Why more children are dying in this country
Toilet paper is worth more than money, people are killed in the street every day and kids are starving - but now more children dying than decades ago.
Venezuela saw 50 years of progress in infant mortality between 1950 and 2000, but the recent humanitarian crisis in the country has set that progress back by 18 years, according to new research.
French and Venezuelan researchers studied infant mortality rates in the struggling country and found rates may have stopped decreasing and started increasing in 2009, when funding for the Venezuelan health system was slashed.
In 2013, the Venezuelan government stopped publishing mortality statistics, leaving a gap the latest study has attempted to fill.
The researchers estimate that by 2016 the infant mortality rate was 21.1 deaths per 1000 live births, which is 1.4 times the rate in 2008, and equivalent to the rate recorded in the late 1990s.
They blame the economic crisis and increases in infectious and parasitic diseases.
It is the first study to attempt to fill the gap in statistics and estimate infant mortality using hospital and census data after 2013.
Without any official data, WHO and the UN Economic Commission for Latin America and the Caribbean (ECLAC) assumed that the historical decreasing trend had continued in recent years.
But researchers say those estimates are unlikely to accurately represent the effects of recent deterioration in living standards and health provision.
Venezuela had once experienced one of the largest declines in infant mortality in Latin America, from 108.0 per 1000 livebirths in 1950 to 18.2 per 1000 in 2000.
The drop was driven by economic progress, rising living standards, improved sanitation, mass vaccination campaigns, antibiotic distribution, and elimination of disease vectors.
Since the crisis, nutritional status has deteriorated, with 89.4 per cent of households reporting not having enough money to buy food in 2017.
Since 2007, Government health care spending has diminished, resulting in decreased patient-to-doctor and hospital bed ratios and inadequate vaccination campaigns.
In 2014, household expenditure accounted for 64 per cent of total health expenditures, one of the highest percentages in Latin America.
Health care has become unaffordable for most Venezuelans with infant formula prices increasing and shortages of basic medicines and surgical supplies.
Researcher Jenny Garcia said during the 2000s, Venezuela had created policies aimed at protecting their most vulnerable populations, but these efforts were not reflected in the avoidable death rates of Venezuelan children seen today.
"Regrettably, the country is showing a deterioration of child survival for the first time," she said.
"Venezuela is the only country in South America that has risen back to the infant mortality rate levels of the 1990s.
"Trends in infant mortality rates started changing from 2009 onwards, rates stopped declining and began increasing, with the steepest increase seen after 2011.
"In 2016, the Venezuelan National Assembly declared a humanitarian crisis in the country and requested international humanitarian aid to facilitate the importation of medical supplies and medicines into the country.
"This attempt and all others have been vetoed by the Government. This study provides a strong evidence base for action to be taken to alleviate and aid the humanitarian crisis under way in Venezuela."
The latest figures mean Venezuela is far from keeping its commitment to its UN Millennium Development Goal (MDG) to reduce infant mortality to 9 or less deaths per 1000 livebirths by 2015.
Since 2016, WHO has reported an increase in infectious and parasitic diseases that had been controlled or eradicated in previous decades.
"During important crises, the most common causes of death are the same as those reported in countries with the highest child mortality rates: diarrhoeal diseases, acute respiratory infections, measles, malaria, and severe malnutrition," Ms Garcia said.
"All these elements are present in Venezuela and will certainly adversely affect future infant mortality."
Professor Chris Beyer, from the Johns Hopkins Bloomberg School of Public Health, said the suppression of information about the health crisis, taken together with its political and economic root causes, made this arguably a complex humanitarian emergency.
"Given these realities, and the unfortunately grim prognosis for reform, (researchers) suggest the regional and international response to this crisis has been muted, slow, and nowhere near to scale," he said.
He said a recent $5 million (US) commitment from the Global Fund to Fight AIDS, Tuberculosis and Malaria, and $9.2 million (US) emergency funding from the UN was a step in the right direction, but too small to have a substantial mitigating impact.