The right to health is articulated in multiple human rights treaties including the Universal Declaration of Human Rights [UDHR] (Art.25) ; International Covenant of Economic, Social and Cultural Rights [ICESCR] (Art.12) ; Convention on the Rights of the Child [CRC](Art. 24) ; Convention on the Elimination of all forms of discrimination against women [CEDAW] (Art.12) ; United Nations Declaration on the Rights of Indigenous Peoples [UNDRIP] (Art. 24) ; Convention on the Rights of People with Disabilities [CRPD] (Art. 25) ; International Convention on the Elimination of All Forms of Racial Discrimination [CEAFRD] (Art. 5 (e.iv)) . It is further articulated in General Comment 14  of the UN Committee on Economic, Social and Cultural Rights which identifies social determinants of health as fundamental to the realization of the right to the highest attainable standard of health, including the right to clean water, the right to a healthy environment (like clean air, healthy environments and protection from toxic wastes), food, housing and jobs.
Realization of the right to health [41, 47] in Venezuela has been hindered by the government’s failure to take action to prevent vector-borne diseases like malaria, and now infectious diseases like COVID-19. In comparison with neighboring countries, Venezuelans are more likely to die from malaria and to arrive to the hospital with complication due to malnutrition  and health care in Venezuela has become progressively less available, accessibly, acceptable and of high quality. Health facilities commonly lack the necessary supplies and/or medicines to provide treatment, lack health personnel, and even basic provisions [11, 12, 22, 48]. This situation is worse for people living with disabilities, children, pregnant women and indigenous communities [4, 11].
Examining the actions, and inactions, of the Venezuelan government with respect to malaria and COVID-19, it is clear that they are failing to uphold their human rights obligations, both in terms of the overall population and in terms of populations subjects of special protection such as children, pregnant women, people living with disabilities, and indigenous communities . This includes taking the necessary measures to reduce child morbidity and mortality, the prevention, treatment and control of epidemic, endemic, occupational and other diseases and the creation of conditions which would assure access to all medical service and medical attention in the event of sickness -all of which are aspects of the right to health as conceptualized in international human rights law as well domestic laws and Constitutional protection. The Venezuelan government’s failure to implement disease control measures, to collect and report epidemiological surveillance data and to cooperate with its neighboring countries to address the regional spread of infectious disease threats also entails a failure to uphold the WHO International Health Regulations . Table 1 summarizes relevant human rights related to the re-emergence of malaria, COVID-19 and the government’s obligations from both international treaties and Constitutional protections.
Case study: Venezuela’s indigenous communities
Bolívar State, with a high concentration of illegal gold mines, accounted for 74% of Venezuela’s malaria in 2016 - the highest incidence in the Americas . Illegal gold mining affects ecosystems as it involves vast deforestation and contamination of food and water sources, which favors mosquito proliferation . The increase in malaria incidence has been associated with these human activities and the massive migration to these areas of people looking for jobs ; but also to the conditions in which miners work, being overexposed to long periods outside and pressured to live in camps where living conditions lack sanitary standards of health and protection (complete walls, mosquito nets, roof protection) [36, 51]. This violates their rights to work and housing as understood in international human rights law (ICESC, Arts. 6,7; CEAFRD, Art. 5 (e.i)). The Venezuelan State has neglected to take effective measures that ensure the protection of the environment and the disposal of hazardous materials derived from mining, which greatly harms indigenous communities in the area , violating their right to a clean environment and the protection of its resources according to the Declaration on the Rights of Indigenous People and the Venezuelan Constitution . Expansion of endemic transmission from Zulia to Mérida is also due to domestic massive migration patterns that spread the disease to areas of chronic under-investment in public health in the Southeast of the country .
Indigenous people have repeatedly denounced the exploitation and detrimental impact that mining has on their territories, bringing settlers into their land, increasing disease infection rates and exposing their communities, particularly women and children, to sexual and labor exploitation [55, 56]. COVID-19 aggravates this situation, which is compounded by the lack of efforts to prepare for or address the crisis, especially in the Amazon and Amazon-adjacent areas . In addition to illegal mining, Bolívar state, has high levels of drug and human trafficking, sexual exploitation and illegal guerrilla activities involving training, children’s forced recruitment and labor exploitation under arbitrarily declared ‘war laws’ . The scarcity of health infrastructure is also exacerbated by the lack of occupational health care arising from illegal labor . Lack of information on malaria prevention and treatment for indigenous populations also contribute to poor health outcomes and represents failures of the government to uphold human rights obligations .
Indigenous communities were recognized by the Venezuelan government as part of the country in the 1999 Constitution (see Table 1) and Venezuela proclaimed itself a multicultural nation . However, the government has historically protected private companies and investors that exploit natural resources in Amazon-adjacent and border territories, infringing indigenous people’s rights to land, resources and protection, and failing to uphold human rights obligations related to the right to a healthy environment. Under the guise of responding to the economic impact of the COVID-19 pandemic, the rights of indigenous communities in Venezuela could be further threatened, as has been the case in Brazil, where the country’s President, Jair Bolsonaro, has stripped the Amazon and the indigenous communities of constitutional protections that protect them, their land and the ecosystem [57, 58]. In Venezuela, mining companies operate under the protection of the army, which is suspected to take a part of the royalties in exchange for services provided . Human rights and international organizations have documented how indigenous women are forced into prostitution by mining activities and further exposed to violence under territory disputes between armed illegal actors [55, 56]. These communities are often forced to flee in search of protection, which causes them to seek refuge outside of their ancestral land in neighboring countries, potentially exacerbating vulnerability to infection and the spread of disease.