Humanitarian organisations are concerned that border closures and health-care shortages are amplifying the challenges posed by COVID-19. Joe Parkin Daniels reports from Bogotá. The coronavirus disease 2019 (COVID-19) pandemic is exacerbating an already precarious health crisis for Venezuelan migrants fleeing a collapsed health system at home. At the time of going to press, the outbreak is continuing to spread in Venezuela despite a military-enforced quarantine. Venezuela remains mired in economic and social turmoil. Hyperinflation last year reached 10 000%, according to the central bank, while shortages in basic foodstuffs and medical supplies were already a daily reality. Hospitals regularly facing power outages and basic medical supplies—from latex gloves to routine antibiotics—are often hard to come by. 4·5 million people have fled Venezuela in recent years, including health workers and disease specialists. Most Venezuelan migrants cross on foot into neighbouring Colombia, which houses an estimated 1·4 million Venezuelans. In Cúcuta, a city on the Colombian side of the border, as many as 40 000 Venezuelans arrived daily until March 14, when Colombia closed its borders in a bid to stem the spread of COVID-19. Colombia had 306 confirmed cases of the disease, with three deaths, as of March 24. The seven official entry points along the 1378-mile border remain closed, although countless informal crossings are still in use. The International Rescue Committee, a non-governmental organisation (NGO) with a clinic for Venezuelan migrants in Cúcuta, reports an emerging crisis. “Needs are very strongly felt here in terms of access to health and other services”, said Minerva Márquez, the NGO's representative in Cúcuta. “Migrants are struggling to survive without soup kitchens or any means of work. Few partner organisations are able to work at full capacity either.” The Colombian government has returned a number of migrants to Venezuela in response to the outbreak, while permitting those with ongoing medical treatments—including dialysis—to cross into Colombia. It is unclear how many people have been returned or how many have able to cross the border as medical exceptions; humanitarian actors report that the Colombian authorities are working on a case-by-case basis. The Pan American Health Organization announced on March 16 that it will facilitate cooperation between the two countries in battling the spread of COVID-19 on the border, despite the breakdown in diplomatic relations a year ago. Other NGOs have expressed concerns about what effects the border shutdown could have. Ellen Rymshaw, Colombia's head of mission at Médecins Sans Frontières (MSF), said that fewer patients have attended their clinics in border provinces since the shutdown. “We are also seeing an increase of xenophobia and discrimination against this population, which is falsely accused of the spread of COVID-19 in the border areas. MSF is extremely concerned that the growing xenophobia toward the Venezuelan community will prevent access to basic medical services they so desperately need.” Both countries have also announced strict quarantines, preventing many of those wishing to return home from doing so. Even if they could, the Venezuelan health system continues to buckle. A survey of doctors by the local Venezuelan NGO Médicos Unidos found that only 25% of respondents had reliable tap water in their hospitals and clinics. 65% said they did not have gloves, masks, soap, goggles, or scrubs. At one of the country's largest hospitals, the University Hospital of Caracas, 80% of health workers reported being without protective equipment. José Félix Oletta, Venezuela's health minister from 1997 to 1999, said that while the health system is “unprepared” for the COVID-19 pandemic, professionals will still do everything they can. “We are used to witnessing complex scenarios, of uncertainty, and rationalising our behaviours, and this gives us a shield against fear”, he told The Lancet. Venezuela's health crisis is also a political one. Nicolás Maduro sits in Miraflores, the presidential palace, although a US-led coalition of more than 50 countries does not recognise him as the legitimate leader. Instead, those countries back Juan Guaidó, a young opposition leader who declared himself Venezuela's legitimate president in January, last year. The deadlock was never resolved, and opposition supporters and international observers say that the Maduro administration's intransigence has contributed to the crisis. Maduro says that sweeping US-led sanctions are hamstringing Venezuela's ability to respond to the pandemic, prohibiting the country from importing medicines and supplies. He requested US$5 billion from the International Monetary Fund to tackle the outbreak, which was rebuffed on March 18. He subsequently asked for $1 billion, Bloomberg News reported.