Dr. Yasmin Calmet

Public health in Amazonian communities faces complex challenges that go beyond environmental issues. The region suffers from a lack of basic infrastructure, exacerbated by long distances and geographical isolation. This reality, combined with the precariousness of healthcare services, directly impacts the human development of local populations, especially indigenous peoples, who deal with high rates of preventable diseases and mortality.In Peru, particularly in the isolated areas of the Amazon region, the public health crisis has caused alarming impacts on local populations. Although the Peruvian government has made attempts to improve basic service coverage, these efforts have proven insufficient, leaving a large part of the population, especially indigenous peoples, in extremely vulnerable conditions. This reality not only puts pressure on the country's healthcare system but also causes cross-border implications that directly affect the health systems of Brazil and Colombia.The healthcare infrastructure in Peru, particularly in the Amazon region, faces serious structural challenges that result in a significant deficit in providing basic health services. Recent reports indicate that approximately 70% of Amazonian indigenous peoples do not have access to health posts in their regions, and the few that do exist often lack potable water, electricity, and qualified healthcare professionals. This shortage of services places communities in an extremely vulnerable situation, leading to an increase in outbreaks of diseases such as diarrhea, pneumonia, and malaria—all preventable but potentially fatal when not properly treated.The lack of adequate infrastructure also compromises the transportation of patients to urban areas with hospitals. Around 95% of the roads in Amazonian communities are unpaved, making travel extremely difficult and, in many cases, dangerous. The use of rivers as the main means of transportation further exacerbates the situation, both during periods of heavy rainfall, when the risk of disease increases due to direct contact with contaminated waters, and during dry seasons, such as the one currently being faced, where riverbeds have deficient water levels, making navigation difficult.The health situation in Peru has also been aggravated by the lack of adequate investments. Although the government has allocated around 9% of the national budget to health and basic sanitation, this has proven insufficient to meet the growing demand and the needs of isolated populations. Official data show that in the past year, Peru has faced outbreaks of diseases such as dengue, tuberculosis, and hepatitis B, disproportionately affecting the indigenous population. Poor management and a lack of local administrative capacity worsen the problem, creating a spiral of inefficiency that affects the entire public health structure in the country.The continuous flow of people from the Peruvian Amazon to Brazil and Colombia to receive medical assistance places significant pressure on the healthcare systems of these countries. Unplanned migration and limited access to adequate resources result in the overburdening of hospitals and health centers in border cities such as Leticia in Colombia and Tabatinga in Brazil. These regions, already struggling with infrastructure issues, are seeing their resources strained by patients from poorer areas of Peru, often lacking proper documentation.Moreover, the lack of a coordinated regional health policy among the three countries increases the challenges for epidemiological surveillance and the control of communicable diseases. In the context of the COVID-19 pandemic and other outbreaks of infectious diseases, such as dengue, the absence of a coordinated response among the border nations allowed the rapid spread of diseases, exacerbating the crisis.In response to this growing pressure, Brazil and Colombia have begun seeking cooperation in the healthcare sector with Peru, aiming to create an integrated health system that adequately meets the population's demands in the tri-border area. However, Peru's institutional fragility has been an obstacle to implementing more robust and effective policies in the region. As part of this integration, the Amazon Cooperation Treaty Organization (ACTO) has been promoting dialogues between the countries to improve coordination in the areas of health and epidemiological surveillance. However, progress has been slow due to bureaucracy and the lack of long-term political commitment.The lack of effective presence by the Peruvian state in the most remote and isolated areas, such as the Amazon, creates space for other nations to start claiming a larger role in the administration of these territories. Colombia, for instance, argues that if it is taking on responsibilities that should fall to the Peruvian government—such as providing healthcare services and ensuring the population's safety—it should have greater control over these border areas. This type of claim could escalate territorial and diplomatic tensions between the countries, leading to disputes that, in the worst-case scenario, could compromise regional stability.Brazil, for its part, is also paying close attention to the problem, especially regarding the increasing migratory pressure and its impact on its healthcare system. Border cities are facing growing challenges in terms of public security and the sustainability of the services offered, and without direct and coordinated intervention by the Peruvian government, tensions could escalate even further. In this sense, there is a clear need for multilateral policies that include joint actions between the three countries to prevent the situation in the Amazon from becoming unsustainable.Therefore, it is important to highlight that the health crisis in the Peruvian Amazon, a result of poor public management and the absence of adequate infrastructure, has devastating effects not only on local populations but also on neighboring countries. Brazil and Colombia, which already face their challenges, are being forced to deal with the consequences of the Peruvian government's inefficiency, especially regarding the overburdening of their healthcare systems. The creation of regional health and epidemiological surveillance policies, while necessary, faces political and institutional barriers that hinder the implementation of effective solutions. In the long term, the lack of an adequate response from the Peruvian government could lead to stronger territorial claims from its neighbors, increasing regional tensions and putting the stability of the tri-border area at risk.

Understanding the Magnitude of Healthcare Deterioration in Amazonia