The lights are flickering. There’s no toilet paper, no soap, and no medicine. People crowd the hallways. Patients lie in pools of their own blood. Doctors pump air into an infant’s lungs by hand. The mentally ill lie on the floor in chains. People beg for care, but none can be offered. This is what a typical Venezuelan hospital looks like right now, and the government isn’t doing anything about it.

Since 2014, Venezuela has been experiencing a major public health crisis fueled by a dire lack of resources that has left hundreds of people without access to life-saving care. Hospitals are filled with patients who need emergency surgery and treatment, but cabinets are completely devoid of the resources necessary to save them, from items such as antibiotics and soap to chemotherapy drugs and X-rays. Hospitals teeming with patients sitting in half-lit hallways are turning away dozens of people each day because they are unable to provide care. Some patients have been waiting for surgery for months, often in the hospital itself. Moreover, hospitals have begun suggesting that people bring their own medicines to clinics, forcing them to pay outrageous prices for medications through the black market. A bottle of saline solution, which would normally cost less than USD$1, now costs USD$201 on the black market. These costs have imposed tremendous financial burdens on civilians when the monthly minimum wage is only about USD$33.30 and food rations cost about half of that.

At the heart of this health care crisis lies the economic turbulence that arose from falling oil prices starting in 2014. Oil, the main export of Venezuela, fell 70 percent in price compared to June 2014 levels, exacerbating economic problems such as debt and devalued currency that had existed in Venezuela for years. After a 500 percent increase in inflation between 2015 and 2016 that was meant to ameliorate the loss in oil revenue, many Venezuelans saw their incomes devalued and basic necessities such as water and electricity stripped away. Crime, including theft and violence, has been on the rise as people are fighting for access to food rations. Death rates have soared due to increased violence and a shortage of care, and many people are dying from minuscule injuries like scraped knees.

Although it might seem evident that Venezuela is experiencing a major humanitarian crisis, the government and the Venezuelan people have drastically different perspectives on the situation. President Nicolas Maduro and the Venezuelan government, dominated by the United Socialist Party of Venezuela, contend that there is no health care crisis and continue to deny aid in the form of donated medical supplies and medications from international organizations, even in the face of accusations of human rights violations. United Socialist Party member and Health Minister Luisana Melo regularly makes televised appearances to convince citizens that the government is doing its best to increase production of medicines and medical equipment and has the capacity to provide all of its citizens with adequate care. On the other hand, doctors and Venezuelan citizens who witness the dire lack of basic medical equipment realize that there is an immense crisis going on that the government has so far failed to properly address.

Why is Maduro is unwilling to accept foreign aid from neither the United States nor countries in Latin America and Europe? Throughout his presidency, Maduro has explicitly stated his distrust of the United States and has continued to reject foreign aid even amidst the crisis and growing opposition to his policies. Since assuming office in 2013, Maduro has led an intense nationalization campaign and has fought opposition and Congressional attempts to oust him. After only narrowly winning the election against Henrique Capriles by less than two percent, Maduro has since received weak support from a sizeable portion of his constituents, and the recent crisis has left many Venezuelans feeling eager to remove him from office.

Since becoming president, Maduro has led a steadfast crusade to uphold the policies of his predecessor, Hugo Chavez. Throughout his presidency, Chavez maintained a Bolivarian rhetoric. He hoped to create a strong Latin American alliance free from interference from foreign governments. He actively distanced himself from the United States and other European powers and tried to form a tight coalition but ended up deeply dividing his own nation. The combination of his authoritarian rule—he took control of all three branches of government—and worsening conditions within Venezuela created a deeply polarized society. Maduro came into office hoping to uphold Chavez’s legacy, and his staunch rejection of international aid reflects his endorsement of Chavez’s ideology.

Additionally, accepting international aid would strip Maduro of control by allowing other countries to intervene in his government’s affairs. According to Miguel Santos, a senior research fellow at the Center for International Development at Harvard University, accepting international aid will mean “recognizing that [Maduro] has totally failed, and the revolution was a whole scheme, and [it] will also imply losing control.” The United States and Venezuela have had strained diplomatic relations for years, but United States officials have said that they fear the humanitarian crisis and violence could spread across borders if something isn’t done soon.

Nicolas Maduro’s pride has rendered him incapable of admitting that Venezuela is in a state of shambles, but as a response to both internal and international pressure Maduro needs to swallow his pride and admit that the domestic situation is not going to improve unless he makes drastic changes. According to Amnesty International, “the government must abandon its stubbornness and ask for help.” Improving health care needs to be made a priority, because many individuals are not getting the care they need and the current conditions in Venezuela border on human rights abuses, according to Erika Guevara-Rosas of Amnesty International. Solving a problem begins with acknowledging the problem itself. If Maduro is unable to take that first step, conditions will deteriorate further and Venezuelans will continue to suffer. Maduro has shown inadequate leadership since the economic crisis began and the government has been largely static. Whether Maduro will take the initiative to swallow his pride and reach out to foreign organizations for aid is uncertain, but it’s the only foreseeable solution to a problem that has thus far been poorly addressed.