Colombia: Indigenous Kids at Risk of Malnutrition, Death

(New York) – The Covid-19 pandemic and related lockdown are making it even harder for the Wayuu, an indigenous group in Colombia and Venezuela, to survive, Human Rights Watch and the Johns Hopkins Center for Humanitarian Health said in a joint report and accompanying multimedia piece released today.

The pandemic and lockdown are making it harder than ever for the Wayuu, many of whom live in the Colombian northeastern state of La Guajira, to get adequate food, water, and health care at a time when they need them more than ever. The Colombian government should urgently take action to protect indigenous Wayuu children’s rights.

“Rural indigenous communities in La Guajira can’t get sufficient food or enough water for basic hygiene, such as handwashing, and access to health care and information is very poor,” said José Miguel Vivanco, Americas director at Human Rights Watch. “This situation has for years contributed to one of the highest levels of child malnutrition in Colombia, and it raises critical concerns in the current context of Covid-19.”

The multimedia piece, “People of Resilience: Colombia’s Wayuu Indigenous Community Confronts a Malnutrition Crisis Amid Covid-19,” exposes the struggles that some Wayuu families face in a region marked by food and water insecurity and limited health care. Mismanagement and widespread corruption by local officials, a humanitarian crisis in neighboring Venezuela, and the effects of climate change have exacerbated food insecurity and resulting malnutrition. Colombian high courts have found that mining in the region has also degraded the quality of and access to water for some Wayuu communities.

In January 2020, researchers from Human Rights Watch and the Johns Hopkins Center for Humanitarian Health, based at the Johns Hopkins Bloomberg School of Public Health, interviewed more than 150 people in La Guajira and Bogotá, Colombia’s capital, including Wayuu community members and authorities, Venezuelan exiles, United Nations and government officials, representatives from international and domestic nongovernmental organizations, aid workers, healthcare workers, teachers, and environmental scientists. Between January and June, researchers conducted 42 additional interviews by phone. Researchers also analyzed information and data provided by numerous government agencies, hospitals, and international and domestic nongovernmental organizations, as well as several court and prosecutors’ files on corruption investigations.

With a population of at least 270,000, the Wayuu are Colombia’s largest group of indigenous people. The vast majority live in the partially desert state of La Guajira. Most live in rural areas or small towns and have traditionally relied on subsistence farming, seasonal foraging, herding goats, or fishing as their main sources of food and income. Many others work in tourism or salt or coal mining, make and sell handicrafts, or depend on market trade with neighboring Venezuela.

According to a 2018 government census, 90 percent of people in La Guajira work in the informal sector, including in tourism, hospitality, and cross-border trade.

While Colombia has reduced the national death rate of children under 5 years of age over the last five years, the death rate of children in La Guajira increased during that same period. The official death rate of children under 5 from malnutrition in La Guajira was nearly six times the national rate in 2019. Yet the real rate may be even higher, according to doctors, nurses, government officials, and aid workers. The government does not register all deaths, in part because many children die at home. While the nationwide average child mortality rate due to malnutrition has dropped dramatically in recent years, the rate has not improved in La Guajira, and the state currently has the highest number of childhood malnutrition deaths in the country.

Water and food insecurity, along with barriers to accessing healthcare, drive these deaths. Government figures show that only 4 percent of Wayuu people in rural La Guajira have access to clean water, while those in urban areas get irregular service. The most recent national nutritional government survey, from 2015, shows that 77 percent of indigenous households in La Guajira are food insecure, meaning they lack secure and permanent access to food of sufficient quality and quantity for a healthy and active life.

Healthcare facilities are often distant and costly for many Wayuu, who may travel hours to reach a center. Many sick children may not survive the journey or may relapse after they leave a center.

Only 3 of 16 La Guajira hospitals offer specialized health care to manage complicated cases of acute malnutrition. Alta Guajira, a region in the north where the largest number of Wayuu people live, has just one hospital that only offers basic care. Children requiring more specialized care must be transported to Riohacha, La Guajira’s capital, often several hours away from their communities, assuming road conditions are even navigable.

Government authorities have in recent years implemented a wide range of programs and policies to address the malnutrition crisis, including trying to expand access to water. However, these efforts have been marred by serious shortcomings and resulted in limited progress, Human Rights Watch and the Johns Hopkins Center for Humanitarian Health found.

Pervasive government corruption, including in the procurement and execution of contracts, is also undermining water projects, school meal programs, and health services in La Guajira. Fourteen government audits of school meal programs in La Guajira found 30 billion Colombian pesos (almost US$10 million) were lost to corruption or mismanagement. Despite significant efforts by some officials, authorities have made limited progress in holding corrupt officials in La Guajira to account, virtually guaranteeing that corruption will continue, Human Rights Watch said. A major hurdle is the limited number of prosecutors, judges, and investigators in the state.

Covid-19 introduces a new stress factor, both for the Wayuu and for government programs and services. As of August 10, Colombian authorities had confirmed over 2,700 cases of Covid-19 in La Guajira, including 65 among the Wayuu. In the context of poor access to food and water, the health and economic effects of the Covid-19 pandemic could be devastating for the Wayuu if the virus spreads further in the region, Human Rights Watch and the Johns Hopkins Center for Humanitarian Health said. Nationwide, authorities had confirmed over 397,000 cases of Covid-19 and 13,000 deaths as of August 10, 2020.

Covid-19 could spread easily within Wayuu communities, many of which lack access to continuous and sufficient water to follow public health guidance on hygiene measures to prevent the spread of the virus. If infected, many will not have reliable access to a hospital.

Moreover, Colombia’s nationwide lockdown – which began in March and continues through August 30 – and the associated travel restrictions severely limit the Wayuu’s access to food, say local doctors, officials, and residents.

Under international human rights law, Colombia’s government has an obligation to ensure that everyone in the country has an adequate standard of living, including, at a minimum, adequate – physically accessible and affordable – and safe water, nutritious food, and other essentials for a life with dignity, without discrimination. International human rights law also protects the right to the highest attainable standard of health and obligates Colombia to ensure that medical care is accessible and affordable. These services should be provided in ways that are culturally appropriate and take indigenous peoples’ customs and traditions into account.

“Unpunished government corruption in La Guajira has been a key factor contributing to poor access to water, food, and health services that are essential for the survival of many Wayuu,” said Vivanco. “Colombian authorities need to hold corrupt officials to account and must urgently ensure that government assistance reaches those whose rights are most at risk, especially during the pandemic.”

For a full report, including recommendations and an analysis of the government’s efforts to address the crisis in La Guajira, please see below.

Limited Progress to Ensure Access to Food, Water, and Health Services

Throughout Latin America, extreme poverty, environmental degradation, and the loss of land, territory, and access to traditional foods have contributed to rates of malnutrition for indigenous children that are double that of the region’s general population. For years, reports out of La Guajira have suggested that the disproportionate impact of malnutrition on the Wayuu is even more acute.

While La Guajira is only home to about 7 percent of Colombia’s population, it accounts for more than 20 percent of malnutrition deaths among children under 5. Over 75 percent of malnutrition deaths in La Guajira are of indigenous children, although the indigenous population is 42 percent of the state’s population, according to government data.

The massive arrival of Venezuelans since 2015 has further strained already overstretched health, water, and food systems, according to doctors, teachers, and government officials. La Guajira hosts at least 161,000 of the 1.8 million Venezuelans who have migrated to Colombia, fleeing the humanitarian and human rights crisis in their country. Hundreds of thousands of Venezuelan exiles in Colombia experience food insecurity. The Colombian government and humanitarian organizations have taken steps to provide them with support in La Guajira, including by creating a UN High Commissioner for Refugees (UNHCR) shelter and granting some temporary residence permits, but these measures are insufficient.

In 2015, the Inter-American Commission on Human Rights (IACHR) urged the Colombian government to take immediate action to guarantee the Wayuu people the rights to food, water, and health in several La Guajira municipalities. In 2016and 2017 rulings, the Colombian Constitutional Court ordered the government to address the crisis. In the 2017 case, it found that, in part due to government inaction, the Wayuu experienced a “widespread, disproportionate, and unjustified violation of the rights to water, food, and health,” and ordered the government to take “urgent and priority” measures to ensure that Wayuu children have available, accessible, and quality food, water, and health services.

In February 2017, the national government took over the state entities providing water, health, and education services in La Guajira, assigning temporary authorities from the national government to administer and provide “technical guidance.” On July 2, 2020, the national government returned health oversight to local authorities, but education, food, and water services continue under “intervention” until 2022.

The government has made efforts to improve access to food, water, and health services for the Wayuu amid the massive influx of Venezuelan exiles in La Guajira, with limited results. Over the past four years – aside from a brief improvement in 2017 – the number of La Guajira children suffering from acute malnutrition has not improved significantly. According to government data, there were 1,607 cases of severe malnutrition in La Guajira in 2019, 1,647 in 2018, 993 in 2017, and 1661 in 2016. There were 64 deaths connected to malnutrition in 2019, compared with 105 in 2018, 50 in 2017, 85 in 2016, and 48 in 2015. The rate relative to births of children suffering malnutrition or dying because of it has remained largely unchanged since 2016.

Deaths of children under 5 from diarrhea – often linked to unsafe water or insufficient water for good hygiene – have increased in recent years, according to government data. Forty-six children under 5 died of diarrhea in 2019 in the state, compared with 33 in 2018, 13 in 2017, 23 in 2016 and 6 in 2015. These deaths, like deaths from malnutrition, are largely considered preventable. La Guajira’s disproportionately high diarrheal disease death rate, which is five times greater than the national average, highlights its poor access to water and sanitation.

Human Rights Watch and the Johns Hopkins Center for Humanitarian Health identified serious shortcomings in many government programs and policies to address malnutrition.

The Colombian Family Welfare Institute (Instituto Colombiano de Bienestar Familiar, ICBF) has established two recovery centers for children with acute malnutrition in La Guajira and provided mobile units to screen children, each with a physician, nurse, social worker, and healthcare promoter. Between 2015 and 2018, the government expanded the number of units from 4 to 10. These units screened almost 27,000 children in 2018, according to government figures.

However, a local health authority interviewed in January said that about half of children diagnosed with malnutrition in the state are not served by the agency’s meal or treatment programs. Moreover, the mobile units only operated for three months in 2019, and they have not operated between at least January and July of this year due to lack of funding, agency officials said.

The lack of familiarity and language capacity within the health system, as well as a history of discrimination and neglect, also creates barriers that limit the Wayuu’s access to health services. Many Wayuu people speak only Wayuunaiki, not Spanish, not all healthcare workers speak Wayuunaiki, and translators are not always available.

Malnutrition treatment can involve long in-patient hospital stays, in particular for children suffering both acute malnutrition and other illnesses. Parents may be unaccustomed to staying in hospitals or cities and feel uncomfortable leaving their sick child with healthcare workers they do not trust, health authorities and residents said. And the cost of staying near hospitals while their children are hospitalized is often prohibitive for families, residents and healthcare workers said.

Gaps in healthcare coverage also stem from the logistical difficulties to reach remote communities. Virtual options such as telehealth services are difficult due to the limitations to internet access in the state.

To supplement food security for at-risk children, the government has also invested millions of dollars in school meal programs since 2014, including roughly US$18 million in 2019. Yet the food provided has at times been too little or spoiled, Wayuu community authorities, local prosecutors, and regional aid workers said. Private food providers hired by the government have at times failed to account for the hundreds of children coming from Venezuela; teachers said they have had to split meals to cover those children.

Government initiatives to bring water to La Guajira’s indigenous communities are being carried out slowly, even as water is becoming scarcer and more urgently needed. Government authorities have created wells, provisional public water points, and aqueducts to improve communities’ access to water. As part of a multi-agency program, Alliance for Water and Life in La Guajira (Alianza por el Agua y la Vida en la Guajira), which began in 2015, the government reports it had built or repaired 249 “water solutions” as of late 2019, including wells based on solar energy and wind, facilities to store water, and some deep tube wells.

But residents said that many “water solutions” have been contaminated or stopped working due to lack of maintenance and others depend on wind to operate their pumps, so they only work intermittently. Wayuu people, government officials, and aid workers said that water from these wells may be dirty, brown, green, or salty. Human Rights Watch visited several wells and jagüeyes – indigenous open-pit water reservoirs – in various communities, and found that, while some were functioning and accessible, water in some cases was turbid and the reservoir or well was frequented by animals such as goats or dogs, risking contamination.

The Housing Ministry has begun to install provisional public water points in the region as part of its initiative Guajira Azul, which began in 2018. While these can provide access to water in this urgent context, they are not permanent. Instead, safe and sustainable drinking water sources should be constructed and maintained.

Even these emergency measures are being carried out slowly: as of March, the ministry had only finalized one of the 19 provisional water points it planned to build with support of international cooperation before 2022. It had also secured the budget for four others, a high-level government official in La Guajira said. The plan is currently halted due to the pandemic, a local official said.

As another temporary measure, some communities receive government water tank deliveries, but delivery is difficult because Wayuu communities tend to be rural and dispersed. Deliveries can be infrequent, and people at times need to walk for hours to retrieve this water, residents and local authorities said. The quality of the water and prevention of contamination at the points of collection or use cannot be assured without ongoing funding for monitoring and water treatment supplies, which is currently lacking.

Colombian authorities, including the Inspector-General’s Office, the Comptroller General’s Office, and the Human Rights Ombudsperson’s Office, have also identified serious shortcomings in the government’s response to the crisis. An official from the Inspector-General’s Office, an independent body charged with “protecting human rights” and conducting oversight of decisions by government officials, said that “most [government] entities” had “failed” to take “adequate and necessary actions” to address the situation in La Guajira. Similarly, in December 2019, the Human Rights Ombudsperson’s Office concluded, in a report reviewed by Human Rights Watch, that there was “no significant progress in the long-term measures” required to address the crisis.

Barriers to Prosecuting Corruption

In 2016 and 2017, the Constitutional Court of Colombia concluded that corruption was one of the main factors undermining children’s access to water, school meal programs, and health services in La Guajira. The court found limited transparency in the procurement of these services and said that the Attorney General’s Office, the Inspector-General’s Office, and the Comptroller General’s Office should prioritize prosecuting corruption in the state.

In cases currently under investigation involving corruption in health and food programs, the Attorney General’s Office estimates that over 13 billion Colombian pesos (roughly US$5 million) have been lost to corruption in the state since 2014. The Comptroller General’s Office found, through 14 audits into school meal programs in La Guajira, that approximately 30 billion pesos (almost US$10 million) had been lost to corruption or mismanagement. In most of these cases, corruption occurred during the execution of contracts with companies hired to provide health and food services. Since these figures only reflect investigations into a limited set of cases, the total money lost to corruption in La Guajira is most likely much higher.

In April 2020, the Attorney General’s Office, which carries out criminal investigations and prosecutions, told Human Rights Watch that it was conducting at least 28 investigations in La Guajira for misappropriation of public funds intended for food and health services. These included three investigations against former governors and four against former mayors. As of March, 21 people had been charged in corruption cases and at least 13 – including one state governor and five private contractors – had been convicted, the Attorney General’s Office said.

For example, in two investigations carried out in 2015 and 2016 involving ICBF programs, investigators found that agency officials, as well as employees of a private health provider, misappropriated nearly 3,712 million pesos (roughly US$1.2 million) from plans to provide food and comprehensive healthcare to over 28,000 children under age 5 and pregnant or breastfeeding women in 2015. They used false invoices, lease payments that exceeded twice the real value, and fabricated names, prosecutors found. As of March, the Attorney General’s Office had indicted 17 people, including senior ICBF officials, some of whom are currently awaiting trial.

In 2017, the then-mayor of Riohacha, a La Guajira municipality, and his then-education secretary were charged in another case for misappropriating over 1 billion Colombian pesos (US$385,000) in 2016 from a plan to feed over 16,000 children in schools in rural and indigenous communities in Riohacha. The Attorney General’s Office found that some contractors were paid twice and that there were cost overruns in transportation. Some food was not delivered, “not fit for human consumption,” or “of poor quality,” prosecutors found. The former mayor and secretary were charged and sent to pretrial detention in February 2017, while other people are still under investigation in the case, prosecutors said.

There have also been cases of corruption connected to water services in La Guajira. For example, in November 2016 prosecutors charged 11 people, including a former mayor of Riohacha, for corruption in the 2012-2014 building of an aqueduct. The aqueduct never functioned, and prosecutors estimate that over 12 billion Colombian pesos (roughly US$3.9 million) were lost to corruption.

While prosecutors have initiated and pursued many investigations into corruption in La Guajira, these and future investigations into corruption in the state face major hurdles.

A key obstacle is the limited number of prosecutors to investigate and prosecute corruption cases in La Guajira and their excessive workload, prosecutors said. Out of the 47 prosecutors currently working in La Guajira, only two, both based in Riohacha, focus on corruption by public officials. Each manages over 400 cases, the Attorney General’s Office said.

The number of investigators who support the work of prosecutors is also insufficient. The Technical Investigation Unit (Cuerpo Técnico de Investigación, CTI) – the branch of the Attorney General’s Office charged with providing investigative and forensic support to prosecutors in criminal cases – has about 60 investigators in La Guajira. Yet only three of them work on the over 900 corruption cases currently being investigated. Only one of the three has received some training to pursue corruption investigations. None are trained in accounting or financial analysis, which prosecutors said are key skills needed to carry out these investigations.

Security risks to prosecutors and investigators have also undermined their ability to investigate crimes. Several prosecutors said they have received threats for carrying out investigations in the region. In 2016, at least six prosecutors and four investigators handling corruption cases in La Guajira were transferred to Bogotá because their safety was at risk, prosecutors said.

Numerous investigations are carried out in Bogotá, where there are many more prosecutors and investigators, some of which specialize in investigating corruption. Indeed, many of the cases where the Attorney General’s Office has made substantial progress on corruption in La Guajira have been investigated by the National Anti-Corruption Unit in Bogotá. However, under Colombian law, prosecutors in Bogotá are generally required to bring such cases before La Guajira courts, which are also few in number and face significant delays and backlogs.

The Superior Council of the Judiciary, which is charged with overseeing the work of judges nationwide, said that only six courts in La Guajira handle corruption cases; as of June, they were handling an average of 1,000 cases each and had between three and five staff members. The state has two criminal appeals courts with only two staff members each, including the judge. Because of the overwhelming number of cases, corruption hearings are scheduled roughly every seven months, causing significant delays, said prosecutors, authorities within the Attorney General’s Office, and an Inspector-General’s Office official.

Other types of investigations into corruption in La Guajira have also been limited.

The Inspector-General’s Office, which carries out disciplinary investigations of government officials, has made limited, if any, progress in investigating corruption in La Guajira. The office said it had been investigating 92 cases of corruption in La Guajira since 2016. Government officials have been indicted in two cases, but no one has been sanctioned so far in disciplinary proceedings. One key reason for delays is the limited number of staff members. An Inspector-General’s Office official said in March that only one official was in charge of corruption cases. As of March, he had a caseload of roughly 1,000 cases, as well as several other tasks.

The Comptroller General’s Office, which can fine government officials or private citizens who mismanage government resources, has also achieved very limited results. The Office said in April that it had initiated 28 investigations into corruption in La Guajira since 2016, including 21 concerning food services. Twenty-three of the 28 were still under investigation as of March, and three have been closed.

In three other cases, the Comptroller General’s Office closed the investigations because people under investigation returned part of the allegedly stolen or mismanaged money. Those under investigation include seven government officials, including two former mayors and at least 21 contractors, including several from indigenous communities. In cases involving alleged irregularities in food and healthcare contracts since 2016, the Comptroller General’s Office had only recovered 8 million Colombian pesos (roughly US$2,719) of the almost 6.4 billion Colombian pesos (roughly US$2.1 million) the Office estimates have been lost to mismanagement.

Recommendations

Human Rights Watch and the Johns Hopkins Center for Humanitarian Health urge the administration of President Iván Duque to take specific measures to guarantee the rights of indigenous Wayuu children in La Guajira to food, water, and health, including by leading efforts to:

Urgently increase and target efforts to deliver food assistance, safe drinking water, and hygiene supplies to households in La Guajira that are most at risk of malnutrition, particularly when schools are closed due to the pandemic or for other reasons.
Ensure that, in coordination with community authorities, Wayuu communities receive the allocated national and local financial relief pledged by the government as part of Colombia’s Covid-19 fiscal stimulus package. Application requirements and requests for support should be communicated clearly and in Wayuunaiki as well as Spanish, and they should be appropriately designed to avoid technical or bureaucratic roadblocks.
Provide accessible and affordable Covid-19 testing and care to everyone in La Guajira.
Guarantee immediate access to health services to Wayuu communities, including by increasing funding to reinstate mobile units from the Colombian Family Welfare Institute (Instituto Colombiano de Bienestar Familiar, ICBF) to detect and treat malnutrition; offering assistance, such as travel vouchers to subsidize transport to and from hospitals; and providing economic support to enable Wayuu families to afford health care and medicines.
Integrate traditional Wayuu beliefs, customs, and methods into healthcare practices and centers, including by partnering with traditional healers, ensuring availability of Wayuunaki translators, and employing culturally appropriate services in medical centers, such as using hammocks, in which many Wayuu are accustomed to sleeping, when feasible.
Prioritize plans to establish permanent healthcare facilities in or closer to Wayuu communities, especially in Alta Guajira.
Prioritize plans to strengthen internet service connectivity in rural areas to implement telehealth services and to improve access to information and health service consultation, in accordance with trusted local healers and cultural norms.
Scale up livelihood initiatives in Wayuu communities, such as agricultural extension support, animal health brigades, and support for farm cooperatives or community farms in the short-term, and continue to monitor and mitigate the effects of climate change in La Guajira in the long-term.
Speed up the Housing Ministry’s “Guajira Azul” project to build water tanks as a temporary measure throughout La Guajira, targeting the communities most at risk, and to conduct regular testing and maintenance.
Speed up and prioritize plans to establish and maintain permanent water infrastructure in Wayuu communities.
Expand the capacity to register and assist Venezuelan migrants seeking to obtain IDs and permits.
Carry out a comprehensive census and nutritional survey of Wayuu communities in the region to determine the burden of child mortality and malnutrition, as well as the extent of Venezuelan migration, to inform policies to ensure their rights.
Increase the number of prosecutors, judges, and investigators handling criminal, disciplinary, and other investigations into corruption in La Guajira, and provide them with protection against people threatening them as well as adequate training in skills to investigate corruption.
Ramp up efforts to prevent corruption in La Guajira, including with participatory budgeting and meaningful community oversight, and by ensuring a competitive and transparent procurement processes.

This report was researched and written by staff of Human Rights Watch and the Johns Hopkins Center for Humanitarian Health. Authors with Human Rights Watch are Hilary Rosenthal, Leonard H. Sandler Fellow; Nathalye Cotrino, research assistant, Juan Pappier, Americas researcher; and Tamara Taraciuk Broner, acting Americas deputy director. Shannon Doocy, associate professor of International Health at Johns Hopkins Bloomberg School of Public Health, and Dr. Alia Sunderji, pediatric emergency physician and MPH from Johns Hopkins, are also authors of the report.