Bolivia in times of Coronavirus
With the Coronavirus emerging in China in December 2019 and spreading to Europe and the United States soon after, it was a question of time when it would arrive in Bolivia, a sword of Damocles waiting to strike. By the beginning of March, Bolivia’s neighbours had all reported cases and the WHO warned that the weakness of the health sector in Bolivia made it particularly vulnerable. The first two cases were confirmed on 10 March, two women who had flown home to Santa Cruz and Oruro from Bergamo in Italy. Most of the early ‘imported’ cases were from Spain and Italy, where many Bolivians had travelled to find work, particularly in the caring professions. By 26 April, less than seven weeks later, there were 950 people testing positive and 50 people had died, Santa Cruz currently accounting for over half the reported cases nationwide. First measures -- the suspension of school and university classes, stopping flights from Europe, prohibiting mass events -- were introduced shortly afterwards, with further measures thereafter. A first quarantine, with closure of borders and reducing the working day to 1 p.m., was declared on 16 March, and this was followed by a ‘total’ quarantine on 21 March, with all transport and movement of people prohibited from 1 p.m. through to 6 a.m. Once a week, it was possible to shop locally in the morning. This ‘total’ quarantine was due to end on 15 April, but was prolonged for a further two weeks, until the end of April. With the number of cases still rising, a further extension -- albeit selective -- into May seemed likely.
While the measure of imposing a strict quarantine from early on was probably correct, it did not take into account people’s needs to work to bring home food for their families. The government was slow to carry out preparations in the first months of 2020, and payments to help vulnerable populations were made only after weeks of delay. The way the quarantine has been enforced has been unnecessarily authoritarian. It appears to be, at least in part, an attempt to stifle dissent. For a government that lacks legitimacy, it has applied draconian measures that label as ‘terrorists’ and ‘subversives’ those that contravene the rules, accusing its predecessors of efforts to destabilise it. Bolivia is still no closer to knowing definitively when the ‘interim’ administration will end and when elections will be held. The scars created by the enforced resignation of Evo Morales last October are far from healed. Meanwhile, the country is ill-prepared to face up to the huge cost that the Coronavirus pandemic will exact.
A brief look at the situation locally will help to put things into context.
The upheavals of last October and November, ending in the coup that forced Evo Morales to stand down as president, together with the unconstitutional naming of the president of an interim government (Jeanine Añez) caught Bolivia in a situation of relative political limbo, with a new electoral process under way when the virus struck. The last poll to be published (CiesMori) showed the MAS candidate, Luis Arce, ahead with a 15-point lead over his nearest rival, Carlos Mesa of Comunidad Ciudadana. Mesa was followed by Jeanine Añez who, though supposedly an ‘interim’ president, had decided to stand as candidate for a coalition named Juntos. (See BIF Bulletin 48 for more information). On 26 March, after the ‘total’ quarantine was declared, the Supreme Electoral Tribunal (TSE) recommended that the elections, scheduled for 3 May, be postponed until things began to return to normal. The president of the Electoral Court, Salvador Romero initially thought that this would be between 7 June and 6 September. At the end of April, discussions were under way regarding setting a new date.
When the MAS came to government in 2006, the functions of the state had been eroded by years of neoliberal policies, reduced to performing basic regulatory functions. The government worked to reverse this situation, for example, increasing state income from gas sales, taking on new initiatives in the field of energy (lithium production in particular), re-building state bodies to help run the economy, building up state monetary reserves, and re-writing the constitution in a highly participative process. The payment of allowances to more vulnerable sectors aimed to improve public welfare, while steps were taken to improve indigenous inclusion.
Advances in public health were partial. In the first years of the MAS government, an attempt to set up a national health service was challenged by workers in the more privileged sectors of the health system (the cajas de salud). When the MAS government instituted a comprehensive health system, the Sistema Unico de Salud, at the beginning of 2019, an important part of the medical profession went on strike for weeks, afraid this would affect their position in what amounts to a largely privately-run health system. In a recent interview, Dr. Gabriela Montaño, former minister of health, explained that during the MAS government 16,686 new medical jobs were funded (more than doubling the 15,475 posts that existed in 2005) and 3,231 health facilities were built (compared to 2,268 that existed in 2005).
Several new hospitals, such as the Hospital del Norte in Río Seco in El Alto, are up and running, fully equipped and with the necessary staff; others were finished but are awaiting equipment and staffing. These included hospitals at Ocurí, Llallagua, Montero, and the Hospital del Sur in El Alto. Even so, Bolivia’s public health provision is still very deficient.
Recent reports indicate that there are 430 Intensive Care beds available nationwide, while at least 1,150 are required to attend minimally the needs posed by the virus (La Razón, 24-3-20). The government has named specific (state) hospitals to deal with coronavirus patients, not involving private clinics. In El Alto, there were eight beds able to cope with coronavirus patients, five in the Hospital del Norte and three in the Boliviano-Holandés: this for a population of about one million.
To date, most people testing positive have been isolated in their own homes. Bolivia lacks medical staff specialised in intensive care, necessary equipment such as respirators, even basic protective clothing such as face masks, the chemicals needed to carry out tests, and places in which to isolate patients who test positive or are suspected to be carrying the virus. Though orders have been placed, many of these needs will not be met until May at the earliest. The effects of the interim government’s decision last November to expel a substantial contingent of Cuban doctors is beginning to be felt.
Access to potable water, recommended as key to prevention tasks, is impossible for some 3 million people who, according to the National Statistics Institute (INE) still obtain water from wells and rivers.
Moreover, 60-70% of the population works in the informal sector, living from hand to mouth. They need to work every day to be able to take food home to their families, unable to save money. With people only allowed out from their homes one day a week, the situation is critical for a large part of the population who therefore cannot work.
Some have sought work in neighbouring countries, Argentina, Chile, Brazil, or further afield in Spain and Italy. In the first months of the year, there were large movements of people travelling to Chile for the fruit harvest, for example, and within Bolivia to harvest quinoa or potatoes. With the onslaught of the virus, many had no alternative but to try to make their way home.
Cultural practices and customs also need to be taken into account, making social isolation difficult. These include street markets (there are some 400 different street ferias in El Alto) and religious/cultural celebrations, such as the prestería held recently in the Altiplano town of Patacamaya. There are also different ways of understanding and dealing with death. In a recent case, family members of a cooperative miner who died from the virus wanted his death certificate to read kari kari as the cause of death, i.e. the extraction of body fat. Reports are that there has been a return to earlier practices such as exchange of produce between different ecological levels.
Traditional social organisation, which exists across much of the country at communal and municipal levels, is able to contribute in terms of its capacity to mobilise in response to emergencies.
In spite of several months warning, it took the arrival of the virus in Bolivia to prompt the government into action by imposing the quarantine. Indeed, in Oruro the local authorities took action before the national government, imposing its own quarantine. Initially the lockdown was less draconian, but within ten days of the first cases being announced the government had moved to a ‘total’ quarantine. The express purpose of this was to create more time to get ready to attend to cases (equipment, staffing, dedicated hospitals/beds, etc.). It led to the virtual shutdown of the productive apparatus.
To alleviate the critical situation caused by inability to work, the government approved payments of Bs. 500 (about US$ 70) for each schoolchild, being paid in April (bono familiar), and for those receiving no other state allowances or wages from employment, the sum of Bs. 500 (bono universal) is to be paid from mid-May. It has ordered basic services not to be cut off because of non-payment, and the state is subsidising part of the cost of electricity, water and gas over a three-month period. Repayment of loans has been delayed until October and the government will provide loans to companies to cover their salary bills. Added to this, some municipalities have taken steps to help those worst off, in Tarija, El Alto, Santa Cruz and La Paz for example, by handing out food packages. Some companies have also made contributions of this sort.
Meanwhile, the race to gear up the health system is underway. On 19 April, Health Minister Marcelo Navajas reported that Bolivia had 16 centres for isolating patients (hotels and other spaces) and apparently 25 hospitals operating with 769 beds. He said that only 3,948 tests had been carried out by that date, applying them to the most ‘active’ cases or those showing a fever. Medical staff have been calling attention to the lack of available protective clothing. As of 26 April, the government was waiting for the arrival of 200,000 test kits. 500 respirators were due to arrive in May.
Dealing with the pandemic has suffered from the lack of coherent policy by government and a failure to communicate either its overall plan or to provide clear information on what it is doing. This has not helped people obey the quarantine. This disarray from the start has had serious consequences. Richard Sandoval, a La Paz businessman, was turned away by a private clinic, sent to a supposedly dedicated hospital for virus cases, and then died, according to his family, because of negligent practice. The government has also intervened in the SEDES (departmental health bodies) in La Paz and Cochabamba, taking back into centralised control faculties that correspond to local authorities.
In implementing the quarantine, the government has adopted an authoritarian and frequently heavy-handed approach. This has involved arresting people disobeying the measure, holding those trying to get back into the country on its borders, isolating some towns or areas, and deploying the military to patrol whole cities.
The decrees setting down the conditions for the quarantine include detention and sentencing of people who disobey the rules. Those found not respecting the quarantine can be arrested and detained for eight hours, and then fined approximately US$ 145; those found using their vehicles without good reason faced the impounding of their vehicle and a fine of around US$ 290. Just taking two random dates as examples, it was reported that on 28 March that 608 people were arrested nationwide and 202 vehicles impounded, while on 8 April, some 338 people were arrested and 233 vehicles detained.
More serious have been the bringing to trial and sentencing of people for ‘crimes against health’. It was reported on 4 April that 41 people had been sentenced to several years in prison. Then, in the first half of April, 39 were sentenced on evidence provided by the so-called ‘cyber patrols’ that trail the use of social media. As one commentator put it, why can’t those committing feminicide be given such rapid sentences? In the case of the prestería in Patacamaya, the two hosts/organisers and the local mayor were detained for letting the festivities go ahead, and the couple organising the event were given three-year jail sentences.
Arbitrary policing has produced hostile responses at times. In Oruro, the police were targets of people throwing stones at their vehicles. There have also been protests at Yapacaní and San Julián in Santa Cruz, in El Alto and in Potosí. Notwithstanding the political sensitivities still remaining after the conflicts of last October and November, the minister of the interior ordered police contingents to return to the coca-growing Chapare area of Cochabamba. He appeared surprised by the hostile response to this move.
When the frontiers were closed on 21 March, large numbers returning from Chile were caught en route. They were initially held at the frontier, with the government refusing them entry. A temporary camp was set up in Pisiga (Bolivia) as a quarantine centre for 435 people. A further 1,600 were put up eventually in the Chilean towns of Iquique and Antofagasta and allowed to return only after complying with quarantine there. Chilean authorities raised complaints over Bolivia’s failure to repatriate its nationals. The mayor of Colchane (Chile) even denounced their treatment to the UN and Organization of American States (OAS). At one stage the Bolivian army resorted to force to stop people crossing the border. Many decided to try to return on foot, despite the inhospitable climate and the difficult mountainous terrain.
The government has deployed police and army personnel to patrol the streets in several cities. Some have been ‘encapsulated’, such as Montero to the north of Santa Cruz. This involved a six-day complete shutdown, followed by one day to enable shopping, and then another six-day lockdown with army patrols in the streets to enforce it. In some rural areas of La Paz, municipalities have decided to ‘self-encapsulate’ to avoid spread of the virus, depending largely on social control by local organisations. There have been some other cases of partial ‘encapsulation’ like attempts to impose controls on markets in La Paz and El Alto.
With the incidence of cases much higher in Santa Cruz than elsewhere, the city was ‘militarised’ from 14 April onwards, with troops enforcing the quarantine. People were allowed to shop once a week. The government has made concessions to the police and army operating in these conditions, allowing them to make ‘confidential’ purchases, which will not face scrutiny.
Amongst others, US-based Human Rights Watch has questioned one of the decrees (DS 4200) that the government has brought out, worried that dissent from the government line can be treated as a criminal issue. Those detained as a result of their on-line activities can bear witness to limitations of the freedom of expression. With most newspapers and TV channels operating at minimal capacity, reliable news is hard to obtain.
The health crisis has greatly accentuated fiscal difficulties, forcing the government to return to time-honoured dependence on international monetary bodies following a period of relative autonomy under the MAS. The Añez government is seeking funding of the costs it faces for the purchase of equipment/hiring of new staff, approval of the two welfare payments and increased military and police spending, from three main sources:
- Loans from the Bolivian Central Bank. Following on from a loan to cover current expenditure at the end of 2019, the government has now received two more loans, one for US$ 1,000 million to cover costs of the health emergency, and another for US$ 500 million for injecting into the banking system. International reserves currently stand at US$ 5.9 billion. In 2014, they stood at over US$ 15 billion.
- Loans from the international monetary bodies, US$20 million from the World Bank, $320 million from the International Monetary Fund , and US$50 million from the Corporación Andina de Fomento (which has also made a US$400,000 grant to Bolivia).
- Donations from various sources. On 8 April, the minister of planning informed of donations of US$1.4 million (including the CAF grant). Other donors include the UNDP (US$500,000 for medical equipment), the German Development Bank, and the Fonplata Development Bank, amongst others.
Minister of the Presidency Yerko Núñez has said that the government is prepared to “break the piggy bank” in order to be able to meet needs, which will no doubt leave the next government to pay the bill.
Whilst access to news is at best patchy, it would seem that, in the absence of much by way of oversight from the Legislative Assembly, the government is also carrying out some policies that prompt a reversal of the previous government’s agenda and which, in less restrictive circumstances, would have prompted protest:
- The Ministry of Mines approved a resolution permitting export of tin concentrates, rather than carrying out smelting in Bolivia; their export took place as planned, according to declarations by the minister.
- The public works company, ABC, responsible for road building, is able for a period of seven months to contract works directly without going to tender.
- Eliminating tariffs on wheat imports for two years as of April. The producers’ organisation, ANAPO, opposed the measure.
- Even before the health emergency, the government had stopped production in state companies producing urea in Bulo Bulo and lithium/potassium chloride (potash) in Uyuni.
The current crisis will have overwhelming economic impacts in the foreseeable future.
The World Bank points to a fall in the GNP of 3.4%, the IMF of 2.9%. It could be much more, depending on how long the shutdown lasts.
- The crisis has produced a collapse in oil prices, which determine the prices at which Bolivia sells natural gas to Brazil and Argentina. Both countries were already seeking a reduction in the volumes bought. With the price at US$20 a barrel or lower, this will seriously impact on the state’s income and the funds distributed to decentralised bodies (departmental governments, municipalities, universities etc.).
- Mineral prices have also dropped, and most mines have stopped operation because of the quarantine. These include Huanuni in the public sector and San Cristóbal in the private sector.
- The quarantine will impact directly most sectors. Among those showing their concern for their members’ livelihoods are those involved in the transport of goods, workers in the tourism sector, micro-entrepreneurs and hairdressers. Those in the informal sector, though, are probably the hardest hit. Large numbers of people are likely to lose their jobs.
- The international effects of the coronavirus are expected to hit the value of remittances from Bolivians living abroad, especially those in the United States and Spain.
- Advances made in recent years in the reduction of extreme poverty and in the widening of the middle classes will be reversed. By 20 April, the government was beginning to talk of the need to draw up a post-virus economic plan. Others (Mesa, Arce) point to the need to sit down to draw up a national plan involving all sectors.
- The imposition of a strict quarantine from early on was probably the correct measure but it failed to take into account people’s needs to work to bring home food for their families.
- The government was slow to prepare for the virus and to provide support to vulnerable populations. Payments of allowances were only being made from mid-April when the quarantine had been in force for a month. The system of allowances owes much to the system already in existence under the MAS government.
- The payment of the allowances in banks between 8 a.m. and 12 p.m. encourages people to throng together, as does shopping at markets on weekday mornings.
- Calling those who don’t obey quarantine “delinquents” and “terrorists” (the director of migration), “subversives” (the minister of the interior), “shameful” (the defence minister), “rotten apples” (the minister of public works), irresponsible, ignorant, etc. is hardly conducive to political healing. This lack of respect at times has taken an openly racist tone.
- The government has used its authoritarian demeanour to clamp down on political opposition, blaming its predecessors for its own shortcomings. Any failure in the policy to contain the virus, likewise, is not its fault, but that of the people who don’t obey the rules.
- There is lack of a clear policy in containing the virus and a unified voice to explain the measures taken. The government is failing to protect people through an adequate policy of testing and treating those deemed positive. There is a chronic lack of the necessary equipment to deal with the pandemic.
- Treatment of Bolivian citizens stuck on the border with Chile has been verging on the inhuman.
- The rate of people dying, especially in La Paz and Oruro, is high, 5.2% nationwide on 26 April. This may partly be due to the low numbers tested, but also to the low number of people presenting themselves with initial symptoms.
- The move towards re-centralisation contrasts with the arguments for autonomy deployed previously by those now in government. The central government has stepped on the toes of departmental governments, municipalities and in the running of departmental health bodies. It has recoiled against working with social organisations which it distrusts.
- The government has accused critics of Añez’s decision to stand as candidate of conducting a ‘destabilisation’ plan.