healthcare – UAB Institute for Human Rights Blog

Another Battle for Bodily Autonomy in Trans Youth

On February 10, 2021 the Alabama Senate Health Committee voted to criminalize transgender medicaltreatment for minors. With an 11-2 vote, the committee approved Senate Bill 10 (SB-10), a bill that will “outlaw puberty blocking medications and gender-affirming care for minors.” On March 3, the Alabama Senate passed this legislation, and it is currently awaiting Governor Kay Ivey’s approval. SB-10 empowers the legal system to prosecute clinicians and pharmacists with felony charges if they prescribe medication or provide treatment to aid in the transitional processes of minors. Bill sponsor Senator Shay Shellnutt (R-AL) claims that “minors are too young to be making this decision.” The Senator has also admitted that he’s never interacted with a trans teen before submitting the bill. Opponents of the SB-10 refute Shellnutt’s claim by acknowledging this decision is between the medical care provider, the patient, and the patient guardians. As such, SB-10 infringes on the private rights of parents to care for their children with necessary and proper interventions. Shellnut has mentioned that hormonal treatment and other transgender interventions cause long term issues and that a child is not mature enough to be making such a permanent decision. Shellnut’s claims are false; the effects of hormonal drugs that are puberty blockers are reversible. Also, when evaluating long term effects of gender reassignment surgeries, doctors prefer to wait until the patient is at least 18 years old before they perform the surgery.

A person holding a sign with a metaphor describing gender. — Source: www.mindfulword.org

Doctors must take the Hippocratic Oath which defines their ethical conduct and moral reasoning. There are two main tenets of the Oath: “benefitting the ill and protecting patients against personal and social harm and injustice.” Not only does SB-10 force doctors to dishonor the Hippocratic Oath, but it is also medically harmful to the patient pursuing care and prevents them from confiding in their medical care team. Dr. Marsha Raulerson says it will “take away child’s confidence in trusting doctors with their thoughts and to talk candidly.”

Healthcare providers are only one pillar of the support system for patients wishing to transition. So, when healthcare providers are unable to provide care to these young individuals, it can harm their mental and physical wellbeing and contribute to gender dysphoria. Adolescent and young adult years are incredibly formative. It’s in these years that young people thrive and when they are in need of a lot of support and care. When their support systems and adequate healthcare is taken away “adolescents can feel alone, stigmatized, and undervalued”. Rejection, discrimination, and stigma during these formative years can put young adults at a higher risk of mental health disorders such as depression and anxiety. The aforementioned mental health disorders can lead to the usage of addictive substances like drugs and/or alcohol, and suicidal ideation. These factors contribute to significant health disparities within the LBGTQ+ community. It’s vital the care they receive is given without stigma and affirms the patient’s sexuality and gender identity, but this care cannot be given with government intervention that holds traces of transphobia.

Protestors gathering against the transgender military ban legislation. — Source: www.britishherald.com

Gender is a very dynamic concept, and there is no binary. It is up to the individual to choose their identity. Gender reassignment treatments and procedures are one way to reaffirm and respect an individual’s choice. LGBTQ+ youth deserve to know that they are respected and that they deserve quality healthcare and treatment. Healthcare providers should not be prevented from fulfilling their responsibilities. They should be able to provide quality care and treatment for their patients. If they can’t, they should be able to refer the patient to a doctor who can provide adequate healthcare. This is not the first time SB-10 has been passed to the full Alabama Senate. It was passed all the way up to the Governor in 2020 to be signed into action and is only back on the table due to COVID-19 complications. Advocacy is an important aspect of healthcare, and providers should be willing to advocate the most for marginalized communities. It is important to lift barriers to care for these groups, instead of continuing to make healthcare inaccessible.

A separate companion bill (HB-391) is currently in the Alabama House. This bill would restrict transgender students from participating in school athletics with the gender they identify with. Lawmakers that support the bill claim that it protects fairness for female and “keeps them from having to compete against transgender athletes who were born male.” The biggest difference to make right now is to call Alabama Senate representatives and tell them the harms these bills will cause to LGBTQ+ youth and to the healthcare providers that try to help them.

Human Rights in Appalachia: Socioeconomic and health disparities in Appalachia

The previous blog posts in this series are located here:
Human Rights in the Appalachian Region of the United States of America: an introduction
Human Rights in Appalachia: The Battle of Blair Mountain and Workers’ Rights as Human Rights

In the Appalachian region of the United States, there have long been overarching socioeconomic problems that have prevented the region from seeing the same levels of growth as other parts of the country, and even been part of its decline in other domains. Much of Appalachia’s population of twenty-five million people remains remote, isolated from urban growth centers and beneficial resources that exist in cities. The rural towns and counties in which many Appalachian people live have not had the ability to maintain the public infrastructure, furnish the business opportunities, or provide the medical services that are necessary to sustain populations.

There are three regions of Appalachia: the southern region, which covers parts of Georgia, Alabama, Mississippi, the Carolinas, and Tennessee; the central region, which covers parts of Kentucky, southern West Virginia, southern and southeastern Ohio, Virginia, and Tennessee; and the northern region, which includes parts of New York, Pennsylvania, northern West Virginia, Maryland, and northern and northeastern Ohio. While the entire Appalachian region struggles with higher levels of poverty, unemployment, and lack of services and infrastructure, some sub-regions suffer worse than others, and in different ways (Tickamyer & Duncan).

graph of people in poverty by age group — Percent of persons in poverty in rural Appalachia by age group: 2014-2018

Even when compared to other rural areas, Appalachia struggles on measures of educational attainment, household income, population growth, and labor force participation. Rates of disability and poverty are significantly higher in rural Appalachia than they are in other rural areas of America. In 2018, the number of Appalachian residents living below the poverty line was higher than the national average in every age group except those 65 and older. The largest disparity was among young adults (18-24), where the Appalachian population was more than 3% higher than elsewhere. From 2009 to 2018, median household income in Appalachia went up by 5%, not far behind the national average of 5.3%. However, the median household income in Appalachia remains more than $10,000 lower than the national median.

map of population age in appalachia — Map of population age in Appalachia

One area where disparities between Appalachia and elsewhere in the country are particularly noticeable is in healthcare. The Appalachian Regional Commission released in 2017 “Health Disparities in Appalachia”, which reviews forty-one population and public health indicators in a comprehensive overview of the health of the twenty-five million people living in Appalachia. The study found that Appalachia has higher mortality rates than the rest of the nation in seven of the nation’s leading causes of death: heart disease, cancer, COPD, injury, stroke, diabetes, and suicide. In addition, diseases of despair are much more prevalent in Appalachia than the rest of the country. Rates of drug overdose deaths are dramatically higher in the Appalachian region than the rest of the country, especially in the region’s more rural and economically distressed areas. Research indicates that diseases of despair will increase under COVID-19, as well. This will be especially true for women, who experience death from diseases of despair at a rate 45% higher than the national average in Appalachia. The ARC found that, while deaths as a result of diseases of despair were more numerous in metropolitan counties of Appalachia, rates of suicide and liver disease were higher in rural counties.

These issues are exacerbated by the fact that there is a much lower supply of health care professionals per capita, including primary care physicians, mental health providers, specialists, and dentists in Appalachia. The supply of speciality physicians is sixty-five percent lower in the central sub-region of Appalachia than the rest of the nation as a whole. Other factors negatively impact health in Appalachia, as well. Nearly twenty-five percent of adults in Appalachia are smokers, compared to just over sixteen percent of all American adults, and obesity and physical inactivity are extremely prevalent. However, it is worth noting that in some areas of public health interest, such as the occurrence of STIs/STDs and HIV, Appalachia does better than the rest of the country.   Healthcare disparities are an increasingly dramatic phenomenon. From 1989-1995, the cancer mortality rate in Appalachia was only 1% higher than the rest of the US, but by 2008-2014, it had risen to be 10% higher. In the same time frames, the infant mortality rate was 4% higher versus 16% higher, respectively. And, in 1995, the household poverty rate in Appalachia was 0.6% higher than the national average, but by 2014 was 1.6% higher. We like to think of these problems as things of the past, but the gaps are still very much relevant. Fortunately, people living in Appalachian communities are more likely to have health insurance coverage than other Americans. 8.8% of the population in Appalachia do not have health insurance versus the national average of 9.4%.

This year, in the midst of the coronavirus pandemic, some factors of the Appalachian population have put people living there at greater risk of COVID-19. 18.4% of people living in Appalachia are over age sixty-five, which is more than two percent higher than the national average. In more than half of Appalachian counties, over 20% of people are older than 65. This, combined with high rates of obesity and smoking, put many people in the “high-risk” category. COVID-19 has affected Appalachian communities in ways that don’t result in death but make surviving even more difficult. Food insecurity, for instance, is an increasingly severe problem. At one soup kitchen, “…we were serving about 200 people a day, and our numbers have nearly tripled since COVID started,” social worker Brooke Parker, from Charleston, West Virginia, said.
However, perhaps due to the isolated nature of many Appalachian communities, mortality rates from COVID-19 have not been markedly higher than the national averages.

With schools moving to online learning, problems with access to internet in Appalachia become more relevant and pressing. Around 84% of Appalachian households have a computer, which is five percentage points below the national average. 75% have access to reliable internet, which is also five percent lower than average. There is no easy solution to this lack of access to education. Even in non-Appalachian counties, students are being severely impacted by the disruption to their normal education activities.

Human rights organizations ought to keep a close eye on Appalachia as we see the results of COVID-19 on an already vulnerable and at-risk population. The ultimate consequences of the pandemic will likely be more severe here than elsewhere in the country. People living in Appalachia deserve the same assistance being offered to and resources being put towards urban centers in other parts of America. Too often have they seemingly been forgotten.

Additional References:
1. “Health Disparities in Appalachia”. Marshall, J.,Thomas, L., Lane, N., Holmes, G., Arcury, T., Randolph, R., Silberman, P., Holding, W., Villamil, L., Thomas, S., Lane, M., Latus, J., Rodgers, J., and Ivey, K. August 23, 2017. https://www.arc.gov/wp-content/uploads/2020/06/Health_Disparities_in_Appalachia_August_2017.pdf. Retrieved December 3, 2020.
2. Population Reference Bureau. https://www.prb.org/appalachias-current-strengths-and-vulnerabilities/. Retrieved December 9, 2020.
3. Tickamyer, A., Duncan, C. (1990). Poverty and Opportunity Structure in Rural America. Annual Review of Sociology. 16:67-86.

COVID-19’s Impact on Gender Equality

COVID-19 has had a significant impact on the health and social structure of the world. Over one million lives have been lost, and over 35 million people have been infected with the virus. While infectious diseases don’t discriminate by age, race, social class, or gender, these factors do influence how COVID-19 and the related social ramifications will affect the illness experience for different people. For instance, when looking at gender, women have been more severely impacted than men. Men are more likely to die as a result of contracting COVID-19, but women experience the brunt of the long-term social effects, partially due to preexisting gender inequalities.

Looking at the healthcare sector alone, women were affected tremendously for many reasons. First of all, about 70% of healthcare workers are female. This means that a disproportionate number of females are putting their health and lives at risk to improve the lives of others. They were more heavily affected by PPE shortages at the beginning of the pandemic, and when PPE did become available, the “one-size fits all” design, which defaulted to the typical cisgender male body, was often ill-fitting and not conducive to managing menstrual cycles. Additionally, women who work in healthcare delivery have been historically overworked and underpaid. In normal circumstances, many healthcare professions, like nursing, have high burnout rates. However, studies have shown that the pandemic has increased the negative mental health effects of the job, primarily in females and in nurses.

Additionally, women live longer than men, and women are the vast majority of the population in nursing homes. During the pandemic, nursing homes have had to take drastic action to ensure the safety of their residents through restricting visitation and group events. This has led to significant social isolation in nursing homes, and loneliness follows closely behind. Further, many elderly people that live alone are women who rely on the care from their family. With the social distancing and their increased risk for severe disease, this has left many women almost entirely isolated—with the exception of family and friends dropping off groceries. This has led many women over 65 to meet up with friends. This makes them more likely to contract COVID-19, but for many, the increased risk is worth it to not be lonely.

Another health effect of the pandemic for women has been reduced access to healthcare, especially sexual and reproductive health. Across the globe, procedures considered elective were postponed due to concerns of restricting nonessential personnel from being in hospitals. However, many elective procedures can play an important role in a woman’s health. For example, endometriosis is a disease in which the uterine lining grows in areas where it shouldn’t, such as in the fallopian tubes and on the bladder, and it can cause immense pain in women who have it. One of the treatments is surgery to remove the excess growth. This not only may relieve pain but also increase fertility, so women who want to have children are more likely to be able to do so. While this surgery undoubtably improves the lives of women with endometriosis, it is considered an elective surgery, and in many places, women had their surgeries postponed. For women with immense pain, finally seeing the light at the end of the tunnel, this was devastating.

This is one of many experiences that women have faced. Many treatments and prevention methods for women’s sexual and reproductive health are considered nonessential, so many women have had to postpone their HPV vaccines, and STI and cervical cancer screenings. Additionally, some states have tried to roll back abortion services. India had a very strict lockdown, which prevented many women from access to contraceptives. This led to “over 800,000 unsafe abortions,” which is the third most common cause of death among pregnant women in India.

Outside of the healthcare sector, women have experienced many social repercussions due to the pandemic. Even before the pandemic, women were largely responsible for the unpaid care work, such as taking care of children or older family members. Now, with children home from school, and older people less able to do their own errands because of the risk of contracting COVID-19, the burden is falling on women and girls. Because of this, many women have to give up their job, or at least cut back hours, and many girls have to put their education on pause.

mom reading a book and son holding a baby while doing homework — Homeschooling. Source: Iowapolitics.com, Creative Commons

Before the pandemic, there were indications that great strides were being made towards gender equality in society and in work. However, a lot of the progress was lost with the onset of the pandemic and with lockdowns. While female-dominated jobs are typically the most protected during economic downturns, lockdowns affected female-dominated jobs at a higher rate than male-dominated jobs: it is estimated that female job loss was 1.8 times higher than male job loss. This is mainly because women are more likely to work jobs that are part-time or temporary, which makes their job security decrease significantly. As mentioned before, women are more likely to take care of family due to closures in school and older family needing assistance, making them less able to work, even from home. All of these factors mean women will be making less money because of the pandemic.

Finally, because of lockdowns, women are staying home more. While this is frustrating for many people, it can be dangerous for women in abusive relationships. Abusive relationships are dangerous to begin with, but with the added stress of the pandemic and being stuck in the same house for days, weeks, or even months, the severity rises. Additionally, a lockdown places women experiencing domestic abuse in a dangerous situation because it’s harder for them to escape the abuse through women’s shelters. Another way some women would typically be able to escape a domestic violence situation would be through a community, but even in normal circumstances those can be hard to come by as it’s typical for abusers to isolate their victims, and with the added isolation of the pandemic, it’s even harder.

Everyone has been significantly impacted by the pandemic. However, some people have been affected more than others, especially when indirect health effects and social effects are taken into account. Because of the disparity between the effects on men and women, we must aim interventions at women and girls. Not doing so could negatively affect years of progress made toward gender equality, and negatively impact the mental and physical health of women in the future.

COVID-19 and Teenage Pregnancies

by Grace Ndanu

It takes a lot of love, effort and dedication to be a good mother. For that reason, I believe it is important that everyone has the choice whether or not to be a parent, and when to take on that responsibility. Unfortunately, many girls around the world do not get to choose. Globally, the COVID-19 pandemic remains a pain to society because it is definitely complicating the efforts of reducing teenage pregnancies. It has caused an immeasurable disruption to every aspect of our lives in the last few months. To contain the spread of the novel coronavirus, governments have taken drastic measures to minimise the spread. Learning has been suspended, with schools being closed indefinitely. Religious meetings and worship programs have been affected similarly meaning there will be no more youth programs in the religious institutions, including churches and mosques for the time being.

In Kenya, the Ministry of Education has put in place strategies to ensure continuity of education through distance online learning delivered through radio, television and the internet. However, these strategies have further widened the inequality gap, as learners from poor, vulnerable, and marginalized households are unable to benefit from continued learning through these platforms due to lack of access. Further, with the loss of livelihoods particularly in low income households, some children may be forced into income-generating activities to support their families’ survival. Also, school closure has stopped the provision of school meals and sanitary towels.

And it’s more complicated for girls living in refugee camps or girls that are internally displaced. For them, school closures are even more devastating as they are already a disadvantaged group. Girls at secondary level are only half as likely to enroll as their male peers. While the magnitude of the COVID-19 crisis is unprecedented, we can look to the lessons learned from the Ebola epidemic. At the height of the epidemic, five million girls were affected by school closure across Guinea, Liberia and Sierra Leone, the countries hardest hit by the outbreak. And poverty levels rose significantly as education was interrupted.

There is evidence that links poverty with teenage pregnancies during this pandemic. One reason is because many young girls are getting involved in economic activities to supplement what their parents are bringing home. On the other hand, as the cases rise day by day there is a strain on the healthcare system, leading to the disruption of healthcare services, re-prioritization of sexual and reproductive and health services and a. shortage of contraceptive commodities and essential drugs. As SRHR services are reducing, sexual behaviour is rising since the teenagers have nothing to do, and it seems to be more risky where parents don’t really care what their children are doing while at home. I feel that there will be more unintended pregnancies all over the world, many of which will occur among teenage girls.

As I have discussed, there is no culture or tradition, it just happens. There are girls, especially those who come from communities or families that are rooted in culture and traditions, these girls must undergo what their parents wants them to, and the girls have no choice in the matter because their hope was school where they would run for help.

A positive pregnancy test — Source: Creative Commons

For example, in the Maasai community, when a girl is at least nine years old she is circumcised then married after two to four weeks. These girls are now expected to take care of their husband and to bear children at that early age.

Unintended pregnancies among teenagers may result in some difficulties in the lives of young girls. There are unsafe abortions, which may happen as a decision of the girl maybe to feel clean and also as a result of family decision in order to keep the family name clean. There is increased poverty where a girl who is being provided everything with the struggling parents bring another baby who needs to be taken care off and be provided everything as they are babies and as they grow all the way to adulthood. At some point there may be denial where by the parents kick out their daughters because of getting pregnant early because they have disgraced the family. This may cause psychological problems because she doesn’t have the supporting system which may force her to get married not only at an early age but also to an old man who may be violent on her. If not marriage she may have suicidal thoughts. Early pregnancies are the leading cause of deaths among the teenage girls because their bodies are not yet matured to give birth. The girls who are forced into marriage as teenagers, the responsibility that they are given drains them off because also their minds are not yet matured to do what is expected of them, which may lead them to be beaten and abused. Everyone deserves to enjoy their childhood.

Something has to be done before it’s too late. The governments should have committees that will develop and implement proven solutions. Different stakeholders should work to respond and to prevent by meeting the unique needs of adolescents by may be providing sanitary towels and also help them access SRHR services. The people responsible for taking care of pregnant teenage girls should teach them how to improve their sexual and reproductive health and well-being. Lastly I believe there are already existing activists in our towns and villages and they can potentially help to reduce negative coping mechanisms, such as child, early and forced marriage, especially during this time, where every energy is driven to the corona situation.

Challenges with Undocumented Immigrants in the U.S.

Humans have always been regarded as higher animals due to several similarities we share, including instinct, cognition, problem solving skills, introspection, creativity, emotional intelligence and planning skills. Just as planning is an ability of both humans and animals, it involves adequate effort and encompasses a wide range of ideas and research put in place to actualize our desired objective. One of the most fascinating parts of planning to me includes identifying the best place or location we can truly reach our goals, achieve our objectives and fulfil our purpose, which all basically centers around migration. Migration remains a constant and unending phenomenon for both humans and animals, and various motives can be attributed to this endeavor, such as the search for food and water, seasonal weather change, mating reasons, employment opportunities, health and education reasons, adventures and thrills, insecurity, and many others. More still, we can basically summarize migration purposes as a search for a better life, which is a basic instinct all living things possess.

In the last ten years, migration within the international context has risen to a significant level despite continuous efforts many countries have dedicated in ensuring their borders are adequately tightened with hope of discouraging immigrants from illegally entering their borders. According to Ross, Cunningham, & Hanna, an estimation of 244 million migrants are presently living temporarily or permanently outside their country of birth. Violent conflict, discrimination and lack of employment opportunities are major reasons for the increasing number of immigrants in several developed countries, and has forced many countries into adopting drastic measures such as rigorous identity checks, detention camps and deportation, to reduce their entry. Another means of curbing the increasing number of immigrants includes formulating and enforcing policies that limits them access to affordable healthcare services. For instance, the United States Affordable Care Act excludes undocumented immigrants from accessing health insurance, while the immigrant provisions of the 1996 Welfare Reform Act, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) excludes undocumented immigrants from publicly funded services.

Several immigration laws and policies within the United States continuously hinder undocumented immigrants’ access to adequate healthcare services, which constitutes a major challenge to all who fall under this category despite evidence proving they contribute more money in taxes to the U.S. economy than they consume in services. What I believe the U.S. government has failed to understand is the fact that these laws and policies not only put the health of these undocumented immigrants at a high risk, but also the health of the general public and socioeconomic development of the country. One of the most detrimental ways these laws and policies have greatly affected this vulnerable population is in the fight against the HIV epidemic. According to Ross et al., migrants who reside in developed countries are disproportionately affected by HIV as the proportion of new HIV diagnosis amongst migrants exceeds the percentage of the general population. HIV, as we all know, is a global epidemic that demands the best care and treatment which was the reason that spurred world leaders in 2015 to restate their commitment to the right to health by enacting the universal health coverage in the sustainable development goals that guarantees all people and communities access to high quality health services.

It is clear the United States government clearly disregards this universal policy that aims at ensuring everyone receives the best healthcare services irrespective of their personality or condition. I guess the U.S. government by their own understanding believes migrants do not fall under the universal coverage as it is evident through their discouraging treatment of undocumented immigrants, more so, those living with HIV. Ross et al. believes migrants persons living with HIV have more characteristics that are associated with poor HIV clinical outcome, and are more likely to die from HIV compared to non-immigrants. For undocumented people living with HIV, there are more factors that exacerbate their condition such as discriminatory laws and policies, lack of follow-up care, ignorance, stigmatization and discrimination. I do believe these discriminating laws and policies serves as the major factor affecting undocumented people living with HIV. One area that typifies this can be seen during the documentation process of a patient health record, which compulsorily demands the immigration status information of individuals. This got me wondering if a client’s immigration status information is actually needed in their health record.

Kim, Molina & Saadi believes documenting immigration status in patient records not only possess a challenge to the clients but also to clinicians. Although by recording this, the information would most likely improve the communication process between the client and the clinician, and also facilitate continuity of care, on the other hand, recording the same information could expose the client alongside their family to risks of being stigmatized or discriminated by non-immigrant friendly clinicians who may expose them to immigration enforcement officers even though it violates patient confidentiality. They believe explicit documentation of immigration status of patients alongside their families in a health record be avoided as evidence suggest risks outweigh benefits in this regard. Conversation about immigration status using indirect language in describing social context should rather be prioritized over written documentation to ensure patients have their healthcare needs met without fear. They concluded by advising clinicians and the general healthcare system to ensure policies and guidelines reduce the high level of stigma and discrimination for all rather than the present opposite.

Families fighting against forced separation — Madison, WI, USA- February 18, 2016 – group of people protesting new Wisconsin immigration laws. Source: Yahoo Image.

Another area that strikes me hard for undocumented immigrants living with HIV are those who are currently in detention camps across various states in the U.S., a revelation which came to me through one of my on-campus events with the representative of the Alabama Latino Aids Coalition. The speaker spoke about the inhumane treatment undocumented immigrants go through while in detention, more so, people living with HIV. This made me do some research and I found several evidences that confirmed undocumented immigrants living with HIV can actually maintain continuous access to care and treatment while being detained in correctional facilities to ensure they sustain or achieve good virologic outcomes and well-tolerated regimens if structured protocols are implemented and enforced. It should be noted that the detention process for migrants during their deportation proceedings is complex and rigid which has led to several lapses due to poor access to proper medical care. Even though there are 21 Federal Detention Centers across the U.S., which are operated by the Bureau of Prisons, and all provide Antiretroviral treatment and medication to detainees who disclose their HIV status, there exists fear of stigmatization or discrimination amongst detainees living with HIV as they believe their disclosure may negatively impact their immigration trial, especially if they also fall under any gender or sexual minority groups. Also, the poor living condition and environment of this population while in detention forces some to relapse into substance use, engage in risky sexual behaviors, and disregard their treatment plan.

Based on this understanding, it is hard to imagine the inhumane condition undocumented immigrants are forced to live through while being detained. There is need for the U.S. government to understand that even though several undocumented immigrants after their trial, are usually deported or released at the nearest borders or territories close to their home countries, several others return into the society without receiving adequate rehabilitation or reintegrative education which possess a challenge to the society at large. Human and material resources that could have been used to resolve other pressing needs will then be used to serve their avoidable demands. To resolve this challenge, there is the need to abolish any form of discrimination against detainees living with HIV and ensure it does not affect their deportation trial. Also, clinicians and correctional officers need to be more sensitive to the needs of the detainees having been separated from their families and may never see them again, which is a situation that can easily exacerbate their condition in such a hostile detention environment. Human rights institutions, immigration right advocates, academicians, alongside health authorities, media and the general public should also advocate and help raise awareness about the poor condition of these detention facilities. For deported detainees living with HIV, the U.S. government alongside non-governmental institutions should provide adequate health education using evidence-based treatment medications and materials that meets the specification of their home country to ensure transnational HIV continuity of care.

Picture of Undocumented Immigrants — Undocumented Immigrants in dire need of help. Source: Yahoo Image

In all, we all should understand that undocumented immigrants are also humans and should be treated with utmost respect irrespective of their situation. There is need to ensure their health and wellbeing are adequately met and well taken care of. As humans, we should not only sympathize with them, but also support them by raising awareness and advocating for better laws and policies that can assist them during their ordeal. We should always aim for a multi-sectoral approach that addresses the structural challenges for undocumented immigrants living with HIV such as housing, food security, mental health, and access to employment because there is a continuous effort by the U.S. government to dehumanize undocumented immigrants as community members and remove vital resources that is available to them. As we all know the U.S. government remains extremely resolute in enforcing the 2015 immigration laws that places all undocumented immigrants at risk of being deported, they can also ensure the universal law on respect to all life is adequately respected by enforcing laws, guidelines and policies that protects the lives and wellbeing of undocumented immigrants.

How Covid-19 Exposes the American Healthcare System

When I studied abroad in Spain, I had many discussions with my host family comparing the United States and Spain. These conversation topics ranged from politics, social expectations, and the weather. One topic that my host mother was especially interested in is the American health care system in comparison to the Spanish health care system. Spain has a universal health care system while still allowing private insurance whereas the United States has purely private insurance. Neither system is perfect. However, as the Covid-19 crisis continues to progress it is important to understand how the crisis brings to light the many issues with the American health care system.

A woman in a mask. — Woman in Mask. Source: Patrice CALATAYU. Creative Commons.

It is a well-accepted fact that the United States was significantly less prepared for the impact of Covid-19 than most other developed countries. By any metric of pandemic preparedness, America is significantly behind the rest of the developed world in regard to medical supplies. The country has a severe lack of health care infrastructure within the system; even before the international pandemic, the United States had fewer doctors and hospital beds than the majority of other developed countries. The United States lacks in the number of doctors per capita with 2.6 doctors per 1,000 people. The comparable country average is 3.5 per 1,000 people, which shows just how behind America is. The United States also has fewer hospital beds per capita than the majority of other developed countries. To make matters worse, America has some of the highest rates of unnecessary hospitalizations. These are hospitalizations of patients with chronic conditions that have preventable treatment, making it unnecessary for the patient to be hospitalized. With a pandemic such as Covid-19, these unnecessary hospitalizations are diminishing. However, in the beginning of the crisis within the United States, unnecessary hospitalization significantly slowed down the efficiency of the health care system in caring for Covid-19 patients.

An important trend in the preparedness of the United States for Covid-19 is that the United States, with a private health care system, was noticeably less prepared than countries with universal health care systems. It is true that universal health care is not the perfect response to pandemic emergencies like Covid-19. This is shown by Italy, a country who has a federalized national health insurance program. Italy still needed to lock down and for a while had the highest case and death rate than any other country. However, countries like Italy with universal health care were able to begin recovery and slow the spread of the virus much quicker than those without.

a hospital — Hospital Beds. Source: Presidencia de la Republica Mexicana. Creative Commons.

As health providers have been working tirelessly to make the necessary changes to care for Covid-19 patients, private health insurance companies have been making very few changes to their processes. One system health care providers have been implementing is telemedicine, a program that allows patients to securely consult with their health care providers virtually therefore easing the burden on the infrastructure of the hospitals. Despite President Trump expanding provisions on telemedicine, private health companies are not required to pay health systems for telemedicine. At the same time, while some insurance companies have waived some Covid-19 related costs, out-of-pocket expenses are not waived resulting in patients needing to pay thousands of dollars. To put these costs in perspective, in 2018 the average amount for a patient covered by private insurance admitted to the hospital for a respiratory condition similar to coronavirus was $20,000. Additionally, as hospitals across the country prepared for an influx of Covid-19 patients, stable patients without the virus were forced to stay in the hospital beds. These patients, who should have been moved to a rehab facility or released, were taking up unnecessary space due to private insurance companies taking multiple days to authorize the next steps for each patient. This has been a known delay in hospitals before the pandemic but now it is a delay that has dire consequences.

Quite possibly the biggest problem in the American health care system is cost. This problem is unique to the United States. Citizens are required to pay higher out-of-pocket costs than those in most other countries, leading Americans to forgo their health care in order to save money. Reports have shown that 33 percent of Americans reported a cost-related barrier to receiving care. This is in comparison to the 7 percent who reported the same in Germany. In 2019, a study showed that 33 percent of Americans also reported postponing medical care due to the cost of that care. It is only in the United States that citizens are risking thousands of dollars in order to seek help in a medical crisis like the one posed by Covid-19. A major concern across the world is that Americans will not seek care for corona symptoms due to the high costs of healthcare in the United States and the high amount of people without insurance in the country. This will spread the disease significantly faster than officials within the country would like to believe.

man with supplies — Medical Supplies. Source: Navy Medicine. Creative Commons.

As the Covid-19 cases rise in number across the country, an unusually high number of African Americans in the United States have been infected with Covid-19. This news, while terrible, is unfortunately not shocking and highlights the many racial inequalities in the health care systems. Coronavirus does not have a racial factor but the structural racism within the American health care system is evident. African Americans are over-represented in many essential workplaces making the population more at-risk than other populations. At the same time, African American populations are less likely to have health insurance coverage leading to a disproportionate number to not receive the necessary help from the health care system. There also exists a racial empathy gap that disproportionately affects African Americans and Hispanics within the United States. A racial empathy gap is when medical professionals show less empathy and sympathy to African American patients who are experiencing pain. Human rights workers have been working on mandatory reviews to ensure that health workers are providing an equitable form of treatment for minority patients. However, due to a bias developed and enforced by societal constructs of different races, there exists a higher risk for minority populations within the American health care system.

A few examples of problems within the American health care system that have been exacerbated by Covid-19 are highlighted above. While officials within this system and within the government must work to make necessary changes, it is also important to recognize the lifesaving and tireless health care workers who work within the imperfect system. Covid-19 has shown the country how necessary health care workers are. Nurses, doctors, surgeons, and so many other health care providers have dedicated an immense number of hours to fighting Covid-19. These individuals who are working to save lives within the corrupt health care system are extremely important and we must recognize their hard work while we work to make the system fairer and more equitable.

Responding to COVID-19 in Developing Countries: An Appeal from Our Friends at Nashulai Maasai Conservancy in Kenya

Just a few short months ago, the IHR hosted Nelson and Maggie Reiyia from Kenya who spoke to us about Nashulai Maasai Conservancy, wildlife conservation, preservation of culture, and how to empower whole communities from the inside out, especially girls and women.

How long ago this seems now, in the midst of the COVID-19 crisis. The impetus of this blog post is Nelson and Maggie’s desperate appeal to help support their people who have been hit extremely hard by this crisis, and to show how COVID-19 affects people in the developing world.

COVID-19 in developing countries

While we have raised awareness of what this crisis means for some of the most vulnerable and marginalized in our own society, having to deal with a pandemic in developing countries is a whole different endeavor. The virus itself and the sickness it causes are only half of the danger. Major societal issues such as widespread poverty, economic deprivation, and lack of access to water, food, sanitation, and healthcare present huge challenges for people in the Global South. The COVID-19 crisis threatens already fragile economies and has the potential to negatively impact human rights, education, basic resource allocation, and food security. Under-resourced healthcare systems and hospitals are likely to be overwhelmed, creating a probability for higher death rates. A majority of people in developing countries also lack access to water and soap, increasing the likelihood of infections and facilitating the spread of the disease. In addition, there are no social safety nets or government bailouts for workers and businesses, exacerbating scarcity, political struggles, violence, and poverty.

Women and children talking in Maasai house. — Women and children in a Maasai house at Nashulai Conservancy. Source: Nora Nord, nashulai.com

In other words, it is not just the virus that threatens people’s lives in developing countries, but the whole context – poverty, underdevelopment, structural violence, lack of government resources to respond to the pandemic – that puts lives in peril and threatens the existence and survival of whole communities. People in developing countries are doubly at risk. This crisis will leave deep scars, not only with regards to lives lost, but also with regards to international development gains made in the last decades in development, human rights, and human dignity. These are the issues Nelson and Maggie are afraid of. They are not only worried about the immediate impact of this crisis on their people, but also about the setback this crisis will cause to the wildlife, economic, and cultural advances that have sustained and elevated their community for the last years and made Nashulai indispensable for their society. Their people, their project, and their way of life are in peril of survival.

What COVID-19 means for Nashulai Conservancy

Nashulai is a community-led conservancy in the Maasai Mara in the southwestern part of Kenya, close to the border to Tanzania. The Maasai are an indigenous community of strong and brave warriors, but poverty and lack of development have negatively affected their quality of life. Most Maasai exist on less than $1 a day, depending mostly on their livestock for food and income. More recently, due to Nashulai’s efforts, the community has been able to garner revenue through tourism by offering safaris and running guest houses and camps. About 2,000 people live on Nashulai’s 6,000 acre conservancy, and an additional 3,000 people live in the surrounding communities. Most of them reside in traditional Maasai villages, in which small dwellings arranged in a large circle for community living. Women, men, and children live together in small spaces and share food, resources, and chores with one another. Men mostly look after cows, sheep, and goats or work in local tourist camps and lodges, while women prepare food, raise children, and make jewelry and art work to sell to tourists. Livestock is sold on twice-weekly open markets in exchange for grains, oil, salt, and other basic necessities.

Picture showing a Maasai man with his cattle in a Maasai village. — The Maasai live in close-knit communities where women, men, and children of different families share all aspects of everyday life. Source: Marianne Nord, nashulai.com

COVID-19 has put all of this in danger. The markets are closed due to government safety measures, leaving people without food and without income. Tourist streams have run dry, which means no money and no jobs (90% of employed Maasai rely on the tourist industry). The communal way of Maasai life is in direct opposition to the guidelines of social distancing and self-isolation. There is no running water in Maasai homes, making constant handwashing not an option. Healthcare in the rural areas of Kenya is difficult access in the best case, and Sekenani health clinic in the conservancy is not equipped to deal with COVID-19 cases. It is unclear what should happen to people who become infected. There is a lack of information and education about the crisis, and an absence of guidance of what the WHO guidelines of handwashing, social distancing, and self-isolation and quarantine mean for people in places like Nashulai. There is no electricity beyond solar power, and while some people have phones or radios, spreading news and information is extremely difficult.

The situation is dire. People are starving.

Nelson and Maggie have developed an emergency plan to provide each household with basic food items, to repurpose part of Nashulai’s tourist camp to isolate sick people, and find ways to educate the community about safety measures and health. They have established a strategy on how they can become self-sustaining in terms of food production and continue their important conservancy work over the next months. However, because their stream of revenue has been cut, they rely on us, their friends, to support them, the Maasai people in their community, and the long-term survival of their project.

Please visit Nashulai Maasai Conservancy’s website if you would like to learn more and/or if you would like to donate to Nashulai Maasai Conservancy’s COVID-19 Emergency Fund.

Impact of Covid-19 in Conflict Zones

“Wash your hands.” “Avoid close contact with others.” “Stay home.” These are the CDC’s recommendations for protecting yourself against the coronavirus and the disease that it causes, COVID-19. For those of us fortunate enough to have clean water and soap and space and a home, that is helpful advice and easy enough to follow, even if it is somewhat of a disruption to our normal lives. Unfortunately, these recommendations are completely irrelevant to the millions of people across the globe who live in conflict zones and refugee camps where fresh water is scarce, sanitary facilities are lacking, and the healthcare infrastructure has been decimated by war and continuous violence. In places where day to day survival is already a key concern, the novel coronavirus poses a new kind of threat, one that the struggling healthcare systems in these countries is not prepared to take on.

While the U.S. government and media have focused on individual vulnerabilities, such as age and underlying respiratory conditions, very little has been done to address social and structural vulnerabilities, including limited access to basic services, health care, safe water, sanitation, and hygiene, in some of the most dangerous places in the world. Overcrowded refugee camps are a virus’ dream – they provide conditions in which the virus can spread rapidly and easily. Individuals living in these places are already prone to respiratory problems due to air pollution and living in close quarters. Unsanitary conditions and lack of housing, food, and clean water exacerbate the risk of contracting an infectious disease, and the lack of access to basic health care makes fighting any kind of infection difficult. The coronavirus is highly contagious and has a very high global mortality rate, even in places where social distancing and healthcare are accessible, and this rate will likely be significantly higher in conflict zones where large numbers of displaced people live. Preventing the virus from entering these spaces is the only hope, but as Dr. Esperanza Martinez, head of health for the International Committee of the Red Cross, has said, “this is uncharted territory,” and it is unclear how effective containment strategies will be in reality (or if they are even possible in certain places).

According to the Center for Strategic and International Studies, 126 million people around the world are in need of humanitarian assistance, including 70 million who have been forcibly displaced from their homes, mostly due to violence. COVID-19 is adding a new layer of uncertainty and fear to the already precarious and vulnerable status of these individuals and families. The UN High Commissioner for Refugees (UNHCR) and the International Organization for Migration have suspended refugee resettlement programs, and many governments worldwide have stopped the intake of refugees who are fleeing violence and food insecurity. Cases of COVID-19 have been confirmed in war-torn areas in the Middle East, including Afghanistan, the Gaza Strip, and Ninevah, a displaced persons camp in Iraq, as well as in several African countries, including war-torn Libya, Cameroon, and the Congo. This post considers how this global pandemic will likely impact people living in three particularly dangerous and vulnerable countries in the Middle East and West Africa: Syria, Yemen, and Burkina Faso.

Syria

Nine years into the seemingly endless civil war in Syria, more than 380,000 people have died, dozens of towns and cities razed to the ground and half of the country’s entire population displaced. Targeted attacks have left Syria’s once thriving public health care system in shambles. Hospitals and clinics have been destroyed or damaged to the point of not functioning. Medicine and medical supplies are limited, healthcare workers are few, and travel to the still-operational clinics and hospitals is out of the question for many of the sick and suffering. Of particular concern is the refugee camp in Idlib, a town in the northwestern province near Turkey, where many displaced individuals now live. The conditions of the camp are dire – there is limited access to soap and water and overcrowding makes social distancing impossible – so self-protecting is a major challenge.

Syria reported its first case of coronavirus a few days ago, from a woman who had recently traveled to Iran, a country that is backing the Syrian government in the civil war and where Shia pilgrims frequently travel. There are now five confirmed cases (the actual number is suspected to be much higher), and there is growing fear that the virus is spreading unimpeded throughout the northwest, where there is limited capacity to test and monitor the situation, but experts have warned that “if the disease starts, it will spread massively.” Jan Egeland, director general of the Norwegian Refugee Council, has warned that COVID-19 could “decimate refugee communities.” Containment is the only hope, but the shortage of supplies, including test kits, makes this unlikely.

Yemen

The United Nations has labeled the situation in Yemen the world’s worst humanitarian crisis. No cases of COVID-19 have been confirmed yet in Yemen, but the country is bracing for a devastating catastrophe if and when the virus arrives. Since the U.S.-backed war in Yemen began five years ago, Saudi and Emirati coalitions have leveled 120 attacks on medical facilities throughout the country. These attacks, including airstrikes, ground-launched mortar and rockets, and attempts to occupy hospitals and clinics, have led to widespread disruptions in access and service to some of the world’s most vulnerable people, including displaced women, children, and persons with disability. With a mere 51% of the country’s health centers operational, there is a severe shortage of medicine and medical equipment. Even if people in this area can get to a hospital, many hospitals don’t have electricity, rendering a ventilator — a potentially life-saving device for people suffering the most severe symptoms of COVID-19 — out of the question. The decimated healthcare infrastructure is unable to control preventable disease (there was a cholera outbreak a few years ago) and is completely ill-equipped to handle a pandemic. Both the Houthi rebel group (aligned with Iran) and the government recognize the threat the virus poses and are implementing precautionary measures, such as closing schools and halting flights into the area. However, both sides are amping up their rhetoric and are posed to blame the other if and when cases of COVID-19 are confirmed. The United States, for its part, has cut off emergency aid to Yemen, citing the Houthi’s interference in the distribution of supplies and services to starving Yemenis (likely a Saudi-directed approach), but humanitarian officials have warned that this decision will create major funding gaps in efforts to provide hand soap and medicine to clinics and to staff health centers with trained healthcare workers. Yemen’s basic healthcare programs are heavily reliant on foreign aid – about 8 out of 10 Yeminis rely on some form of aid. Eliminating this source of funding could mean suffering and death for millions of displaced persons in Yemen.

Burkina Faso

On March 18, Burkina Faso, the impoverished West African country of 20 million people, registered its first confirmed case of COVID-19. A week and a half later, that number leapt to146 cases, with hundreds more suspected, making it the hardest hit West African country so far. This tiny, conflict-scarred country is no stranger to hardships, including poverty, drought, rampant hunger, and militia-led coups. In 2019, clashes between government forces and militia groups linked to ISIL and al-Qaeda led to more than 2,000 deaths in Burkina Faso and forced more than 700,000 people to flee their homes. This escalation of violence has led to the closure of 135 health centers in the country, and an additional 140 have reduced their services, leaving 1.5 million Burkinabe in dire need of humanitarian health assistance. With a healthcare system that has been ravaged by war, a mere three facilities in the country are able to carry out the tests, and only a few hundred test kits have been provided. As part of the government’s response, Malian refugees once displaced into Burkina Faso are being forced back into Mali, where ongoing violence inhibits humanitarian and medical access to affected populations. COVID-19 will exacerbate an already dire situation — it is feared that an outbreak would see fatality rates of ten times higher than the global average. “These populations are already very vulnerable to diseases that are otherwise easy to treat,” says Alexandra Lamarche, senior advocate for West and Central Africa at Refugees International, “but that’s not the case when they have no access to water or proper sanitation or health care.” She adds, “We could watch entire populations vanish.”

Bumper sticker that says "All people are created equal members of One Human Family" — Source: Yahoo Images

Against a common enemy?

Rarely does a disaster – natural or otherwise – affect the entire world. The coronavirus is a different story, unlike anything we have witnessed in the modern age. It is exposing the fragility of even the most advanced economic, technological, social and medical systems, and it poses a grave threat to humans the world over. The virus doesn’t discriminate on the basis of status or religion or skin color or any of the other things that divide us or give us cause to fight each other. It travels across borders and between enemies, and the more people it infects, the greater the risk for everyone. Just like the virus, the distribution of basic human rights must not be qualified on the basis of anything other than humanity. Turning a blind eye to the suffering and inadequate conditions of the world’s most vulnerable populations only facilitates the spread of the virus. In a practical sense, limiting the spread of the virus in refugee camps and conflict zones in Yemen and Syria and West Africa is just as important as it is in wealthy countries if the goal is to eliminate the virus and end this global pandemic. That requires distributing resources and investing in large-scale infrastructure improvements in places where people are not able to follow the protocols for containment under the current conditions. As we scramble to make enough surgical-grade masks for healthcare workers in the United States to wear, we need to be concerned with sending as many as possible to medical facilities in places around the world that are under-served and over-taxed, including displaced persons camps. We cannot hope to protect ourselves if we refuse to protect our fellow humans, no matter the distance or cultural difference between us. U.N. Secretary-General Antonio Guterres has called this “the true fight of our lives,” insisting that we put aside our differences, which now seem small and inconsequential, and turn our aggression toward a common enemy. “That is what our human family needs, now more than ever.”

A Time to Recognize and Safeguard The Rights That Connect Us

by Peter Verbeek, Ph.D. (Associate Professor, Program Director MA Anthropology of Peace and Human Rights)

A picture of a girl with a surgical mask covering her mouth and nose — Source: Yahoo Images

On March 6, 2020, the UN High Commissioner for Human Rights, Michelle Bachelet, issued a statement calling for an holistic human rights based approach to combat COVID-19. She wrote, “As a medical doctor, I understand the need for a range of steps to combat COVID-19, and as a former head of government, I understand the often difficult balancing act when hard decisions need to be taken.” However our efforts to combat this virus won’t work unless we approach it holistically, which means taking great care to protect the most vulnerable and neglected people in society, both medically and economically.” She added, “COVID-19 is a test for our societies, and we are all learning and adapting as we respond to the virus. Human dignity and rights need to be front and centre in that effort, not an afterthought.”

To heed Dr. Bachelet’s call we must remind ourselves of the fact that human rights are universal and inalienable, indivisible, interdependent and interrelated. We also must recognize that the essence of human rights is human dignity. All human rights arise from it and all human beings are born with it and posses it throughout their life span. Human dignity is not measured on a sliding scale. To illustrate, there is no difference in human dignity between that of the office holder of the Presidency of the United States and the migrant at the US Southern border. The accused in the court proceeding has the same human dignity as the judge presiding over her case. The convict and the prison guard do not differ in their human dignity. The human dignity of the disabled veteran is the same as that of the person pushing her wheelchair. And the human dignity of the COVID-19 patient in the isolation ward is the same as that of the health-care worker taking care of him.

The recognition of our shared human dignity and the safeguarding of the rights that arise from it is a powerful unifier in troubled times. Now that we are faced with a near global outbreak of an until recently unidentified corona virus we can stand united in the recognition that every person on this Earth has an irrevocable right to health care and security in the case of illness (UDHR, Article 25). With rights come responsibilities, and the unifying power of universal human rights is the way that each of us in accordance with our specific context and abilities has a role to play in safeguarding access to appropriate preventive and interventional health care and personal security regarding COVID-19. Our individual roles are necessarily varied, from driving a neighbor without proper means of transportation to a health care facility, to following “doctor’s orders” concerning personal hygiene or social distancing. If infected or taken ill we have a right to receive the best available care and the responsibility to follow the guidelines in place so as to minimize the risk of infecting others. Each of us has a responsibility to listen to the relevant and evolving science as communicated by medical experts, and each of us has the responsibility to comply with the local and national guidelines that are based on this science.

Some of those taken ill with COVID-19 will die in spite of our best efforts to care for them and protect them. If the fight to save their life is at the cusp of being lost we have the responsibility to see to it that their death reflects the human dignity that they possess. Medical science does not yet have the answer to the question of how to protect oneself conclusively against viral infections such as the current corona virus. That realization, while sobering, should not keep us from doing all we can in terms of what we do know about prevention. There is much that we can do to limit the risk of infection, provided we follow the relevant science. The human rights motto is that any infection, or worse, any death, linked to insufficient preventive measures is one too many, and we all stand united in this through the human dignity that each of us possesses.

The Nutrition and Health Crisis in Venezuela

Child wears hat that says Venezuela on it and stares off into the distance. — ELEICOES 2013 NA VENEZUELA. Source: Joka Madruga, Creative Commons

The current president of Venezuela, Nicolás Maduro, was elected in 2013 by a very small margin. During his first term, the Venezuelan economy took a turn for the worst. He was reelected for a second term in 2018, but his opponents feel that the election wasn’t valid because many of the other candidates were made ineligible to run or even jailed, so the National Assembly does not recognize his presidency and considers the presidency vacant. According to the Venezuelan Constitution, in cases of a vacant presidency, the leader of the National Assembly (currently Juan Guaidó) takes over as president. Guaidó has very little political power because the military still supports Maduro.

I first heard about the political and economic unrest in Venezuela when I went on an exchange trip to Spain in May of 2016. My host family had moved to Spain eight months earlier because their jobs had been the first affected by the economic downturn. They were lucky that the dad was a Spanish citizen—it was much easier for them to move to Spain than if none of them had been citizens—but many Venezuelans have not been so lucky.

Protests in Venezuela — Venezuelan Protests. Source: Trong Khiem Nguyen, Creative Commons

Since 2015, health statistics have been underreported—if they’ve been reported at all. December of 2016 marked the last report from the Venezuelan Ministry of Health. This report describes an alarming increase in previously eliminated and controlled infectious diseases, such as malaria and diphtheria, and in maternal and infant mortality rates. The report has many alarming statistics, but aside from that, it is the last one to have been published. Additionally, the Health Minister who published the report was fired immediately afterward.

With no one within the country reporting on the health needs and statistics of the people, it is nearly impossible for other countries to give external aid. Additionally, even when aid sent, the Venezuelan government refuses help. Even nongovernmental organizations (NGOs) are forced by law to refuse help: the Supreme Court ruled in 2010 that any NGOs receiving financial assistance from other countries would be committing treason. This has a devastating impact on the citizens as they are not receiving the help that they need.

The situations in the hospitals are dismal. According to a survey conducted by the political opposition, many services in hospitals are not consistently available, if at all, due to lack of supplies. Many supplies have gone missing from public hospitals and clinics, and those being shipped in often are embargoed and never make it past the ports. The reason is unknown, but many suspect it has to do with the corruption of the government. This has forced patients to bring their own medical equipment—which can include anything from medicine to surgical equipment—when going to the hospital, so they know they’ll have what they need. Private clinics, which have most of the supplies they need, ask for payment in US dollars, which means only the wealthiest can get that level of care. This leaves the average citizen without proper medical care in a country where the government is actively keeping lifesaving materials out of the hands of doctors.

Because of the low levels of health care, many diseases are reemerging and worsening. Between 2008 and 2015, there were no cases of diphtheria reported and one case of measles reported. However, in the past three years, over one thousand cases of diphtheria and over six thousand cases of measles have been confirmed. These statistics show a lack of vaccinations in children, which is potentially due to limited vaccines available. Malaria rates, which were once controlled through pesticides, medication, and reduction of mosquito breeding areas, have increased by over ten times from 2009 to 2017. Tuberculosis cases more than doubled from 2014 to 2017, which is even more concerning with the cases of untreated HIV on the rise as well. According to the Human Rights Watch, “Venezuela is the only country in the world where large numbers of individuals living with HIV have been forced to discontinue their treatment as a result of the lack of availability of antiretroviral (ARV) medicines.” 90 percent of HIV positive Venezuelans have to live without ARV medicines, and these people are majorly susceptible to and will be severely affected by the many diseases that are on the rise. Because all of these diseases are on the rise and the limitations of hospitals, maternal and infant mortality rates in Venezuela have risen back to their levels from the 1990s. Venezuela is the only Latin American country where this has occurred.

In addition to the health crisis, there is also a nutrition crisis. The last nutrition data published was in 2007, but many Venezuelans report only eating yuca or a tin of sardines for their one meal of the day. According to the UN’s Food and Agriculture Organization (FAO), 11.7 percent of the population is undernourished, meaning they are not getting enough nutrients. This is severely affecting Venezuelan children; as of March 2018, 17 percent of children under 5 in lower income areas of Venezuela have moderate acute malnutrition (MAM) or severe acute malnutrition (SAM)—a 7 percent increase from February 2017 and a level of crisis. According to WHO, the fatality rates for children under the age of five who have SAM and MAM are between 30-50 percent, so it is important that children not only have access to healthy food, but that hospitals also have access to the necessary treatments, and at this time that is not generally the case in Venezuela. Pregnant women are also affected by MAM and SAM, which can lead to adverse outcomes during pregnancy, childbirth, and the child’s infancy.

Venezuela is not the only country that is experiencing a health and food crisis. However, many countries have these issues due to lack of resources, funding, or aid. While Venezuela is experiencing an economic downturn, they have been offered plenty of aid, which they have repeatedly refused. Additionally, the lack of reporting health and nutrition statistics is concerning for many reasons. First, this most likely means that no one, including the Venezuelan government, knows the extent to which the Venezuelan citizens are suffering. Second, it shows that the Venezuelan government is willing to conceal the level of suffering experienced by its citizens in order to protect their image, instead of asking for assistance; it sends a message that they do not care about the wellbeing of the citizens they are supposed to serve and protect. The UN continues to urge the Venezuelan government to let them send assistance, warning that their situation can become much worse than it already is, but they continue to refuse and push back on any assistance offered and put the lives of their citizens on the line.