When the earth shakes on fragile foundations: the Venezuelan earthquakes and two decades of public health system erosion

Summary: The two earthquakes that recently struck the northern coast of Venezuela will deepen a health crisis that has troubled the country for twenty years. They have exposed how weak its health infrastructure is, how scarce medicines are, how little epidemiological surveillance remains, and how long investment has been lacking. The humanitarian health crisis in Venezuela did not arise from armed conflict, as it has elsewhere. Its roots lie in decades of authoritarian rule and institutional decay, which have eroded public health capacity, research infrastructure, vaccination coverage and the control of infectious diseases in general. Because these weaknesses have accumulated, the earthquakes may well turn into an even graver humanitarian emergency. Recovery that lasts will not be secured by short-term international aid alone. It will require the rebuilding of accountable institutions able to govern transparently and to apply equitable health policies, so that the health system can regain its resilience.