Venezuela is not only in a state of political turmoil. It’s also deeply submerged in a humanitarian crisis that has prompted 3 million people to flee the country as migrants and refugees. And its health system has collapsed.

New research published this week in the Lancet Global Health journal estimated that Venezuela’s infant mortality rates have risen from 15 deaths per 1,000 live births in 2008 to 21.1 deaths in 2016.

That means that Venezuela did not just fail to reach new targets established to improve infant mortality rates but also backtracked on its previous gains. Venezuela is now the only country in South America to have regressed to its infant mortality levels from the 1990s, researchers behind the study said. (An infant is identified as any child younger than 1 year old).

“We lost 18 years of progress,” Jenny García, the lead researcher on the study, told The Washington Post in a phone call. She also said her statistical model is conservative and that she is “confident that it’s going to be worse than what we are showing.”

This week, Venezuela and the United States found themselves in a standoff, after Washington recognized opposition leader Juan Guaidó as the country’s interim leader. President Nicolás Maduro, who took over in 2013, has ordered all U.S. diplomats to leave the country. The move came after years of instability, which also worsened the health crisis.

By focusing on the year 2016, García said, the data does not account for how much the crisis may have worsened since then, as more doctors fled the country, and the economic crisis worsened. She believes that as data emerges for 2017 and 2018, it will be even worse than before.

Measles and diphtheria — diseases that had once been controlled in Venezuela — have re-emerged, and widespread hunger and medicine shortages have only deepened the health crisis. And the study said that in 2016, “65.8 percent more deaths were associated with complications during childbirth than in previous years.”

The Venezuelan government has not published official infant mortality statistics in recent years, so García and her colleagues had to rely on other data sources to estimate an accurate death rate. The study said it was the first “attempt to fill this gap and estimate infant mortality using hospital and census data after 2013.”

Despite earlier progress made toward improving infant mortality, including vaccination campaigns and antibiotics distribution, the researchers found that Venezuela has now backslid.

García blamed the regression on government cuts to health-care funding and said that her team could trace worsening infant mortality to 2009, long before the current political crisis. Starting in 2007, the researchers wrote, the Venezuelan health ministry stopped providing vaccines for children younger than 5 years old for diseases, including polio and diphtheria.

García said that despite government denial that they caused the crisis in Venezuela, this study shows that “we have reached a point where it’s not possible to continue to deny.”

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