Protests have continued over inequalities, including in the health system, as COVID-19 worsens disparities. Joe Parkin Daniels reports from Bogotá.
Since late April, 2021, Colombians have taken to the streets in their thousands, initially against a proposed tax hike that would have hit the middle and working classes. Although that reform was swiftly axed, the protests have since morphed into a nationwide expression of rage against entrenched economic disparity that has only worsened during the COVID-19 pandemic.
The police crackdown has been brutal, with at least 45 demonstrators killed and hundreds injured, according to Temblores, a local human rights monitor. Protest tactics such as roadblocks have proved divisive, while incidents of vandalism and looting have faced widespread condemnation. However, despite ongoing negotiations between the government and protesters, observers say the protests—a continuation of demonstrations that began in late 2019 but were put on hold by the pandemic—are as much about public health as other issues, and are unlikely to subside soon.
“Any health system in the world is a mirror of its country's social health, and Colombia's is fundamentally unequal”, said Roman Vega, a professor of public health at Universidad Javeriana in Bogotá and specialist in health inequality and social security. “It's a system that doesn’t exist in rural areas across the country—where there are no doctors, nurses, or health promoters—because it is a system that exists to finance itself, more than because of any social mission.”
Colombia's health system, comprising both private and subsidised tiers, has long failed to adequately serve the country's rural and urban poor. A health reform plan, which would have strengthened the role of private health promoters and allowed private providers to merge with public hospitals, was rejected by lawmakers as protests gained momentum in mid-May, 2021.
Colombia's president, Iván Duque, acknowledged the pandemic's “devastating effects” while speaking at a conference last week. “Today we are seeing the boiling over of many problems brought by the pandemic, and not only in Colombia but in the world.”
In Colombia, the pandemic has pushed 3·5 million additional people into poverty, with those from the poorest neighbourhoods ten times more likely to be hospitalised or die from COVID-19 than those from the wealthiest, according to a recent study by Universidad de Los Andes in Bogotá.
“We have to deal with some sectors of the population that have been the most affected”, Duque said, referring specifically to young people and women. “We have to quickly build measures that meet their needs.”
One such young person is Jefferson, a medical student who has been tending to injured protesters in Bogotá during nightly battles with police. “I support these strikes because this country is unjust, from health care to education”, he said, declining to give his surname for fear of reprisal, ahead of another night of skirmishes with authorities. “If you can’t afford good health care, you’re left to your own luck.”
Colombia is mired in a third wave of COVID-19 cases. On June 20, the 7-day average of new cases was 27 420, the highest since the pandemic began, while intensive care unit occupancy in Bogotá, Medellín, and Cali—the three largest cities—is above 97%. More than 100 000 patients have died.
20% of the population have received at least one dose of a COVID-19 vaccine, usually the Pfizer-BioNTech or Sinovac vaccines. Those with the means have travelled to the USA, where vaccines are abundant—something observers say will add to the perception of health inequity. “We don’t have statistics of how many people have left the country to get vaccinated, but we can safely assume that it's people from the wealthiest sectors of society, which will only increase the disparity between those that are vaccinated and those that are not”, said Vega.
Despite understanding the anger of many protesters, some medical professionals are imploring those in the streets to lift roadblocks that have caused sporadic shortages of medical supplies, including oxygen, as well as food and fuel. According to the government, over 2750 roadblocks have been set up nationwide. Outcry swept the country in mid-May after the death of an intubated newborn baby in an ambulance stuck in a tailback. Others worry that the crowds at protests will facilitate the easy circulation of COVID-19. The national strike committee, which coordinates the demonstrations, last week announced a temporary suspension on mass marches, though people continue to protest online and in person, albeit in smaller numbers, and with sporadic roadblocks.
“Patients are going to die because of these protests”, said Marcela Gómez, a general practitioner in Cali (the southwestern city that has seen the most unrest), while attending a counter-protest. “People have a right to protest, but it should be geared towards dialogue, not destruction.”