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The public-health case against Nicolás Maduro

Apr 22,2019 - Last updated at Apr 22,2019

NEW YORK — In medical school, we learned about the ghastly effects of severe protein-calorie malnutrition. But we thought that conditions such as kwashiorkor and marasmus were mainly of historical significance, the scourges of long-ago wars and prison camps. We did not expect to witness them in our lifetimes.

Yet today, severe malnutrition is engulfing Venezuela, with catastrophic consequences for the country’s people and its future generations. The recent stand-off at Venezuela’s border with Colombia, in which Venezuelan government forces fired bullets and tear gas to prevent 80 tonnes of humanitarian aid from entering the country, is evidence that the regime is deliberately starving its own people.

That is why I believe there are strong and urgent public-health grounds for international criminal charges against President Nicolás Maduro and officials in his government. And with diplomatic efforts to remove Maduro seemingly at a standstill, such an approach could offer another route towards changing the country’s leadership.

Widespread malnutrition in Venezuela is the result of years of social, political and economic failure. Venezuela was once one of Latin America’s richest countries, with the world’s largest proven oil reserves. But it is now experiencing one of the most dramatic economic collapses in history, owing to political mismanagement, massive state expropriations, lack of foreign exchange and crippling debt. GDP has fallen by more than 50 per cent over the past three years, and inflation has reached incomprehensible levels.

Given this chaos, many economists have argued for a more meaningful measure of economic collapse at the household level. For example, Ricardo Hausmann, a professor at Harvard’s Kennedy School, estimates that Venezuela’s minimum wage currently buys only about 700 calories a day, far below the recommended individual intake. One national survey in 2017 indicated that nearly all Venezuelan households were facing food insecurity, and that more than half the population had lost 11kg in the past year.

Although the Venezuelan authorities have released few country-level health statistics for years, isolated and leaked reports show that hunger may be having a severe impact on the population. The health ministry’s 2015 annual report, for example, showed a hundredfold increase in the neonatal mortality rate, to over 2 per cent from 0.02 per cent in 2012.

How might criminal charges come about? Under the Rome Statute, a multilateral treaty, the International Criminal Court (ICC) has jurisdiction to prosecute crimes against humanity. These include “inhumane acts... intentionally causing great suffering, or serious injury to body or to mental or physical health.” I would argue that this definition includes severe and intentional protein-calorie malnutrition on a national scale.

ICC examinations and investigations can arise in several ways. The court’s individual member countries and the United Nations Security Council can refer cases. Alternatively, the ICC prosecutor can open a case on his or her own authority. The prosecutor’s office is currently examining one case concerning the conduct of Venezuela’s security forces, referred to it by five Latin American countries and Canada. Should a full ICC investigation follow, these additional public-health grounds may constitute further evidence to support charges of crimes against humanity against the Maduro regime.

An international criminal investigation would serve two purposes. First, most other diplomatic screws on the regime have already been tightened, to no avail. The United States and more than 50 other countries have already recognised opposition leader Juan Guaidó as Venezuela’s interim president. And the US has imposed crippling economic sanctions on the country’s state-owned oil and gold-mining sectors, limiting their access to export revenue.

Michelle Bachelet, the UN High Commissioner for Human Rights, recently warned that US sanctions might worsen Venezuelans’ plight. Others have drawn a parallel with Iraq, where international sanctions against former president Saddam Hussein’s regime led to widespread malnutrition among children. An international, human-rights-based criminal investigation, by contrast, would target Maduro’s dictatorship directly rather than the Venezuelan people.

Second, an investigation by the ICC, which 122 countries have joined, would send a clear message about the enforceability of norms through international law. Although public-health claims have not yet been used as a basis for international criminal charges, some experts believe that they could be. According to Alex Whiting, a Harvard Law School professor and former Prosecutions Coordinator at the ICC, “when certain regimes adopt extreme policies that strangle their own populations, we have to consider, and investigate, whether it meets the threshold of international criminality”.

US Secretary of State Mike Pompeo said last month that “every option is on the table” to end Maduro’s rule. But with the US having recently withdrawn all staff from its embassy in Caracas, diplomacy may have run its course. And any military option would have to contend with the historical legacy of failed US-backed interventions in Latin America.

Venezuela’s economic collapse is a tragedy in itself. But by deliberately aggravating the population’s access to nutrition, the Maduro regime is arguably committing crimes against humanity. We must hold it accountable.


Akash Goel, a professor of medicine at Weill Cornell/New York-Presbyterian Hospital, has been recognised by the United Nations and awarded a Cannes Lion for his human-rights advocacy. Copyright: Project Syndicate, 2019.

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