By Sarah Rawlins January 9, 2020 Topics: Emergency Response Maternal Health Venezuela Crisis Women and Children Sarah Rawlins is the Medical Teams International Humanitarian Response Program Manager and a Registered Nurse. She recently was a member of our first-in team to assess the urgent needs of Venezuelans and local families over the border in Colombia. We are launching an immediate response to this crisis, focusing on caring for pregnant and lactating women and young children and getting vulnerable communities access to life-saving medical care. In this post, Sarah shares stories of need from her first visit to Colombia. A Cry Behind the Curtain Stefanie is in her early twenties. A new mother and single parent with a 6-month old baby to raise. We found her living in a garbage dump on the outskirts of Barranquilla; the largest city and port on the northern Caribbean coast of Colombia. In Barranquilla, migrants are scattered across the city, forced to settle in areas that would not be considered prime real estate. Due to the close proximity to the border of Venezuela and the lure of potential work, thousands of Venezuelan migrants have settled here in recent years. They’ve been forced out of their country due to unfathomable inflation, a collapsing healthcare system and the inability to access basic necessities such as food and water. The crisis in Venezuela has, in fact, led to the largest migratory flow ever recorded in Latin America. Worldwide, the crisis is now second only to what is happening in Syria. Unlike Syria, however, the casualties in this crisis don’t often make the news headlines. As our team entered the outskirts of a settlement of approximately 1,000 Venezuelan families, it became clear very quickly that this was no place to live. Descending down a garbage heap of debris, I watched carefully where I placed my feet so as to not impale myself on the jagged pieces of metal, broken glass and PVC pipes which threatened to trip me up. The settlement was built in four stages with conditions deteriorating the further down the hill we walked. Those late comers who are unfortunate enough to settle at the very bottom of the hill are not only located in the middle of a floodplain but are also at high risk of landslides from the surrounding mountains. With the assistance of our guides, we were able to visit several families who had taken up residence here. That is how we met Stefanie. We entered through what was essentially a rectangular hole cut in the side of flimsy sheet metal into what could barely be called a home. The walls were a patchwork of tarp, blankets, plastic and metal sheeting. What struck me the most upon entering was the unmistakable fact that when I looked up, instead of seeing a roof I saw nothing but the blue of the sky. Even worse, we were right in the middle of the rainy season. The need was overwhelming. From behind a curtain I heard a muffled cry. Stefanie emerged holding a small baby. I do not know the details of what happened to the father or of her journey to come to Colombia, but like all families we spoke with, I have no doubt that it involved great pain and suffering. Stefanie’s baby was born in the local Barranquilla government hospital, as births are generally considered emergency care–the only form of health service that is offered free for Venezuelan migrants. For women like Stefanie who do not have insurance, there is absolutely no prenatal care, thus no detection of high-risk pregnancies. Once the baby is delivered there is no follow up or postnatal care. Although we had been told by one government official that all babies born in Colombia can receive care up until 6 months of age, Stefanie knew nothing about this, and it seemed doubtful that this policy was followed. She shared how hard it is to keep the baby healthy when they have no shelter to stay dry. In addition, the incessant burning of garbage within the settlement creates a constant gray haze leading to chronic respiratory problems, especially for the children and elderly. As Stefanie shared her story, we were interrupted by an elderly woman, part of Stefanie’s adopted family. The woman began to speak very quickly, passion building with each word. Her arms cut through the air with aggressive force. As her words tumbled out, I started piecing together her story. As she did not have a passport, she had to cross an illegal border where she was forced to pay a very large bribe. Initially she settled close to the border. The landlord began to steadily increase the rent until she was unable to pay. Her only option was to sell all her belongings. She pawned off her television, one of her most prized possessions. She was determined to buy back her television later. After collecting money from the community and picking up odd jobs, she returned to the pawn shop to buy back her television, but the owner who she had pawned it to was now demanding more than double what she had sold it for. It was at this point during her story that she began to cry. “Here, we are nothing. We are constantly being humiliated. People know that we can’t work and that we have no money, so they take advantage of us. We are shown no dignity. This is more painful than anything else.” Families in Need of Care Just two doors down we visited with another family. Here we found an elderly couple caring for their gravely handicapped daughter. One sheet separated the bedroom from the kitchen. They had dug a pit latrine out back. I cannot even imagine how their daughter was able to access this. There are absolutely no services for people with special needs, and I imagine that her wheelchair does not venture far from their tarpaulin and sheet metal shack. When asked about healthcare, the couple reported that they had only been able to receive help once when a traveling medical brigade visited the settlement. The parents have two older children, but neither of them are able to find work. Since the parents cannot provide, the children are sent out every day to fend for themselves. “This is shameful, humiliating. Parents, who cannot provide for their children.” A Prayer for Hope Venezuelan migrants are denied any service that is not seen as an acute emergency. Residents in these settlements suffer from a wide range of curable and preventable acute and chronic diseases, in addition to urgent surgical needs. The fertility rate in the settlement is high, which is unfortunately common in a cohort exposed to sexual, gender-based violence, transactional sex, minimal education in younger females and no access to family planning services. Women and vulnerable populations such as the elderly and those with special needs are at further risk of violence, especially at night when there are no lights or means of providing protection. Those with whom we spoke do not know how long they will stay. Right now there seems to be no other option but to stay and hope that conditions will improve. The Colombian public healthcare system has completely collapsed under the weight of thousands of Venezuelans who have fled across the border in need of care. The fact that urgent support is needed is undeniable. Medical Teams has conducted two assessments in the region and is currently working to build a program that will support the Colombian government to be able to provide care for Venezuelan migrants and vulnerable Colombians. It is our prayer that with the funds raised, we will be able to provide not only healthcare but also hope to individuals like Stefanie who have asked that we share their stories and that we not forget them. You can help provide life-saving medical care for refugees like Stefanie and her child, donate today.