In Venezuela's hospitals, the chaos starts early, as every day is a struggle for survival.
At the Hospital Universitario in Caracas items that are taken for granted in most hospitals — medicine and sterile operating facilities — are scarce, as are the basic necessities such as electricity and running water.
On a recent day, dozens of patients crowded the dilapidated, darkened hallways demanding surgeries they've been awaiting for months. They were stretched out on mattresses on the floor and in wheelchairs blocking the entrance to the operating rooms, their frustration at a boiling point.
"It's the only way to get things done," said Marlen Busnego, 34 — whose mother-in-law has been in the hospital for three months waiting for surgery — describing the protests that have become common at the medical center. "They'll help a little and in two days it'll be bad again, or worse."
The place where they protested showed the miserable state of the hospital — only half of the hallway had electricity, the walls were scratched and dirty. Some patients have been waiting for life-saving surgery for up to a year because only six of the 32 operating rooms work at the massive public hospital. Even those that work don't have the resources to hold all needed procedures, and supplies are depleted quickly with emergency cases.
"When people come, we have to tell them to leave because we can't treat them," Gherzon Casanova, a fourth-year medical resident at the hospital, told ABC News. "We have empty beds, not because people don't come but because we have to send them away. We tell them they'll die if we get them in."
The economic crisis in the South American country has sparked a public health emergency that has claimed the lives of countless Venezuelans and deprived others of treatment and care. The medical needs are basic, but deeply felt, ranging from gloves to antibiotics and from running water to chemotherapy. Inside and out, the country appears to have come to a standstill, its citizens waiting in line to buy food, medicine, materials for surgery and more. More often than not, there's a stinging "Sold Out" at the end of the lines, which snake around for blocks in cities across the country.
Lawmakers estimate that the country is lacking about 95 percent of resources to treat a variety of conditions, according to a spokesman for the country's congressional Commission on Health. Since the Venezuelan Ministry of Health has not released official numbers, the commission has had to rely on reports from doctors around the country.
As hospital care collapses, death rates have ballooned. The national cancer death rate has more than doubled, from about 60 per 100,000 inhabitants in 2000 to more than 140 in 2013, the last date for which data was available, according to lawmakers. Nine of the country's 23 states don't have resources to give radiation treatment.
And then there's the wait. There are more than 40,000 people in the country waiting for surgery, and about 5,000 waiting for transplants in the country of 30 million, according to a 2016 report from the commission.
At the Universitario, once a top surgical center in the region, mattresses are bare and many restrooms shuttered. To get from one floor to another in some areas, patients must yell through the doors of some of the hospital's elevators to alert the attendant operating it because buttons are broken. Running water comes and goes. Roaches have colonized in some rooms. There's no air conditioning in public areas, hallways or in most patients' rooms.
"We're not living. We're surviving," Busnego told ABC News. Her mother-in-law's back surgery, which requires the replacement of a vertebrae prosthetic, has been postponed six times and the family has scrambled to find antibiotics for complicating infections.
With lack of maintenance and no money, testing equipment is damaged. At this hospital, doctors have resorted to cellphone photos of X-rays and MRI's; there is no material to print out the test results. In a 2015 study of 130 hospitals nationwide, lawmakers found that nearly 90 percent lacked functioning image testing equipment, according to lawmakers.
Around the hospital, unofficial signs from former patients and from families who have lost their loved ones to disease and the crisis advertise everything from needles to respirators and medicines for high blood pressure. Public hospitals ask patients and their families to bring their own supplies. The patients now worry that certain medicines will expire as they wait for surgery. Some have been living in the hospital for months and one for over a year, they said.
"The only things we didn't bring are the rusty beds, the broken chairs and the tray where we get whatever food we get," said Idalia Rodriguez, who now in her 50s has been waiting for heart surgery at the hospital for the past four months. "I thought I’d be here for 15 days…We brought everything for the surgery — medicines, gauze — but now I’m worried they’ll spoil and we won’t be able to find them again."
Next to her, Ubaldo Nogales took a look at his own medicines. He was admitted to this hospital in January after another center said it didn't have doctors or drugs to deal with his heart attack. Almost seven months in, Nogales, a widowed father of eight, has had three heart attacks. His surgery hasn't been scheduled. Now he helps organize protests in his ward.
"I thought they were going to operate on me faster because of all the heart attacks I’ve had but no way," he told ABC News. "I’ve had my medicines for about two months, waiting for the operating room to be ready. My family walked all over Caracas to get those medicines. It was an odyssey for my kids. They were looking around the country for them. Now if those medicines expire, we'll be back to square one."
Shortages and lack of services have ravaged public and private clinics around the country alike, and the price of getting treated in private institutions is insurmountable for many Venezuelans, who have seen inflation skyrocket and their salaries become less valuable. Government-run clinics, once the pride of socialist leaders in the country, don't fare better, experts and doctors said.
At the J.M. de los Rios Children's Hospital also in Caracas, the scene appears to be just as calamitous. Here the victims are younger.
Inside, paint has peeled off walls, there are dirty hallways, broken floors and death. Bloodied needles, used tubes, bandages and soiled diapers — medical waste that should otherwise be disposed of in closed containers — is often left in open bags in some hallways, letting out an acrid stench.
"It's like a war zone," said Erika Guevara-Rosas, Amnesty International's director for the Americas, who recently visited the hospital. "The conditions were deplorable…the doctors had to get creative to treat incoming patients with no resources," she told ABC News in Spanish, calling the situation, which has prompted Venezuelan President Nicolas Maduro to declare a state of emergency, a humanitarian crisis.
During Guevara-Rosas' visit to the hospital, she said a boy was brought with a gunshot to the head and the doctors panicked — there were no materials or drugs to treat the child.
"The doctor was running around trying to help the boy," Guevara-Rosas said. "There was no way of protecting the skull while extracting the bullet, they lack the most basic resources."
It's been five years since the hospital had the resources to perform open-heart surgery on children, said Dr. Jorge Sangines, the center's head of cardiothoracic surgery. Only 10 doctors nationwide are operating on children's hearts, he added, saying many doctors have left the country or, as in his case, don't have supplies to operate.
"I've been offered to leave, but I stay because I have hope we'll persevere," the doctor said. His ward now hosts patients from the hospital's oncology and neurology wards. The wards that remain open depend on the little resources the hospital gets from the state and mostly on humanitarian aid that groups have been able to get into the country.
Officials at this children's hospital estimate there are about 5,000 children in their network waiting for surgery. But of the eight operating rooms in the hospital, only three "have the potential to work," Dr. Augusto Pereira, the hospital's chief of oncology, told ABC News recently. He explained that there are only four anesthesiologists of the at least 30 the hospital needs, and even when they have the medicines, supplies and doctors, often the elevators are damaged and the patients can't get to the operating room.
Dr. Pereira said the hospital has also had to cut back on administering the treatment because they don't have the medicines. The hospital should be able to treat 24 chemotherapy patients a day, he said, but they only have resources to treat 35 a week.
"Those are patients that are not being treated at all," he said, gazing at the empty chairs in the hospital's chemotherapy room.
Children getting any treatment at the center face different challenges. The hospital's kitchen is closed and its nutrition department only provides baby formula to patients who are hospitalized. The formula is distributed in open plastic cups or bags, with some patients bringing their own. Everyone else must bring their own food.
The conditions are hitting the most vulnerable hardest. At the Concepcion Palacios Maternity Hospital also in Caracas, directors told Amnesty International that 101 babies died in the first three months of 2016, double the number for the same period in 2015. About 100 mothers had died there of various conditions by the end of June, the doctors told the organization, according to a report published that month.
At a recent assembly for hospital employees, eight doctors and nurses complained about the circumstances they're working in. As they waited for enough people to hold a vote to close down one of the hospital's programs, they pointed to the deaths of two pregnant women, both of whom succumbed to ravaging infections after miscarrying, as examples of what can happen when there are no resources to treat patients.
"If this is not a crisis, then what is?" Guevara-Rosas of Amnesty International said.
In July, doctors at the maternity hospital protested, asking the country's Ministry of Health for medicines and protesting they didn't have the supplies to run the hospital at full speed.
Directors for the three hospitals did not immediately respond to requests for comment. The country's Ministry of Health did not provide a statement on the situation; however, Venezuelan President Nicolas Maduro defended the country's healthcare this May.
"I doubt there's a better health system in the world," he said.
Country in Crisis
The health crisis in Venezuela is just one side of a larger deterioration of the country, which has seen tensions rise as food and basic goods became scarce, inflation soared to a whopping 500 percent this year, and services such as electricity and water were disrupted. The country with the biggest oil reserves in the world, once the richest and safest in the region, doesn't go a day without a power outage, a water shortage, or a homicide in some areas, local reports say.
"In Venezuela all human rights are being violated at the same time," Guevara-Rosas of Amnesty International said.
At the heart of the crisis is the sharp fall of oil prices, both the Venezuelan government and experts say. The country's dependence on oil as an export exacerbated preexisting economic conditions that were in place before Maduro took office in 2013, such as debt and currency devaluation, according to the International Crisis Group, a transnational non-profit, non-governmental organization that carries out field research on violent conflict. The population below the poverty line is growing fast, the group said.
But experts point to erratic policies and a lack of investment and saving revenue from the oil boom of the early 2000s as the top causes for the current situation.
"Oil went down for the whole world, but you don’t see humanitarian crises in all other oil-producing countries," Dany Bahar, a fellow at the Brookings Institute and an associate at the Harvard Center for International Development, told ABC News.
"What is unique about Venezuela is the self-inflicted damage of such an economically powerful country," Jose Miguel Vivanco, Human Rights Watch's director for the Americas, told ABC News recently.
As the country's politicians battle over Maduro's leadership, Venezuela continues to fall. The country is experiencing a shortage of 80 percent of goods, according to Datanalisis, a Venezuelan polling firm.
In Caracas' Petare neighborhood, a slum in the hills that surround the city, Castorina Irazabal wakes up at 3 a.m. to get in line to buy food.
"We’ve been hungry. You don’t find everything all the time. You have to eat once a day, dinner or lunch. No milk, no coffee, no sugar," the 54-year-old told ABC News in Spanish.
Tension as people wait in lines for basic resources is palpable and Venezuelans have become more desperate.
"All the time, you get to a line and you’re scared," Irazabal said. "If I talk too much or complain too much, they can stab me, they can shoot me, they can rob me. There’s a lot of violence in the lines."
And Caracas is not alone. In other regions in the country, a number of residents and business owners, who asked to be kept anonymous for fear of retribution, have not gotten food in weeks; Maduro recently appointed the country's Defense Minister, a general, to oversee the distribution of food. Four other military officers are now in charge of the country's main ports.
In the western city of Maracaibo, once a hub for oil companies and expats working in the city's oil-rich lake, talk of food dominates public spaces and private meetings alike. From churches to pharmacies, from breakfast parlors to funerals, people worry about getting the food bags distributed by community councils. In a recent week, the bags only included two pounds of powdered milk and ran for a price that's almost half of the monthly minimum wage of about $33.30.
The mounting desperation has built up. Just last month, more than 120,000 Venezuelans crossed the border to neighboring Colombia to buy goods, mostly food and hygiene products. Online, groups advertise round-trip tours to Colombia highlighting the availability of products that are nearly impossible to get in Venezuela.
In June, 153 people were detained in connection to the looting of several shops in the eastern state of Delta Amacuro; lootings have been reported across the country, according to local authorities and reports. In the western city of San Cristobal, a woman was fatally shot in the face earlier this year during looting in a supermarket, local authorities confirmed. By early July, at least 12 people had been killed in food line-related disputes, according to the Associated Press.
Violent crime, meanwhile, is on the rise, with the country's capital, Caracas, recently overtaking Honduras' San Pedro Sula to become the most violent city in the world, according to the Citizen's Council for Public Security and Criminal Justice. As food becomes scarcer and people desperate, basic goods such as flour and oil have become valued items to steal. This has led vigilante violence against people accused of stealing to become increasingly common in an already crime-ridden country, local reports show.
"This is a country that is on the verge of explosion, social explosion," Vivanco of Human Rights Watch said.