Caracas Chronicles

Photo: Share America, retrieved.

Humanitarian aid must abide by its principles of action:

Independence: it must be autonomous and separated from political, economic, military or other kind of objectives;

Impartiality: it must be implemented according to need, prioritizing the most urgent cases regardless of nationality, race, gender, religious beliefs, social standing or political opinion;

Neutrality: it can’t take sides in hostilities, armed conflict or political, racial, religious or ideological controversies;

Humanity: human suffering must be assisted wherever it is, to protect the life, health and dignity of human beings.

The aid that now struggles to enter Venezuela fulfills the requirements of impartiality and humanity, and only those.

Adhering to all four is what makes humanitarian action distinguishable from the activities and objectives of other actors with other agendas that might (even unwillingly) hinder the neutral task of relieving people’s suffering.

Politically, I understand, but as a doctor and humanitarian, I think it’s cruel to use health and hunger as political instruments, and it worries me how the role of foreign aid is unknown and misunderstood in Venezuela. The expectations it has encouraged among the most vulnerable dishearten me.

The aid doesn’t seek (or is able) to replace a government, its function is not to substitute the state’s social security system, the pharmaceutical service. The aid is for critical situations, where the balances and survival mechanisms, already fragile, break down and collapse. The aid is meant for people at the brink of death, not an entire country, not everyone who’s starving, not everyone who’s ill.

The aid that now struggles to enter Venezuela fulfills the requirements of impartiality and humanity, and only those.

It’s cruel, painful and unfair, yes. It’s not the aid’s fault for being incomplete or insufficient, among other reasons, because we’re not the only country in crisis in the world and generic and global aid must be distributed among all of those. The aid must choose. It’s temporary, limited and selective.

The most vulnerable groups, namely, children under five and pregnant women are the target. Epidemics, medical emergencies and surgical emergencies are also a priority, so nobody dies of measles, hypertensive crises, diabetic comas or appendicitis. Then come chronic diseases (kidney and cancer patients, diabetics, HIV patients, epileptics) according to public health, prevalence, incidence and mortality criteria.

Basically, in situations of crisis, we can’t keep acting and planning as would an ordinary Health Ministry in normal times. When we talk about aid, namely health and nutrition, we must know the nature of the aid and its volume. The aid must respond to reality.

There are geographic issues, (more or less central areas, more or less forgotten areas, components of the sanitary map, of access and availability of health services) there are cost/benefit issues (attending surgical cases versus nationwide vaccination campaigns according to available resources, for example) and we must think of treatment programs by day, by patient, by minimum duration of the treatment.

A child with severe malnutrition without associated diseases will require at least two packets of therapeutic food per day, for an average of 30-45 days. How many packets of that therapeutic food have arrived? Based on those estimates: how many children can be treated? A few million dollars, a few tons or shipments of food or medicine aren’t enough and, in practice, they prevent health personnel from organizing and establishing a plan of rational and fair distribution to reach those who need it the most.

I repeat, the aid isn’t meant to replace a government and there isn’t enough for everyone.

When resources are scarce (as they were in Venezuela even before this crisis) there’s always the difficult decision of choosing which patient is saved when there aren’t enough beds for everyone, and this is especially so with humanitarian aid cases, where the limit of the aid may require from us to choose between medical and surgical emergencies, and even surgeries must prioritize urgent caesarean sections above all else. Just to replenish and improve operation rooms across Venezuela, we require a budget similar to the one needed to finance national vaccination campaigns, or therapeutic food for all children with severe malnutrition.

Making these kinds of decisions is an overwhelming and dreadful challenge. For health personnel, volunteers and humanitarian staff, that’s part of the job; it’s tough, but necessary in critical situations.

I repeat, the aid isn’t meant to replace a government and there isn’t enough for everyone.

The inequality and injustice that we experience today regarding health and food won’t be solved with foreign aid. It’ll help, it saves lives and it’s necessary. But it’s not the solution.

The solution is domestic, and political.