Riohacha, Colombia – Six-year-old Wilmer Valero has slept on the streets of Colombia‘s Riohacha with rotting teeth for four months.
He brought the problem from Venezuela, where a molar operation in a country without basic antibiotics had left his gums infected, slowly turning black.
Now, he, his two siblings and his parents find themselves among a tide of migrants and refugees spilling across the continent, including in this small peripheral city in the desert, about 80km from the Venezuelan border.
Migrants here, like Valero‘s parents, compete with thousands of others for what scant work or aid this underdeveloped region can offer.
“If I pay rent, there’s nothing left to eat, much less to buy him medicine when he’s sick,” said Valero‘s mother, 28-year-old Yulibet, who used to sell coffee in Maracaibo, Venezuela.
Valero got his mouth fixed last week on board a US hospital ship, the USNS Comfort, that visited this impoverished region as part of a humanitarian tour of Latin America. Thousands of local Colombians and Venezuelans queued over several days for free simple treatment, laying bare an already deep need driven deeper by the flow of desperate migration.
“The government isn’t prepared for this,” said Ibeth Pinedo, general director of the Red Cross Riohacha.
More than three million people have fled Venezuela’s spiralling collapse, according to the United Nations figures, and the exodus is not expected to slow any time soon. Most are trying to escape the country’s crippling economy, violence or political persecution.
Colombia already hosts more than a million Venezuelans, many of whom are seen begging for change or sleeping in public parks across. Others walk and hitchhike the long mountain highways, on their ways to Ecuador or Peru.
“Every day it keeps growing, many people arrive,” said Jorge Guardiola, project coordinator for social work with the Catholic Church in Riohacha. “We’re going to need more resources.”
The UN refugee agency upped its presence here late last year, and the World Food Programme began funding almost 8,000 daily meals in this region in July.
Healthcare services top the list of costs incurred by Colombia, thanks to the Venezuelan migration.
Colombian public hospitals have provided more than $40 million worth of emergency treatment, childbirth and vaccination services, said Ivan Dario Gonzalez Ortiz, Colombia’s vice minister of health.
“We require the backing of all of our allies and neighbours to be able to respond to this profound humanitarian crisis,” Gonzales Ortiz told Al Jazeera. “There are immense challenges to our health system implied in receiving our Venezuelan brothers who come with complex situations in terms of nutrition, vaccination, chronic illnesses, cancer and more.”
Colombia provided about 100,000 hospital visits to Venezuelans between March 2017 and September 2018.
The number of Venezuelans receiving emergency treatment in Colombian hospitals grew from a monthly average of 123 in 2015 to 2,060 in 2017, jumping further to almost 7,800 in the first seven months of 2018.
But the remaining services at public hospitals remain out of reach to the undocumented, uninsured population.
“It’s unbelievable, it’s a really massive need for care,” said Hunanldo Villalobos, a Florida-based Venezuelan neurosurgeon on the American medical mission. “Many problems here exceed the capabilities we have.”
The situation in Colombia is worsened by the collapse of Venezuela’s own health system, which has left diseases and afflictions to fester untreated for years in the now-migrant and refugee population.
Villalobos joined the mission with a contingent of doctors from the Venezuelan-American Medical Association and lamented the downfall of a once exceptional system. He recalled studying medicine for free as a middle-class student in Caracas in the 1990s at a time when Venezuela was seen as the wealthiest nation of South America.
Now, public hospitals there lack water, oxygen and medicine and basic medical equipment.
It's unbelievable, it's a really massive need for care. Many problems here exceed the capabilities we have.
Katiusca Urdaneta took her eight-year-old son Reynier to a hospital in Venezuela last year, before the two migrated to Colombia, for a hernia operation.
But she’d have to supply all of the gear: gauze, surgical scrubs, gloves, alcohol, sterile solution, needles, stitching, pain medication, clean water and more. The items were expensive and hard to find.
“With the work we had in Venezuela that would be impossible,” she said of paying the surgery costs.
So she gathered money from a family that had already emigrated to pay the bill. Doctors discharged Reynier shortly after his operation because the hospital waiting room lacked water and sported a bacterial infection, Urdaneta said.
Then a month later, the hernia returned. Soon after Urdaneta left home and took her son to Colombia, sleeping for the first months in a single room packed with 27 other Venezuelans.
Doctors on board the ship also removed cataracts, corrected cleft lips, repaired hernias, straightened bent limbs and provided other procedures patients may never have been able to pay for themselves.
Venezuelan doctors on board said they had never felt more emotional providing treatment than now, witnessing the waves of working-class people leaving their country.
Ariel Kaufman, a Florida-based urologist who practised in Caracas until 2015, cautioned, “Of course we’re not going to change the medical situation in Colombia or Venezuela by one ship coming for one week.”
More than healthcare, the daily concerns of many migrant families in Riohacha focus on how to find food. Many beg for change or dig through rubbish bins.
Dario and Andrina Chirinos brought their four young children from Falcon, Venezuela, over the border two months ago. They have slept on a mattress in a public park ever since.
The parents collect recycling material from rubbish heaps to exchange for enough coins to buy themselves meals of potato and hard-boiled egg. Their children rely on one of eight charity kitchens in town, run by the Diocese of Riohacha and funded by the World Food Programme.
Another nine kitchens dot the surrounding region. Together they feed breakfast and lunch to 3,850 people at a cost of approximately $1 each person.
Project coordinator Guardiola said about 80 percent of those served are Venezuelans. Every day, the kitchens eventually close their doors on hungry crowds.
At one kitchen, director Jamila de la Hoz reads a list of names, mostly young mothers and children, to a crowd gathered in a park in the early morning. Those called had registered to eat and had been approved for a breakfast plate with boiled plantain, grated cheese and warm milk.
The programme prioritises first young children, then pregnant women, adolescents and people with disabilities. Young men never qualify.
De la Hoz said most Venezuelans who eat at the kitchens rely on them for all of their daily nutrition. But after distributing 100 meals, the doors close on a few dozen people who still need to eat.
Turning people away, De la Hoz said, is the hardest part of her job.
“I don’t like it, but to do this work you have to be strong,” she said. “We simply don’t have the resources to help everyone who needs it.”
Among those able to eat that day were Luis Ramon Valero and eight-year-old Tomas, the father and older brother to Wilmer, who was on board the USNS Comfort with his mother to have his teeth fixed.
The operation represents a large load off the family’s shoulders. While daily bread consumes most of their attention, the problem in Wilmer’s mouth had been growing and the family knew they were bound for disaster.
“His infection was giving him a fever. They said that if he didn’t get it cared for, he would get worse,” Luis said. “For us this operation is a great blessing.”
But most of his fellow migrants, Luis acknowledged, weren’t so lucky.