In a cramped hospital near Colombia's border with Venezuela, migrants fill stretchers bearing the wounds of the deteriorating nation they left behind.
An 18-year-old woman rubbed her swollen belly after fleeing with her infant daughter when the wounds from her C-section began to ooze pus. A young man whose femur had torn through his skin in a motorcycle crash needed antibiotics for an infection. An elderly retiree with a swollen foot arrived after taking a 20-hour bus ride from Caracas because doctors there told his family the only treatment they could offer was amputation — without anesthesia or antibiotics.
"If you want to sign, sign. But we are not responsible for the life of your father," Teresa Tobar, 36, quoted the doctors in Venezuela as telling her when they handed over the papers to authorize her father's surgery.
As Venezuela's economic crisis worsens, rising numbers are fleeing in a burgeoning refugee crisis that is drawing alarm across Latin America. Independent groups estimate that as many as 3 million to 4 million Venezuelans have abandoned their homeland in recent years, with several hundred thousand departing in 2017 alone.
Many of those migrants are arriving by foot in Colombia and landing in the Andean nation's emergency rooms with urgent medical conditions that Venezuelan hospitals can no longer treat.
According to health officials, Venezuelans made nearly 25,000 visits to Colombian ERs last year, up from just 1,500 in 2015. At hospitals in border cities like Cucuta, patients are packed side by side on stretchers that spill into hallways, not much unlike the deplorable conditions they fled back home. Authorities project that Venezuelan admissions to Colombian hospitals could double in 2018 and say the nation's already overstretched public health system is unprepared to handle the sudden swell.
"We are not in a position to assume the cost of the comprehensive care for the migrants arriving," said Julio Saenz, an adviser on migrant affairs to Colombia's Health Ministry. "That's a very big concern."
The Venezuelans are fleeing an increasingly authoritarian government that has been unable to halt skyrocketing inflation that renders wages nearly worthless and forces millions to go hungry. In Cucuta, ground zero for an exodus that has spread across Latin America, migrants say their nation's rapidly deteriorating health system is also forcing them to leave as everything from simple antibiotics to critical chemotherapy drugs become hard to find or impossible to afford.
"I said to myself, 'I have nowhere else to go,'" recalled Grecia Sabala, a 32-year-old mother who journeyed to Colombia seeking treatment for cervical cancer after doctors in Venezuela were unable to provide chemotherapy and her city's only radiation machine broke. "I'm going to the border to look for a cure."
Venezuelan President Nicolas Maduro has refused to allow humanitarian aid to enter the struggling nation, denying there is a crisis and contending that permitting international relief could pave the way for foreign intervention. But what little data officials have released indicates Venezuelans are facing mounting health challenges. Cases of infant and maternal mortality have risen sharply and long-eradicated maladies like diphtheria have re-emerged.
At least one Venezuelan child has died in Colombia from malnutrition, seeking treatment too late, and officials say many others are arriving dangerously underweight.
Health officials are particularly concerned about the spread of infectious diseases. Authorities confirmed numerous cases of malaria, tuberculosis and HIV among Venezuelan migrants last year.
"It's increasing the numbers of some illnesses that we had under control," Saenz said.
By law, Colombia's hospitals are required to treat any person, local or foreign, who shows up at an emergency room. But many Venezuelans are arriving with chronic conditions like cancer and diabetes that require expensive, continuing care. Health institutions in Colombia are not required to provide those treatments.
"We handle the emergency room care, but beyond that there is no more we can do," said Juan Ramirez, director of the Erasmo Meoz Hospital in Cucuta.
Cucuta health officials estimate the cost of caring for Venezuelan migrants will climb millions of dollars this year. Most of that cost ends up being funded by cash-strapped local institutions that say they need the help of the central government and international community.
Aside from providing health care, border cities are also coping with an array of public safety issues, like a rise in prostitution and groups of men, women and children sleeping on the streets. There is also a widespread perception of worsening crime, though police in Cucuta say the incidents remain relatively isolated.
President Juan Manuel Santos is under pressure to declare a social emergency, freeing up additional resources, and the top U.S. Agency for International Development official for Latin America recently visited Cucuta to evaluate how the Trump administration can help its close ally respond to the growing crisis.
"At some point, it's going to be unpayable," said Juan Alberto Bitar, head of the health agency overseeing Cucuta.
Colombia's health ministry is planning to deploy a half dozen mobile units near the border to treat minor conditions. A Colombia Red Cross medical tent stationed at the foot of the Simon Bolivar International Bridge where about 35,000 Venezuelans enter the country each day — most for short stays to find food or work — already treats several hundred each week. Workers said many of the patients arrive after fainting on the journey because they had nothing to eat.
Michel Briceno, the young new mother who fled to Colombia after the incision from her C-section became infected, said she knew she had to leave after learning that several other women at the same hospital in Venezuela had also gotten ill and died. When her pelvis began to swell, she and her husband gathered their toddler son and newborn daughter and boarded a small bus for a 12-hour ride into Colombia with excruciating pain she rated a nine on a scale of 10.
Seated on a hospital bed as her infant squirmed beside her, Briceno said she had no doubt about what the outcome might have been if she stayed in Venezuela.
"I would have died," she said.