome the health problems caused by the US blockade, Alvarado said Venezuela is strengthening relations within the UN system, including WHO, PAHO, UNAIDS, and UNICEF; as well as with the International Committee of the Red Cross (ICRC) and the International Federation of Red Cross and Red Crescent Societies (IFRC). It is also relying more on countries such as Cuba, China, Russia, Turkey, the Palestinian Authority and Iran, to provide support, he said.

These should lead to direct purchases and humanitarian aid “for more than 300 tonnes” of medical supplies, he said.

Alvarado said that he had also held meetings while in Geneva with top officials from PAHO and ICRC. On Thursday, a Venezuelan delegation met with WHO Director-General Dr Tedros Adhanom Ghebreyesus.

Sanctions Having Damaging Effect on Public Health

Alvarado acknowledged, however, that the sanctions are having a damaging effect. One half of the pharmaceutical companies supplying vital medical products have left the country, which has only about 4 months of vaccines in reserve. And the humanitarian aid health supplies provided by allies such as China, Russia and Cuba, only meet about 10 percent of the country’s needs. Venezuela’s 300 hospitals are functioning “not at 100 percent but they are functioning.”

Also on Wednesday, shortly after Alvarado’s meeting with the press, a second anti-Maduro diplomatic protest was staged on the floor of the assembly when about 20 countries walked out – including the US, Brazil, Chile and Argentina – at the moment when Alvarado took the floor during the annual WHA review of health conditions in occupied Palestinian territory.

Going beyond the US and Venezuela exchanges at the WHA, a recent assessment by the United Nations has warned:

“The humanitarian situation in the country has worsened, due to continued economic challenges, political instability, power outages and a subsequent deterioration in the provision of essential services.”

The most vulnerable groups include: people with chronic health conditions and serious illnesses; pregnant and nursing women; new-borns and children under five; indigenous people; people on the move; older persons; women and children at risk; and people with disabilities, among others, declared a UN Humanitarian Scale-Up situation report, circulated on 15 May.

The report notes that between January-April 2019, the UN and its partners scaled up vaccination coverage for communicable diseases, the provision of generators or hospitals, and for over 189,000 preventative and curative treatments for acute malnutrition, among other activities.

The number of UN staff in the country has doubled since 2017, with 422 staff in Venezuela as of 29 April, including UNICEF (104) and PAHO/WHO (75) as the agencies with the biggest staff numbers.

The UN emergency relief coordinator, Mark Lowcock, told the UN Security Council in April, “there is a very real humanitarian problem in Venezuela,” and stressed the scale of need is “significant and growing.”

“We estimate that seven million people in Venezuela need humanitarian assistance. That is some 25 percent of the population,” he added.

UN Assistance Scaled Up

According to the UN Report, as well as other reports from PAHO and WHO, the scale-up in UN interventions has also included:

• Donation of six generators by UNICEF to priority hospitals in different states.
• Delivery by UNICEF of 176,000 doses of vaccines against measles, mumps and rubella, 6.7 million doses of vaccines against diphtheria for girls and boys in their first year of life and to boost immunization in children under five.
• Emergency Health Kits (IEHK 2011) distributed in hospitals in Caracas, Miranda, Bolivar, Táchira and Zulia.

PAHO/WHO currently have 33 consultants deployed in all states, leading immunization campaigns against measles and diphtheria, overseeing rapid monitoring of vaccine coverage, and building local capacity through training on prevention and detection. This has increased vaccine coverage to over 95 percent, helping to reduce measles transmission risks. PAHO/WHO also have been supporting efforts on biologicals and cold chains (temperature-controlled supply chains), as well as other health interventions, including distribution of:

• 10 million tablets for the treatment of HIV among 50,000 people across all 24 States;
• 6 tons of medicines and supplies for emergency assistance, with another 89 tonnes of medicines and supplies on the way;
• Over 189,000 preventative and curative treatments for acute malnutrition.

Image Credits: WHO/PAHO, John Zarocostas.