It’s 4:00 am, still dark. She stands in line, about 50 people in front of her. Old, middle aged, housewives, even children with their mothers: standard deal. Some brought blankets, some shiver in the cold air, others sleep on the floor. A few places behind her, a man pukes on the sidewalk.

For three days, that was Marianyelys’ life: waiting at the National Guard Regional Command 8 (CORE-8)’s health care center in Puerto Ordaz, from 4 am to 5 pm —hoping to get the malaria treatment she needed after a trip to La Gran Sabana.

The days when Venezuela spearheaded the global war against malaria are gone. In 2015, according to the World Health Organization (WHO), Venezuela had 30% of all malaria cases registered in the Americas. The situation in 2016 was much worse, with 240,613 registered cases, a 76% increase over the previous year. Unofficial sources calculate that Venezuela might have up to 48% of all cases in the Americas in 2016. Back in 2000, that figure was 2%.

This year, the Health Ministry revealed that 17 of Venezuela’s 24 states registered autochthonous (locally mosquito-transmitted) malaria in 2016. The hardest hit region is Guayana, with 177,619 registered cases, of which 102,499 (42,6% of the national total) come from the Sifontes municipality, in the southern part of the state. That’s almost 20% of cases in the whole American continent. Guayaneses like Marianyelys are standing in lines for days on end, while suffering from the disease.

Unofficial sources calculate that Venezuela might have up to 48% of all cases in the Americas in 2016. Back in 2000, that figure was 2%.

And she only got part of her treatment.

By finding someone on facebook with the pills (6 hours away by car), she bought the rest through the friend of a friend. Sending medicine through regular couriers is illegal now, so she had to pay someone to make the trip, and she’s hardly alone in that hell; according to the 2011 census, Sifontes had a population of 50,082 inhabitants. There’s more malaria than people there, with folks getting infected more than twice a year.

That’s just an average. Some people in mosquito-infested areas fare much worse, as José Grifon, a 22 year-old miner, can tell you. He’s contracted malaria 40 times by now.

Because, see, the role that illegal mining plays is dramatically important: Sifontes has more than 100 gold mines that, with the general collapse of the country’s economy and the increasing price of gold, have attracted more than 50,000 people from all over Venezuela. “All of the patients here are from the mines,” a nurse of Puerto Ordaz’ Guaiparo Hospital tells us.

Illegal mining is as lawless as it sounds. Anyone can go and start mining, as long as you give the armed gangs running the show their cut. With no protection or rules to follow, the miners work surrounded by disease-carrying mosquitoes, and their primitive system leaves puddles where vectors actively reproduce. Here’s what an abandoned mine looks like after the pranes are done with it.

Last year, 28 miners were killed in Tumeremo by gangsters but, with the crisis, nothing discourages them. The whole economy in this area revolves around illegal mining; the pills that Maryanyelis got with so much difficulty are easily found here, yet unaffordable for anyone who doesn’t earn in gold. People sell the free, Panamerican Health Organization (PAHO)-subsidized, treatment for up to $150.

“All of the patients here are from the mines,” a nurse of Puerto Ordaz’ Guaiparo Hospital tells us.

And when people go back to where they came from, they sometimes take the parasites with them, spreading the disease anywhere an Anopheles mosquito can reproduce.

We are seeing the results of this phenomenon today.

Last year, Merida was one of the few states that officially registered no cases of malaria, but a few days ago we met Alicia. She’s a 31 year-old mother from El Vigía, 90 km west of Mérida, where she sells pasteles. She has never visited Bolívar. When we met her, she was in the 17th week of her third pregnancy and, as her skin turned yellow, she got a real bad fever. Doctors told her it must be the flu, and sent her home.

Alicia felt better and her fever disappeared. The next day, she had uncontrollable shivers, blood out of her vagina and fever, mystifying doctors from Merida’s University Hospital, until one of them noticed a pattern. She had fever one day, the next felt better and the third day fever again. Cyclic fever is a key feature of malaria.

They ordered a blood test and voila: She was infected with Plasmodium vivax.

Unlike Maryanyelis, Alicia was “lucky”; the local Malariology Department got her the drugs she needed for free. By the time we talked to her, she was doing well, but we later found out she had lost her baby. Although we can’t guarantee that it was due to her disease, malaria is known to cause abortions (and as we wrote this piece, another confirmed case arrived to Merida’s hospital, with a third one suspected; they both came from the Zulia state).

Not even doctors escape this reality: Midgin Mujica, a pregnant, recently graduated doctor, died in Puerto Ordaz after contracting malaria while working in Caicara del Orinoco. She couldn’t find the drugs in time. Her death forced several universities to suspend the deployment of medical students to the zone, as part of their rural training.

Malaria is back for good, and unless something is done to stop the socioeconomic factors currently in motion, sooner than later the scenes we see in Bolívar will expand throughout the nation. All it takes is a single mosquito, if you’re in the wrong place, at the wrong time.

And nobody is doing anything to stop it.

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