Colombia

About Colombia

Colombia is the third-most populous country in Latin America, home to more than 50 million people. Despite steady improvements in quality of life, there is still an extreme inequality gap between the rich and the poor. Nearly 1 in 3 people live below the poverty line, and an increasing number of families struggle to put food on the table.

While the ongoing Venezuela crisis has affected the entire region, Colombia has received the largest number of Venezuelan refugees and migrants. At least 1.8 million Venezuelans have sought refuge in Colombia over the past several years, many of whom need urgent health services. The influx has placed immense strain on the country’s health system, flooding hospitals and clinics with hundreds of thousands of new patients in need of treatment and care.

The situation will only get worse as the country faces COVID-19. The border has been closed and the country is on lockdown, and Venezuelan migrants and refugee populations are most vulnerable to the virus.

The Challenges

A severely strained health care system

The number of displaced Venezuelans seeking treatment at Colombian medical facilities has placed immense strain on the country’s health system.

At the onset of the migration crisis, Colombian authorities reported the number of Venezuelan patients at hospitals in Cúcuta to have increased by 60% or more. At Erasmo Meoz University hospital, just eight miles from the border, the rooms are filled to maximum capacity — even the hallways are lined with beds. The hospital’s department of obstetrics and gynecology is particularly overwhelmed: Colombia has become a destination for Venezuelan women seeking medical assistance and a safe location to give birth.

According to Iván Darío González, the country’s vice-minister of public health, Colombia has provided health services to more than 340,000 Venezuelan migrants since the beginning of 2017.

Health outposts near the Simón Bolívar International Bridge, one of the most active border crossing points, have also been overwhelmed by the rapid influx of Venezuelans in need of medical services. For many people crossing the border into Colombia, these smaller health centers are the first opportunity for treatment — but like larger hospitals, these outposts are having trouble coping with the increasing number of patients in need of health services, and Colombian health policies restrict health workers to providing only emergency secondary and tertiary health services for migrant populations. This has created a bottleneck at primary health care centers, which are not able to absorb the costs or the burden of the influx. Most satellite primary care health centers are supported by international organizations and INGOs with staff surge and technical support, as well as essential medicines for vulnerable migrants, refugees, and host communities.

The resurgence of disease

Poor sanitation and inadequate living conditions have led to the reappearance of several diseases.

Malaria and dengue — not seen in Colombia in years — have made a resurgence because people are sleeping outside without nets or blankets. Meanwhile, the lack of clean water and sanitation has caused diarrheal diseases to spread, while lack of shelter during the rainy season has also led to more and more cases of measles, skin disease, and respiratory tract infections.

Increasing threats to child, maternal health, and lack of protection

Most Venezuelan refugees and migrants are malnourished. According to the World Food Program, more than 90% of migrants say they left their home country because they were going hungry. Children under 5 have suffered most.

Read: Newborn Hope: Reaching Care Across the Border

Women also face disproportionate health risks, as maternal deaths skyrocket due to pregnancy complications and lack of prenatal care in Venezuela. More than 29,000 babies were born to Venezuelan migrants between March 2017 and March 2019, and most of their mothers did not receive any prenatal care.

The added challenge of COVID-19

Those already living in fragile situations are most vulnerable to the spread of COVID-19.

The current global health crisis will make conditions even worse for hundreds of thousands of Venezuelan refugees and migrants. Colombia’s borders have been closed since March 16, relief services are restricted, and the health system is under more stress than ever. Half of all Venezuelan migrants in Colombia are now facing malnutrition or starvation.

Increased exposure to gender-based violence is also a major concern, as women continue to make the dangerous journey by way of unofficial crossings and quarantine restrictions exacerbate domestic violence. Health facilities already struggle to meet the needs of drastically increasing patient populations — and a widespread lack of training in GBV case and clinical management among health providers puts survivors at higher risk of neglect, abuse, and disease. An increase in the prevalence of HIV is also a critical concern, as access to antiretroviral therapy is limited.

Bringing HOPE to Colombia

Our history in Colombia

Project HOPE first started working in Colombia in 1995, when we helped establish a regional emergency medical system at the request of local government, health facilities, and university partners. The EMS was designed to support both daily emergencies and disaster situations, providing the populations of Cartagena and Bolivar with 24/7 emergency support. HOPE also implemented the AIDS Home Care project in an effort to provide patients diagnosed with AIDS in and around Bogotá with high quality, low-cost care at home.

Today, we are working to increase access to critical health services for Venezuelan migrants, refugees, and Colombian returnees. Our response is based out of the border city of Cúcuta, capital of Norte de Santander department, and aligns with the priorities of the Colombian government and UNHCR’s response plan for 2019.

Responding at the border

HOPE deployed an emergency response team to Cúcuta in late 2018, with activities extending to Villa del Rosario and nearby border communities.

Our teams have worked closely with Jorge Cristo Sahium hospital (in Villa del Rosario) and Erasmo Meoz University hospital (in Cúcuta) as well as peripheral health clinics to develop plans to ensure access to free quality health care services for Venezuelan migrants, refugees, and Colombian returnees.

In coordination with these partners, we have supported and built up health services near the border area to help ease the burden on local health workers, connecting vulnerable incoming populations with care and improving access to essential medicine. By adding staff support to primary care health outposts, HOPE is also reducing the number of patients referred on to Erasmo Meoz and Jorge Cristo Sahium.

Ensuring the availability of vital medicines

HOPE supports partner health facilities by overseeing the distribution and use of over 30 essential pharmaceutical and vitamin supplements, in close coordination with regional health authorities. These supplements are essential to sustaining quality primary health care services for Venezuelan migrants, refugees, and Colombian returnees.

Providing medical staff surge support and training health workers

HOPE provides medical staff surge support to strengthen primary health care services at Jorge Cristo Sahium hospital. We also provide specialist staff surge support — for emergency OB/GYN services and delivery room care — at Erasmo Meoz, the only tertiary care hospital in Norte de Santander department.

We support efforts to train primary health care staff as well. We have provided training on treatment of common communicable diseases, proper use of essential drugs, health information systems and data collection management, and gender-based violence.

HOPE has also developed standard quality assurance measures, now adopted by the health facilities in which we work. These measures include the use of suggestion boxes for patients, the establishment of complaint mechanisms, and the formation of migrant and refugee health committees to ensure continuing accountability to patients.

Improving health outreach services for migrants and refugees

HOPE actively participates in outreach campaigns in Villa del Rosario and Cúcuta in close coordination with regional health authorities and other local and international partners. Through these campaigns, we have provided the region’s most vulnerable migrants and refugees with free access to health care, essential medicines, and health education.

We work diligently to enhance the local health referral network to ensure common health conditions are treated, which include childhood malnutrition, gender-based violence, measles, malaria, dengue, and tuberculosis. In coordination with regional health authorities and other local NGOs, HOPE led the establishment of a regional health committee to disseminate information about services available to Venezuelan migrants, refugees, and Colombian returnees.

HOPE has also successfully established referral networks between the migrant and refugee health focal points and local health clinics, as well as between partner health clinics and hospitals. This included educating facility staff about referral routes and partners and providing feedback to local health leadership about referral flow and follow-up.

Responding to COVID-19

In response to COVID-19, HOPE has delivered personal protective equipment and ramped up vital training for frontline health workers in Colombia. We are also supporting contract tracing, lab confirmation, screening, and patient care to mitigate the risks of the virus near the Colombia-Venezuela border. We have established a triage and screening system for respiratory patients in Villa del Rosario, working in coordination with the Pan American Health Organization and the Departmental Institute of Health.

In partnership with Brown University, we are training Colombia’s frontline health workers to become Master Trainers in infection prevention and control, who will train other health workers to be able to recognize and treat COVID-19 in their communities.

In partnership with the Weitzman Institute, HOPE doctors and nurses on the frontlines of the response have been trained to use online platforms to consult with medical experts in the U.S. on prognosis, diagnosis, and treatment of COVID-19. They are also able to consult experts on the implications of the virus for other infectious or communicable diseases and for sexual and reproductive health patients.

Learn more about how HOPE is responding to COVID-19

Our Impact

Since 2018, HOPE has helped equip and empower local health care workers to cope with the influx of Venezuelan patients, especially pregnant women and newborns.

By providing direct medical support, we have minimized the strain on hospitals in Norte de Santander and reached thousands of incoming Venezuelans with lifesaving health services.

Read: Keeping Hope Alive for Venezuelans in Colombia

Last year, we provided primary health care consultations to nearly 16,000 people and OB/GYN consultations to more than 10,000 women. We also reached 4,000 people through gender-based violence awareness campaigns.

Now, HOPE is dedicated to mitigating the threat of COVID-19. We have procured 56,400 N-95 masks for distribution to all regional hospitals and primary health care centers across 40 municipalities in Norte de Santander.

At Jorge Cristo Sahium, we are assisting staff in carrying out triage, screening, and treatment of symptomatic patients. Our doctors and nurses have screened more than 1,100 symptomatic respiratory patients and referred positive cases to the Erasmo Meoz observation and treatment center.

We are also supporting regional health authority COVID-19 call centers with registered nurses. These call centers have received over 3,453 calls to date — 234 of these callers were referred for COVID-19 testing and 938 have been referred to social services for domestic violence during quarantine. To date, our support has helped confirm 96% of all COVID-19 positive cases across our areas of operation.