When the famed Chilean author, Isabel Allende, had to leave her native country in the wake of the military coup against leftist president Salvador Allende in 1973, she and her family fled to the safety and stability of Venezuela, then a beacon among the tumult of Latin America. In a recent interview, Ms. Allende recounted,
“I went to Venezuela, because Venezuela was one of the very few democratic countries left in Latin America where you could go. … The country has all the resources. At the time when I went there in the ‘70s it was one of the richest countries in the world because of the oil boom. The problem, at that time, everything looked very abundant and there was a lot of corruption, but there was enough corruption for everybody.”1

The contrast between Venezuela of the 1960s and 1970s – when it had a per capita GDP six times higher than Spain and was the first country in the world to be declared malaria-free – and today is a sober reminder that stability can be ephemeral.

Venezuela is tied for the most worsened country in the 2019 Fragile States Index (FSI), its sixth consecutive year of decline. Though it is easy to point to the country’s current political turmoil and economic disaster, there is a deeper and more insidious worsening at play. Beyond metaphors, Venezuela is literally getting sick, with the resurgence of diseases from AIDS to Zika reflected in the sharp deterioration in the Public Services and Demographic Pressures indicators. The former encompasses the breakdown in health services (as well as other essential services like policing and electricity) while the latter also includes the decrease in food security and nutrition and an increase in mortality that have occurred in recent years.

Venezuela was once the envy of the region. The country was declared malaria-free nearly a decade before the United States. Today, Venezuela is estimated to have over 1.2 million cases, a figure which has increased by as much as 400 percent in the last ten years due to shortages of medicine and the proliferation of illegal mining in response to the country’s economic crisis. Actions taken over the last five years by the administration of President Nicolas Maduro have exacerbated the crisis; the Ministry of Popular Power for Health stopped publishing its weekly bulletin of epidemiological statistics in 2015 after 77 years of almost continuous publication. In 2016 the Venezuelan Center for Classification of Diseases was eliminated. Health researchers have reported being attacked by pro-government paramilitary colectivos and sick citizens have taken to blockading roads for days to receive even half doses of treatment.

Malaria is not the only infectious disease that Venezuelans are battling – in 2017 Health Minister Antonieta Caporale was fired after her department published a warning concerning a rise in malaria, diphtheria, and Zika cases – one unpublished study estimated that up to 80 percent of pregnant women in Venezuela may be infected with Zika – as well as rising infant and maternal mortality rates. Measles also returned to the country in 2017 and has now spread to neighboring countries, with confirmed reports in Argentina, Brazil, Chile, Colombia, Ecuador, and Peru. Other diseases, including tuberculosis and HIV/AIDS, are also reportedly on the rise.

Hunger and undernourishment have undoubtedly increased, particularly over the past five years, though the extent of the problem is somewhat unclear. Widespread reports from 2017 of 90% of Venezuelans being unable to afford enough food and losing an average of 19 pounds originated from a 2016 study of 6,400 participants. However, the same study reported that only one-quarter of respondents reported their nutrition to be deficient and three-quarters reported eating three meals per day, though the latter figure had fallen by 20 percentage points in a year. The 2018 UN’s Food and Agriculture Organization (FAO) report on food insecurity in Latin America and the Caribbean found that the prevalence of hunger tripled from 2010-2012 to 2015-2017, from 3.6% to 11.7%, representing an increase of 3.7 million people. While this rate is still below that in countries such as Guatemala and Honduras, no other country in the region has recently experienced even a remotely similar increase. Taken together, these figures suggest a deeply concerning substantial increase in hunger and undernourishment, but the most widely reported figures are on the extreme end of the available data.

As a result of the increasing hunger and disease along with the broader economic collapse – GDP has fallen by more than 15% each of the last three years and inflation has surpassed a million percent, with prices on average doubling every 19 days – and breakdown of public services, millions of Venezuelans have fled the country, reflected in the sharp worsening in the Refugees & IDPs indicator in the 2019 FSI. According to the UNHCR, the number of refugees and migrants from Venezuela reached 3 million in November 2018. The UN has estimated that 2 million more could be added to that total in 2019. The region has a history of receptivity towards migrants and refugees and the response to the Venezuelan crisis – one of the largest population movements in Latin American history – has thus far been largely marked by a continuation of this openness, with several countries creating temporary programs to offer legal status and work permits to Venezuelans. Additionally, a coordinated regional strategy was introduced with the signing of the Quito Declaration in September and the launch of an action plan emphasizing regularization and integration of migrants two months later. However, some signs of backlash and restrictions have also started appearing in 2018, including anti-Venezuelan riots in Brazil and Chile’s shift to requiring Venezuelans to acquire a visa in Caracas rather than upon arrival.

Despite economic collapse, increasing hunger, the return of previously eradicated diseases, the departure of about around 10% of his country’s population, and the crumbling legitimacy of his regime (reflected in the FSI’s State Legitimacy indicator), Mr. Maduro has so far managed to hold on to power. The military is Mr. Maduro’s primary support structure, their loyalty secured by control of government institutions and state-owned companies. They also maintain lucrative links to organized crime, with many high-ranking officials holding simultaneous positions in the Cartel de los Soles, or Cartel of the Suns. While small numbers of low-level members of the military have mutinied and joined the opposition, the upper ranks are unlikely to risk their privileged positions. The armed forces are supported by the Fuerza de Acción Especial de la Policía Nacional Bolivariana (FAES), an elite unit created by Mr. Maduro during the protests in 2017 which has largely become an extrajudicial execution squad, and the colectivos, armed groups originally created by former President Hugo Chávez that have evolved into a cross of criminal gang and paramilitary shock troops, often with close links to Colombian guerrilla groups such as the Ejército de Liberación Nacional (ELN) and dissidents of the Fuerzas Armadas Revolucionarias de Colombia (FARC). Those groups have established a strong presence in Venezuela – the ELN has a presence in 13 of Venezuela’s 24 states – and have even assumed various state functions in some areas of the country, vowing to defend the Maduro regime in the event of an armed confrontation. Finally, Mr. Maduro has received foreign economic and military support from Cuba and Russia. While the extent of that support is debated, the Cubans particularly play at least a key advisory role in the Venezuelan intelligence and military sectors, including helping to foil a coup plot in March 2018. Maduro’s hold on power has also been facilitated by the splintering of the opposition after the 2017 protests into seemingly irreconcilable factions split on questions of both strategy and tactics. The emergence of Juan Guaidó as self-declared acting President supported by much of the international community in the first days of 2019 has closed that rift, but it may re-emerge in the future.

The sixth consecutive year of worsening FSI scores for Venezuela reflect a crisis that is deepening and broadening, reversing decades of progress amid the breakdown in the provision of basic goods and public services. A multi-day blackout in March 2019 affected 70% of the country and plunged its major cities into darkness, showing that the situation may deteriorate yet further. With two people now claiming the mantle of presidential legitimacy and millions more refugees and migrants expected to leave the country over the next year, 2019 is likely to see countries outside Venezuela increasingly affected by, and involved in, the crisis.

Hopefully these regional and international stakeholders can coordinate to find a solution that helps the Venezuelans currently suffering inside and outside their country, rather than using the country and its people as a stage on which to pursue their own interests. However, irrespective of any improvement in the short-term, Venezuela demonstrates how even once-prosperous nations can spiral into fragility.