Yuletsy Martinez, 19, and her husband crossed the border into Colombia when she was pregnant with her second child. They left because they couldn't find food or medical care in Venezuela. Martinez gave birth at a hospital in Colombia. "They took good care of me. And they helped me there," Martinez told NPR correspondent Ari Shapiro in a report that aired on All Things Considered.
That kind of generous spirit is part of the story of Colombia's response to the influx of Venezuelans who fled their country's collapsing economy and health care. But it's not the full picture. The Colombian health-care system is already operating under great stress. And not every migrant is as fortunate as Martinez.
In the last 18 months, close to 1.3 million Venezuelans have arrived in Colombia to stay, according to Migration Colombia. "It's as if we had [a new] city the size of [the port city] Cartagena," Iván Darío González, Colombia's vice-minister of public health, told NPR.
A generous promise
This migration movement has been characterized as the largest in the history of the Western hemisphere, and it's an entirely new phenomenon for the region — and for Colombia in particular, says Ellen Rymshaw, head of the Doctors Without Borders (Medecins Sans Frontiers) mission in Colombia. "There's the intention to provide care to all of those people who are caught up in this crisis. And that is admirable," she says.
As González stated: "We need to extend a hand to our Venezuelan brothers and do everything in our power to give them health and protection, and to welcome them as if they were our blood brothers."
Indeed, in May 2017, the Colombian government declared that all public hospitals must provide free emergency treatment for Venezuelan patients. That covers care to people with health emergencies, including diseases like malaria and measles. It means pregnant women can deliver at no cost; more than 29,000 have given birth between March 2017 and March 2019. And it also means free vaccinations for children.
González says that Colombia has provided health care services to 340,000 Venezuelan migrants since early 2017.
And the babies born to Venezuelan migrants in Colombia now have a government promise of health care.
On August 5, the president of Colombia, Iván Duque signed a resolution that grants Colombian nationality to the more than 24,000 Venezuelan children born in Colombia starting on August 19, 2015. This will make it easier for children to access health-care services.
"Colombia has shown the world that the path of xenophobia is the wrong path. We proudly tell [those children] that they are Colombian," Duque said.
Despite Colombia's solidarity, there are notable exceptions to this spirit of free health care. "A sympathetic local government doesn't mean that you as a migrant are going to be given treatment," says Marianne Menjivar, director of the International Rescue Committee (IRC) for Colombia and Venezuela. Migrants have access to life-saving treatment, but for non-emergency care, they must show proof of insurance in Colombia or pay out-of-pocket. "Unless you pay for those services, they won't see you," Menjivar says.
Meanwhile, Colombia's health-care system has its own problems that predate the influx of Venezuelan migrants.
The Colombian health-care system is similar to that of the U.S. The government subsidizes the health care of lower-income Colombians, while those in the middle- and upper-class pay to be insured through their employer or buy a prepaid plan.
But insurance companies often fail to pay hospitals and clinics on time or don't pay at all, says Dr. Juan Agustín Ramirez, head of the Erasmo Meoz University hospital in Cúcuta, a city of 750,000 that's approximately 8.5 miles from the Colombian-Venezuelan border. As of June 2017, the insurance companies owed $2.5 billion to 153 hospitals and clinics in Colombia, according to the Colombian Association of Hospitals and Clinics.
"The public health system has been functioning at a deficit," says Rymshaw, "The system continues to serve the Colombian population, but it's becoming overwhelmed in the locations where there are more migrants or refugees coming in."
The failure of insurance companies to pay has forced the Erasmo Meoz hospital to operate with fewer resources. "We have the will to do everything we can with what we have. We could do so much more if the resources got to us in time, and if the insurance companies paid us," Ramirez tells NPR. He adds that his staff often works overtime and that the lack of funding keeps them from physically growing. They are also unable to hire enough specialists or buy new equipment to keep up with the patient demand.
Is anyone else helping?
Rymshaw says that the international community usually steps in quickly to assist countries dealing with massive migration. "But in Colombia, this hasn't happened yet to any appreciable degree," she says.
But there have been some exceptions. The International Rescue Committee opened a comprehensive care center in Cúcuta in August 2018, converting a home into a clinic focusing on pregnant women and new mothers.
"It's a big whitewashed house. And it's full of light," Marianne Menjivar, Director of the IRC for Colombia and Venezuela told NPR's Ari Shapiro.
The center in Cúcuta, funded by European governments, foundations, trusts and corporate partners, provides sexual and reproductive health care, family planning, treatment for sexually transmitted diseases, and primary health care for children.
On average, the IRC center in Cúcuta sees 100 patients a week – Colombians who used to leave in Venezuela or Venezuelans who live in Colombia. A quarter are "pendulum migrants," so-called because they come to Colombia only for the day to work or buy food and supplies.
MSF has opened mobile clinics that move from town to town in the states of Guajira and Arauca, which are also at the border with Venezuela. The charity also offers outpatient care to migrants in hospitals in Norte de Santander and Guajira. "We look for locations where there is not much assistance," says Rymshaw. Their patients are both pendulum migrants and Venezuelans living in Colombia permanently.
MSF provides primary health care assistance in mental health, pre- and postnatal care, sexual and reproductive health care and family planning (the goal of about 20% of patients), according to Rymshaw. "We have some women who have come all the way from Caracas — that's 420 miles from the border-- to seek family planning methods."
MSF's funding for their projects in Colombia comes from non-governmental donations. "We do not receive any government funding for our activities along the border," Rymshaw says.
She adds that a large portion of the funding for this crisis comes from the U.S government. But because of the global gag rule reinstated by the Trump administration, no U.S. funding goes to health clinics that provide or "promote" abortion.
"It's essential that governments other than the United States contribute more to the humanitarian response in Colombia given the sexual and reproductive health needs that we're seeing among the Venezuelan migrants and refugees," says Rymshaw.
It's a request echoed by González: "We [need] the international community to help us face a crisis that we want to face with solidarity as if it were really ours," he says.
Luisa Torres was this summer's AAAS Mass Media Fellow on NPR's science desk. She's on Twitter @luisatorresduq.