Tag Archives: Medicine Shortage

Venezuela annual inflation at more than 4,000 percent: National Assembly

A woman and a child look at prices in a grocery store in downtown Caracas, Venezuela March 10, 2017.

By Girish Gupta

CARACAS (Reuters) – Prices in Venezuela rose 4,068 percent in the 12 months to the end of January, according to estimates by the country’s opposition-led National Assembly, broadly in line with independent economists’ figures.

Inflation in January alone was 84.2 percent, opposition lawmakers said, amid an economic crisis in which millions of Venezuelans are suffering food and medicine shortages.

The monthly figure implies annualized inflation of more than 150,000 per cent and that prices will double at least every 35 days.

With cash in short supply and banking and communications infrastructures struggling, day-to-day transactions are becoming increasingly difficult for Venezuelans.

The government blames the problems on an economic war waged by the opposition and business leaders, with a helping hand from Washington.

Critics in turn blame strict currency controls, which were enacted by Hugo Chavez 15 years ago this week. The bolivar is down some 40 percent against the dollar in the last month alone.

A million dollars of Venezuelan bolivars bought when the currency controls were introduced would now be worth just $7 on the black market.

The government has not published inflation data for more than two years though has increased the minimum wage repeatedly in a nod to rising prices.

The government raised the minimum wage 40 percent on Jan. 1, making it roughly equivalent now to just over $1 per month.

(Additional reporting by Leon Wietfeld; Editing by Susan Thomas)

Venezuela’s chronic shortages give rise to ‘medical flea markets’

Venezuela's chronic shortages give rise to 'medical flea markets'

By Anggy Polanco and Isaac Urrutia

SAN CRISTOBAL/MARACAIBO, Venezuela (Reuters) – Venezuela’s critical medicine shortage has spurred “medical flea markets,” where peddlers offer everything from antibiotics to contraceptives laid out among the traditional fruits and vegetables.

The crisis-wrought Latin American nation is heaving under worsening scarcity of drugs, as well as basic foods, due to tanking national production and strict currency controls that crimp imports.

The local pharmaceutical association estimates at any given time, there is a shortage of around 85 percent of drugs.

Sick Venezuelans often scour pharmacies and send pleas on social media to find treatment. Increasingly, however, they are turning to a flourishing black market offering medicines surreptitiously bought from Venezuelan hospitals or smuggled in from neighboring Colombia.

“Here I can find the vitamins I need for my memory,” said 56-year-old Marisol Salas, who suffered a stroke, as she bought the pills at a small stand at the main bus terminal in the Andean city of San Cristobal.

Around her, Venezuelans asked sellers for medicine to control blood pressure as well as birth control pills.

“People are looking for anticonvulsants a lot recently,” said Antuam Lopez, 30, who sells medicine alongside vegetables, and said hospital employees usually provide him with the drugs.

Leftist President Nicolas Maduro says resellers are in league with a U.S.-led conspiracy to sabotage socialism and are to blame for medicine shortages.

RISKS

In the middle of a market in the humid and sweltering city of Maracaibo, dozens of boxes full of medicines including antibiotics and pain killers are stacked on top of each other. The packaging is visibly deteriorated: The cases are discolored and some are even dirty.

Doctors warn these drugs — usually smuggled in from Colombia, a few hours’ drive from Maracaibo — pose risks.

“We’ve found that a lot of them have not been maintained at proper temperatures,” warned oncologist Jose Oberto, who leads the Zulia state’s doctors association.

Still, some Venezuelans feel they have no choice but to rely on contraband medicine.

“I had to buy medicine from Colombia, and it worried me because the label said ‘hospital use,'” said retiree Esledy Paez, 62.

But they are often prohibitively expensive for Venezuelans, many of whom earn just a handful of dollars a month at the black market rate due to soaring inflation.

Norkis Pabon struggled to find antibiotics for her hospitalized husband to prevent his foot injury from worsening due to diabetes.

“But the treatment costs 900,000 bolivars ($9.43; twice the minimum wage) and I do not know what to do,” said Pabon, who is unemployed.

(Writing by Corina Pons and Alexandra Ulmer; Editing by Sandra Maler)

Pharma’s Puerto Rico problems could mean drug shortages: FDA chief

U.S. Food and Drug Commissioner Scott Gottlieb attends an interview at Reuters headquarters in New York City, U.S., October 10, 2017. REUTERS/Eduardo Munoz

By Bill Berkrot

NEW YORK (Reuters) – The head of the U.S. Food and Drug Administration said on Tuesday the country may start to see a small number of drug shortages within two or three weeks due to delays in restoring manufacturing operations in Puerto Rico, where 10 percent of drugs prescribed in the United States are made.

Hurricane Maria slammed into the Caribbean island on Sept. 20, knocking out electricity and causing widespread damage to homes and infrastructure. Almost three weeks later, just 16 percent of electricity service has been restored to the U.S. territory.

Drugmakers are working to get facilities fully online, but face an uncertain power supply and difficulty obtaining materials used in the manufacturing process.

“A lot of companies say they’re online, but they basically have one of five lines running at 20 percent or 80 percent or 50 percent,” FDA Commissioner Scott Gottlieb told Reuters in an interview in New York. “They are not manufacturing at full capacity. They are manufacturing well short of that.”

“It’s unclear when they are going to be able to bring that up to full capacity,” he said.

Asked when U.S. hospitals and pharmacies might see shortages as a result, he said: “You might see some in the next two or three weeks if there’s going to be additional shortages coming out of this situation.”

The FDA has warned of 40 drugs made in Puerto Rico that could face shortages, including treatments for cancer, rheumatoid arthritis and HIV, but has not named specific medicines.

Most major drug companies have manufacturing facilities on the island, including Merck & Co, Johnson and Johnson, Amgen Inc, Bristol-Myers Squibb Co, Eli Lilly and Co, Pfizer Inc, AstraZeneca and GSK

The FDA leader said he wants drugmakers to provide the public with more information about the extent of the problems they are facing. He said the plants were all relying on backup generators for electricity, some of which were not designed to operate for sustained periods of time.

“I’m going to ask some of these companies to be a little more transparent around some of these issues,” he said, adding that improvements would likely come slowly, with potential setbacks along the way. “As time goes on, we’re going to see secondary impacts like the generators could start going down.”

Gottlieb said he was “troubleshooting for individual companies” on a daily basis and working with the U.S. Federal Emergency Management Agency and the Department of Homeland Security to address issues such a fuel shortages and shipping problems that could stall operations.

Most of the companies contacted by Reuters said they are working to avoid product shortages.

Bristol-Myers said it has resumed limited operations to ship warehoused products. “As of today, no product supply impact is expected, however we continue to assess the challenging operational conditions on the island,” spokesman Ken Dominski said.

Amgen, in a statement, said it was “preparing to resume manufacturing in various plants over the next several weeks” and did not anticipate an impact on supply to patients.

Merck has one manufacturing facility on the island. “We have brought power back online via on-site generators that will allow most operations to proceed,” spokeswoman Claire Gillespie said.

Of the list of drugs being closely monitored by FDA, 14 medicines are sourced solely out of Puerto Rico, Gottlieb said.

He said the agency was working with drugmakers and would consider approving manufacturing sites in other countries, such as Mexico, Canada or Ireland, to alleviate possible shortages if companies have plants there.

(Additional reporting by Caroline Humer and Michael Erman in New York and Toni Clarke in Washington; Editing by Michele Gershberg and Bill Rigby)

In Puerto Rico, acute shortages plunge the masses into survival struggle

Local residents wait in line during a water distribution in Bayamon following damages caused by Hurricane Maria in Las Piedras, Puerto Rico, October 1, 2017

By Robin Respaut and Nick Brown

FAJARDO, Puerto Rico (Reuters) – Brian Jimenez had burned through dwindling supplies of scarce gasoline on a 45-minute drive in search of somewhere to fill his grandmother’s blood thinner prescription. He ended up in Fajardo, a scruffy town of strip malls on Puerto Rico’s northeastern tip, where a line of 400 waited outside a Walmart.

The store had drawn desperate crowds of storm victims who had heard it took credit or debit cards and offered customers $20 cash back – a lifeline in an increasingly cashless society. Store employees allowed customers in, one by one, for rationed shopping trips of 15 minutes each.

Then, at noon, the store closed after its generator croaked and before Jimenez could get inside to buy his grandmother’s medicine.

“Every day we say, ‘What’s the thing that we need the most today?’ and then we wait in a line for that,” said Jimenez, a 24-year-old medical student from Ponce, on the island’s southern coast.

By Saturday, 11 days after Hurricane Maria crippled this impoverished U.S. territory, residents scrambled for all the staples of modern society – food, water, fuel, medicine, currency – in a grinding survival struggle that has gripped Puerto Ricans across social classes.

For days now, residents have awoken each morning to decide which lifeline they should pursue: gasoline at the few open stations, food and bottled water at the few grocery stores with fuel for generators, or scarce cash at the few operating banks or ATMs. The pursuit of just one of these essentials can consume an entire day – if the mission succeeds at all – as hordes of increasingly desperate residents wait in 12-hour lines.

As criticism mounts about a slow disaster response by President Donald Trump’s administration, residents here in Fajardo said that had seen little if any presence from the federal government. Across the island, the sporadic presence of the Federal Emergency Management Agency or the U.S. military stood in sharp contrast to their comparatively ubiquitous presence after hurricanes Harvey and Irma recently hit Texas and Florida.

The severe shortages have thrown even relatively affluent Puerto Ricans into the same plight as the hundreds of thousands of poor residents here. The broad humanitarian crisis highlights the extreme difficulty of getting local or federal disaster relief to a remote U.S. island territory with an already fragile infrastructure and deeply indebted government.

Even those here with money to spend now cannot often access it or find places open and supplied to spend it as stores are shuttered for lack of electric power, diesel for generators, supplies or employees.

Jimenez’s failed trip to Walmart came after chasing groceries at a store near Yabucoa, near where his grandmother lived. He planned to spend the next day in one of the miles-long gas lines that snake from stations onto highways and up exit ramps.

At the beginning of many lines were stations already out of gas – but motorists still waited, hoping a fuel supply truck would eventually arrive.

“We wasted gas getting here and going back,” Jimenez said as he watched police usher dejected customers away from Walmart’s entrance. “The gas lines are ridiculous. Fifty cars is wonderful. Most are 100-plus cars.”

Another customer turned away from the Walmart, Daniel Santiago, 51, said he had waited in a gas line for 12 hours one day and 14 hours the next. Neither attempt had been successful, so he, his wife and three daughters had walked three miles to the Fajardo shopping complex, where they waited in line for the Econo grocery.

“We have to do this every day,” Santiago said. “Yesterday, we came down walking. The day before that, we walked up a really big hill to try to get a signal to contact our family.”

That had not worked either.

 

UNFORTUNATE REALITY

Even before the storm hit and knocked out the island’s dilapidated electric grid – an outage expected to persist for months – Puerto Rico was suffering through a growing economic crisis that dates back to 2006. The island has an unemployment rate more than twice the U.S. national average and a 45 percent poverty rate.

The island had earlier this year filed the biggest bankruptcy in U.S. municipal history in the face of a $72 billion debt load and near-insolvent public health and pension systems.

In an interview with Reuters on Saturday, Puerto Rico Governor Ricardo Rossello said relief efforts were still focused almost solely on saving lives; restoring basic necessities to the masses would come later.

“We’re not at the phase where we are focusing on comfort,” Rossello said. “Unfortunately, that’s the current reality that we’re dealing with.”

His team was still scrambling to open roads to communities blocked by landslides, and to deliver food, water, medicines and generators to remote homes and hospitals.

The island’s battered infrastructure left Manny De La Rosa, 31, to crisscross the island with his pregnant wife, Mayra Melendez, also 31. They were trying to find places to spend the $40 in coins they had extracted from the family piggybank.

“All of our money is held up in the bank,” De La Rosa said.

They live in Luquillo in the northeast, but found an ATM in Humacao on the southeastern coast. Their cell phones vibrated to life for the first time alongside a stretch of highway in Isla Verde, nearly an hour west of their home.

Now, they were in line in Fajardo, hoping to buy supplies with a credit card to conserve their cash.

“We see these lines, and we think, ‘We’re not even going to make it before the money runs out,’” Melendez said, standing in front of the Walmart.

A military helicopter flight over a residential area following damages caused by Hurricane Maria near Caguas, Puerto Rico, October 1, 2017

A military helicopter flight over a residential area following damages caused by Hurricane Maria near Caguas, Puerto Rico, October 1, 2017 REUTERS/Carlos Barria

DOWN TO $14

In the economically depressed agricultural town of Salinas, an hour-and-a-half drive from Fajardo on the island’s southern coast, 93-year-old Lucia Santiago sat outside in a lawn chair and rested her swollen legs.

Her son, Jose Melero, 67, brought her food that had been delivered by the town’s mayor on a golf cart.

“We have to be out here, because we’d die from the heat in there,” he said, gesturing toward the house.

The two had started eating less every day to conserve provisions. That day, they had split a can of ravioli and a piece of bread.

Melero was down to $14 of cash without the means to withdraw more.

“I have no idea how I’m going to get through the next few days,” he said. “We have money, but we just can’t get to it.”

Others in isolated areas struggled to find medicine. U.S. Army veteran Sandalio DeJesus Maldonado, 87, took a 7 a.m. ferry from his home on Culebra, an island off Puerto Rico’s eastern coast, to Fajardo, to refill blood pressure and prostate medications.

The hurricane had shuttered Culebra’s only pharmacy, DeJesus said.

In Fajardo, DeJesus waited at an overcrowded Walgreens because he did not have enough gas to drive to the Veterans Affairs hospital where he normally filled his prescriptions.

As he waited in line late Saturday morning, DeJesus fretted that he would not be able to return to Culebra until after 5 p.m., when the only scheduled ferry was slated to depart.

“All I need is a few pills,” he said.

 

 

(Additional reporting by Jon Herskovitz; Writing by Brian Thevenot; Editing by Mary Milliken)

 

With fuel and water scarce, Puerto Rico presses for shipping waiver

FILE PHOTO: People queue to fill container with gasoline in a gas station after the area was hit by Hurricane Maria in Toa Baja, Puerto Rico September 24, 2017. REUTERS/Carlos Garcia Rawlins/File Photo

By Robin Respaut and Scott DiSavino

SAN JUAN, Puerto Rico/NEW YORK (Reuters) – As Puerto Rico struggles with a lack of fuel, water and medical supplies following the devastation of Hurricane Maria, it is pressing the Trump administration to lift a prohibition on foreign ships delivering supplies from the U.S. mainland.

The island’s governor is pushing for the federal government to temporarily waive the Jones Act, a law requiring that all goods shipped between U.S. ports be carried by U.S. owned-and-operated ships. President Donald Trump’s administration has so far not granted his request.

“We’re thinking about that,” Trump told reporters when asked about lifting the Jones Act restrictions on Wednesday. “But we have a lot of shippers and …. a lot of people that work in the shipping industry that don’t want the Jones Act lifted, and we have a lot of ships out there right now.”

Many of the U.S. territory’s 3.4 million inhabitants are queuing for scarce supplies of gas and diesel to run generators as the island’s electrical grid remains crippled a week after Maria hit. Government-supplied water trucks have been mobbed.

Puerto Rico gets most of its fuel by ship from the United States, but one of its two main ports is closed and the other is operating only during the daytime.

“We expect them to waive it (the Jones Act),” Governor Ricardo Rossello told CNN on Wednesday, noting there was a brief waiver issued after Hurricane Irma, which was much less devastating as it grazed past the island en route for Florida earlier this month.

Members of Congress from both parties have supported an emergency waiver, he said.

The U.S. government has issued periodic Jones Act waivers following severe storms in the past, to allow the use of cheaper or more readily available foreign-flagged ships.

The U.S. Department of Homeland Security, which waived the law after Irma and after Hurricane Harvey hit Texas in August, said on Wednesday it was considering a request by members of Congress for a waiver, but had not received any formal requests from shippers or other branches of the federal government.

Gregory Moore, a spokesman for Customs and Border Protection, an office of Homeland Security, said in a statement on Tuesday that an agency assessment showed there was “sufficient capacity” of U.S.-flagged vessels to move commodities to Puerto Rico.

“The limitation is going to be port capacity to offload and transit, not vessel availability,” he said.

LACK OF WATER, FUEL

Maria, the most powerful storm to hit Puerto Rico in nearly 90 years, caused widespread flooding and damage to homes and infrastructure.

Residents are scrambling to find clean water, with experts concerned about a looming public health crisis posed by the damaged water system.

On Tuesday, hundreds of people crowded around a government water tanker in the northeastern municipality of Canovanas with containers of every size and shape after a wait that for many had lasted days.

Some residents also waited hours for gasoline and diesel to fuel their automobile tanks and power generators to light their homes.

U.S. Air Force Colonel Michael Valle, on hand for relief efforts in San Juan, said he was most concerned about “the level of desperation” that could arise if fuel distribution did not return to normal within a couple of weeks.

In Washington, Republican leaders who control both chambers of Congress have said they are prepared to boost disaster funding, but are waiting for a detailed request from the Trump administration.

In the meantime, the administration still has $5 billion in aid in a disaster relief fund, and Congress has also approved about $7 billion more that will become available on Oct. 1.

(Reporting by Robin Respaut in San Juan, Puerto Rico and Scott DiSavino in New York; Additional reporting by Doina Chiacu, Richard Cowan, Timothy Gardner and Jeff Mason in Washington; Writing by Bill Rigby; Editing by Frances Kerry and Lisa Shumaker)

Venezuela’s injured activists struggle to heal

Jofre Rodriguez, 18, who was injured during a protest against Venezuela's President Nicolas Maduro's government, poses for a photograph at his home in Turmero, Venezuela, August 11, 2017. REUTERS/Ueslei Marcelino

By Andreina Aponte

CARACAS (Reuters) – Jesus Ibarra, a 19-year-old engineering student, has been barely able to walk or talk since a tear gas canister crushed part of his skull during a protest against President Nicolas Maduro and he fell unconscious into a river that carries sewage.

Chronic shortages of medicine in Venezuela forced his family to ask for drug donations so Ibarra could undergo five surgeries on his skull and treatment for infections from the Guaire river.

Ibarra, who cannot return to his studies any time soon, needs to a sixth operation and therapy. It is unclear if he will fully recover.

“I speak to my son a lot, and sometimes he makes me understand it was not worth suffering this, that he regrets it, that it was a mistake,” said Ibarra’s father Jose at their small home in the sprawling hilltop slum of Petare in Caracas.

“But other times he’s clearly telling me that it was worth fighting for a change he believes in.”

Ibarra is one of nearly 2,000 people injured during four months of fierce anti-Maduro street protests, according to the public prosecutor’s office. Rights groups think the number is probably higher.

Venezuela has been torn by political and economic crises that have led to extreme shortages of food and medicine, crushing inflation and the collapse of the local currency. Its new government structure has been criticized as a dictatorship.

Rubber bullets fired at close range, rocks, and tear gas canisters have caused most of the injuries, doctors and rights groups say. Most of those who have been hurt appear to be opposition protesters, but Maduro supporters, security forces and bystanders have also been harmed.

More than 125 people have died in the unrest since April. Thousands have been arrested.

The unpopular leftist president has said he was facing an armed insurgency intent on overthrowing him.

Opposition politicians have said they were forced to take to the streets after authorities curtailed democratic means for change. They have also accused security forces of using excessive force against protesters.

Culinary student Brian Dalati, 22, said he was passing an opposition-manned street barricade on his way to classes in July when police mistook him for a protester. They hit him and fired buckshot at his legs, fracturing both of Dalati’s shinbones.

“I depend on my siblings to go to the bathroom, shower, brush my teeth, eat, anything. It’s infuriating,” he said. “They didn’t have to do this. It was pure hate. Thank goodness I will be able to walk again soon.”

The government says right-wing media are too focused on injuries to protesters.

Maduro has pointed to a case in which a 21-year-old man was set afire during an opposition protest and died two weeks later. A Reuters witness said the crowd had accused the man of being a thief, but the government said he was targeted for being a Maduro supporter.

Protests have subsided since Maduro’s government established a controversial legislative superbody three weeks ago, but hundreds of Venezuelans are still struggling to nurse their wounds without medicine and state support.

(Click on http://reut.rs/2xt4eoS for related photo essay)

(Additional reporting by Ueslei Marcelino, Liamar Ramos, and Rodrigo Gutierrez; Writing by Alexandra Ulmer)

Anti-Maduro protests persist in Venezuela, teenager dies in unrest

Opposition supporters sit next to a placard that reads: "No more deaths", as they block a highway, during a protest against Venezuelan President Nicolas Maduro's government in Caracas, Venezuela May 15, 2017. REUTERS/Christian Veron

By Andrew Cawthorne and Anggy Polanco

CARACAS/SAN CRISTOBAL (Reuters) – Opponents of President Nicolas Maduro staged sit-ins and roadblocks across Venezuela on Monday to press for elections, sparking new unrest and a death in the border state of Tachira.

Luis Alviarez, 18, was killed during protests in the volatile western state, according to the state ombudsman’s office, which did not give more details.

That brought the death toll in six weeks of protest to at least 39.

Demonstrators have been on the streets daily since early April to demand elections, freedom for jailed activists, foreign humanitarian aid to offset an economic crisis, and autonomy for the opposition-controlled legislature.

Maduro accuses them of seeking a violent coup.

Trying to vary tactics and keep momentum, protesters have gone from throwing excrement at security forces to handing them letters and flowers for Mother’s Day on Sunday.

On Monday, thousands massed from 7 a.m. (1100 GMT) on highways in Caracas and elsewhere, chanting slogans, waving banners, playing cards in deck chairs, enjoying impromptu sports games and sharing food.

“I’m here for the full 12 hours. And I’ll be back every day there’s a protest, for as long as is necessary,” said Anelin Rojas, a 30-year-old human resources worker, sitting cross-legged with a novel and earphones in the middle of Caracas’ main highway.

“Unfortunately, we are up against a dictatorship. Nothing is going to change unless we force them,” Rojas added, surrounded by placards saying “Resistance!” and “Maduro, Your Time Is Up!”

Using branches, rocks and garbage, demonstrators blocked the main Francisco Fajardo thoroughfare in Caracas.

In Tachira, some farmers were striking in solidarity with the protesters. They gave away milk and cheese so it would not go to waste, witnesses said.

On Margarita island, opposition lawmaker Yanet Fermin was detained while mediating between security forces and protesters, her party said.

In Valencia, three policemen were injured, authorities said, with one mistakenly reported by the local Socialist Party governor as having been shot dead earlier in the day.

The opposition, which commands majority support after years in the shadow of the ruling socialists, is more united than during the last wave of anti-Maduro protests in 2014.

But it has been unable to stop violence in its ranks, with youths vandalizing property and starting fires when security forces block marches with tear gas, pepper spray and water cannons.

CLAIMS OF MEDIA BIAS

The deaths have included protesters, government sympathizers, bystanders and security forces, during six weeks of protests. Hundreds have been hurt and arrested.

The current wave of protests, which has attracted hundreds of thousands of demonstrators on some days, has drawn greater support from the poor, who backed late leader Hugo Chavez massively but have soured on Maduro, his successor, and suffered the most from four years of recession.

But the main protests have still been in middle-class areas. Maduro, 54, who narrowly won election in 2013 after Chavez’s death, says he is the victim of an international right-wing conspiracy that has already brought down leftist governments in Brazil, Argentina and Peru in recent years.

Government supporters say international media coverage of Venezuela has been biased, emphasizing government repression and minimizing opposition violence.

“Another crime CNN will unfairly attribute to Nicolas Maduro,” Information Minister Ernesto Villegas tweeted of the original report of the death of the policeman – which turned out to be false.

International pressure on Maduro has been growing. Representatives from 18 members of the Organization of American States approved a meeting of foreign ministers to discuss Venezuela’s crisis for May 31 in Washington. The OAS floated the idea of the meeting last month, prompting Venezuela to announce plans to withdraw from the group.

The European Union on Monday called for elections in its most outspoken statement yet on the Venezuela crisis.

Authorities thwarted an opposition push for a referendum last year and have also delayed state gubernatorial elections. But Maduro vowed at the weekend that the next presidential election, due in late 2018, would go ahead.

“We will thrash them!” he predicted, though pollsters widely foresee defeat for the ruling Socialist Party at any open vote.

The government is also setting up a controversial body called a constituent assembly, with authority to rewrite the constitution and shake up public powers.

Maduro says that is needed to bring peace to Venezuela, but foes view it as a cynical tactic to buy time and create a biased body that could perpetuate the socialists’ rule.

(Additional reporting by Girish Gupta in Caracas, Maria Ramirez in Ciudad Bolivar and Robin Emmott in Brussels; Editing by Leslie Adler and Andrew Hay)

Venezuela replaces health minister after data shows crisis worsening

FILE PHOTO: A woman wearing a costume with medicine boxes that reads "Health crisis" shouts slogans during a rally of workers of the health sector due to the shortages of basic medical supplies and against Venezuelan President Nicolas Maduro's government in Caracas, Venezuela February 7, 2017. REUTERS/Carlos Garcia Rawlins

By Girish Gupta

CARACAS (Reuters) – President Nicolas Maduro has abruptly dismissed Venezuela’s health minister days after the government broke a nearly two-year silence on data that showed the country’s medical crisis significantly worsening.

Gynecologist Antonieta Caporale, who held the post for just over four months, was replaced by pharmacist Luis Lopez, the government said.

Ministry data published this week showed cases of infant mortality rose 30 percent and maternal mortality 65 percent, while malaria shot up 76 percent last year. There was also a jump in illnesses such as diphtheria and Zika.

In the fourth year of a brutal recession, Venezuela is suffering widespread shortages of medicines and basic medical equipment. A leading pharmaceutical association has said the country is running short on roughly 85 percent of medicines.

Millions are also struggling with food shortages and soaring inflation, fuelling protests against Maduro.

In announcing the cabinet change late on Thursday night, Vice President Tareck El Aissami did not provide reasons for the minister’s ouster.

“President Nicolas Maduro is grateful to Doctor Antonieta Caporale for her work,” he wrote on Twitter.

“CRITICAL STEP”

The Health Ministry had stopped releasing figures after July 2015, amid a wider data blackout.

The data release was therefore significant, and welcomed by government critics.

“The publication of the data by the Ministry of Health is a crucial step in addressing health challenges in Venezuela,” read a statement from UNICEF, which had previously avoided criticizing the government.

“(It) provides stark evidence of the impact of the prolonged crisis on women and children in the country.”

Venezuela defines infant mortality as the death of children up to the age of 1 year and maternal mortality as death while pregnant or within 42 days of the end of a pregnancy.

The Venezuelan government provides only the number of cases and percentage changes, rather than rates per thousand people, as most countries do, making useful comparisons with other time periods and countries impossible.

(Additional reporting by Stephanie Nebehay and Tom Miles in Geneva; Editing by Marguerita Choy and Dan Grebler)

With tunnel lifeline cut, pressure mounts on Syrian rebel enclave

Abu Malek, one of the survivors of a chemical attack in the Ghouta region of Damascus that took place in 2013, uses his crutches to walk along a street in the Ghouta town of Ain Tarma, Syria. REUTERS/Bassam Khabieh

By Ellen Francis

BEIRUT (Reuters) – For nearly four years, food, fuel and medicine have traveled across frontlines into the besieged eastern suburbs of Damascus through a network of underground tunnels.

But an army offensive near the Syrian capital has shut the routes into the rebel enclave of Eastern Ghouta, causing supplies to dwindle and prices to rocket, residents say.

“The price of fuel went up like crazy,” said Adnan, 30, the head of a local aid group that distributes food.

A cooking gas canister now costs 50,000 Syrian pounds, nearly four times its price before the attack and almost 20 times the state-regulated price in nearby Damascus.

Adnan, whose aid group buys rice, lentils and other goods that arrive via the tunnels, said the shutdown and steep price hikes had triggered rising despair in the suburbs.

As the army tightens the noose, fighters and civilians are bracing for a full-blown assault and bitter shortages that could last through the winter.

“The operation aims to strangle the Ghouta … by closing off the crossings and tunnels,” Hamza Birqdar, military spokesman for the Jaish al-Islam rebel group, told Reuters.

“Trade through the tunnels has completely stopped.”

Government forces have blockaded Eastern Ghouta, a densely populated pocket of satellite towns and farms, since 2013. It remains the only major rebel bastion near Damascus, though it has shrunk by almost half over the past year.

President Bashar al-Assad’s government has been steadily defeating pockets of armed rebellion near the capital, with the help of Russian air power and Iranian-backed militias.

It ultimately aims to seize the Ghouta, pushing fighters to accept state rule or leave for rebel territory in the north, in a type of negotiated withdrawal that has helped shore up its rule over Syria’s main urban centers.

TUNNEL CRACKDOWN

Heavy fighting and air strikes have rocked the districts that stand between Damascus and Eastern Ghouta, severing smuggling routes that provided a lifeline for around 300,000 people in the besieged suburbs.

The army assault entered a higher gear in recent months in the districts of Barzeh and Qaboun, at the capital’s eastern edges, which abruptly ended a local truce that had been in place with rebels there since 2014.

Their relative calm and location had turned them into a transit point where traders brought supplies from the capital and shuttled them underground into the opposition enclave. Government forces have now swept into most of the two districts.

The siege generated a black market economy and profiteers who traded across frontlines, says an activist who has smuggled medicine through one of the tunnels.

Goods prices were ramped up by payments to checkpoints in government-held areas and rebels that control the tunnels, the activist and other residents said.

Syrian officials were not available for comment on such allegations.

Syrian state media says Ghouta militants dug tunnels hundreds of meters long to move weapons and ambush army positions. The tunnels have been a target of army operations, with several blown up in recent months, it has said.

The wide array of rebels – including hardline jihadists and other groups supported by Turkey, the United States and Gulf monarchies – have been on the back-foot across Syria.

In Eastern Ghouta, a bout of renewed rebel infighting, after a rebel attack at the fringes of Damascus quickly fizzled out in March, could play into the government’s hands.

Birqdar said rebels faced “heavy shelling, air strikes, and incoming tanks” every day. “We must prepare for every scenario that could happen on the battlefield,” he said.

“We are fully ready to negotiate over stopping the bloodshed by the regime, but will not accept any talks that lead to surrender.” He ruled out a local evacuation deal.

The government says such deals have succeeded where U.N.-based peace talks failed. The opposition describes it as a strategy of forced displacement after years of siege – a method of warfare the United Nations has condemned as a war crime.

WHEN WINTER COMES

The U.N. has warned of impending starvation if aid does not reach Eastern Ghouta, where international deliveries have long been erratic and obstructed. A convoy that entered last week, for the first time in months, carried food and supplies for just about 10 percent of the estimated population.

“People have rushed to the markets to stock up,” said Adnan. “Because they have bitter memories of 2013,” when their towns first came under siege.

Merchants inside the Ghouta had filled up large warehouses that would last months, and residents would harvest crops in the area’s remaining farmland in the summer, he said. “Things will get worse when winter comes.”

The Wafideen crossing at the outskirts, where checkpoints allowed food to enter, has also been restricted since February, Adnan and others said.

One resident said rebel fighters also ran their own hidden routes through which they had moved unnoticed or smuggled arms.

Medics relied on the tunnels for antibiotics, anesthetics, and other supplies, said Abu Ibrahim Baker, a surgeon in Eastern Ghouta. Hospitals would be “able to hold out, God willing, but not for very long,” he said.

(Reporting by Ellen Francis; Editing by Tom Perry and Catherine Evans)

Infant mortality and malaria soar in Venezuela, according to government data

Pregnant women lay on beds without sheets during their labour at a maternity hospital in Maracaibo, Venezuela June 19, 2015. REUTERS/Isaac Urrutia

By Alexandra Ulmer

CARACAS (Reuters) – Venezuela’s infant mortality rose 30 percent last year, maternal mortality shot up 65 percent and cases of malaria jumped 76 percent, according to government data, sharp increases reflecting how the country’s deep economic crisis has hammered at citizens’ health.

The statistics, issued on the ministry’s website after nearly two years of data silence from President Nicolas Maduro’s leftist government, also showed a jump in illnesses such as diphtheria and Zika. It was not immediately clear when the ministry posted the data, although local media reported on the statistics on Tuesday.

Recession and currency controls in the oil-exporting South American nation have slashed both local production and imports of foreign goods, and Venezuelans are facing shortages of everything from rice to vaccines. The opposition has organized weeks of protests against Maduro, accusing him of dictatorial rule and calling for elections.

In the health sector, doctors have emigrated in droves and patients have to settle for second-rate treatment or none at all. A leading pharmaceutical association has said roughly 85 percent of medicines are running short. Venezuelans often barter medicine, post pleas on social media, travel to neighboring countries if they can afford it, or line up for hours at pharmacies.

The Health Ministry had stopped releasing figures after July 2015, amid a wider data blackout. It was not clear why it published this latest batch of data.

Its statistics for 2016 showed infant mortality, or death of children aged 0-1, climbed 30.12 percent to 11,466 cases last year. The report cited neonatal sepsis, pneumonia, respiratory distress syndrome, and prematurity as the main causes.

Hospitals often lack basic equipment like incubators, and pregnant women are struggling to eat well, including taking folic acid, factors that can affect a baby’s health.

(To read the story on Venezuelan women seeking sterilizations as crisis sours child-rearing, click http://www.reuters.com/article/us-venezuela-sterilizations-idUSKCN10E1NK)

Maternal mortality, or death while pregnant or within 42 days of the end of a pregnancy, was also up, rising 65.79 percent to 756 deaths, the report said.

The Health Ministry did not respond to a request for further information. Maduro’s government says a coup-mongering elite is hoarding medicines to stoke unrest.

‘TURMOIL’

While Venezuelans are acutely aware of the country’s health issues, the ministry’s statistics bulletin shocked some in the medical community.

“The striking part is turmoil in almost all the categories that this bulletin addresses, with particularly significant increases in the infant and maternal health categories,” said Dr. Julio Castro, an infectious disease specialist and an outspoken critic of the government’s health policies.

Doctors say the health bulletins, meant to be released weekly, should be published in a timely fashion to alert medical practitioners to national trends and threats.

Venezuela, for instance, had controlled diphtheria, a bacterial infection that is fatal in 5 to 10 percent of cases, in the 1990s. Doctors last year sounded the alarm that it had returned, but the government initially said there were no proven cases and admonished those seeking to spread “panic.”

The data now shows diphtheria affected 324 people – up from no cases the previous year.

Diphtheria was once a major global cause of child death but is now increasingly rare thanks to immunizations, and its return showed how vulnerable the country is to health risks.

Reuters documented the case of a 9-year-old girl, Eliannys Vivas, who died of diphtheria earlier this year after being misdiagnosed with asthma, in part because there were no instruments to examine her throat, and shuttled around several run-down hospitals.

(For a story on “Venezuelan girl’s diphtheria death highlights country’s health crisis”, click http://www.reuters.com/article/us-venezuela-health-idUSKBN15P1DA)

There were also 240,613 cases of malaria last year, up 76.4 percent compared with 2015, with most cases of the mosquito-borne disease reported in the rough-and-tumble Bolivar state.

Cases of Zika rose to 59,348 from 71 in 2015, reflecting the spread of the mosquito-borne virus around Latin America last year. There was no data for likely Zika-linked microcephaly, where babies are born with small heads, although doctors say there have been at least several dozen cases.

(To read the story on “Amid government silence, Venezuela’s microcephaly babies struggle”, click http://www.reuters.com/article/us-health-zika-venezuela-idUSKBN12H1NY)

(Reporting by Alexandra Ulmer; Editing by Girish Gupta and Frances Kerry)