Want smart analysis of the most important news in your inbox every weekday, along with other global reads, interesting ideas and opinions? Sign up for the Today’s WorldView newsletter.

Over a year ago, Juan Guaidó hailed himself as Venezuela’s interim president to rapturous support from much of the international community. But today the opposition leader looks no closer to dethroning President Nicolás Maduro, whose regime is firmly ensconced in Caracas even as the situation on the ground deteriorates further and whole tracts of the country are now in the grips of guerrilla groups and criminal outfits.

A study published Sunday by the United Nations World Food Program found that 1 of every 3 Venezuelans are struggling or unable to meet minimum nutrition requirements because of the grim conditions created by a dysfunctional economy. The nationwide survey based on data from more than 8,000 questionnaires — and carried out with the cooperation of Maduro’s government — found that close to three-quarters of Venezuelan households have had to follow “food-related coping strategies,” including simply cutting the amount and quality of food they eat.

The findings add to the already dark picture of the public health crisis reshaping what was once one of the region’s wealthiest nations. Amid reports of children with distended bellies and hunger stalking the land, some 5 million Venezuelans have left the country as refugees in an exodus that mirrors the scale of the humanitarian crisis in Syria.

In an interview with Today’s WorldView, Ecuadoran President Lenín Moreno insisted that Maduro’s “despotic regime” had to go. “They have created an economic debacle in the country,” he said during a visit to Washington earlier this month. “They are starving their people to death, and they are allowing disease to spread.”

Moreno expressed confidence that it would be only a matter of time before Maduro fell. But he was more circumspect about what it would actually take to dislodge the regime. He recognized that the hemispheric bloc of nations backing Guaidó — known collectively as the Lima Group — has “important decisions” ahead of it.

Guaidó, for his part, does not seem as confident. “We underestimated the ability of the regime to do bad,” Guaidó told an audience of sympathizers at the World Economic Forum in Davos, Switzerland, in January. “We are really climbing a mountain at the moment.” After the summit, he toured the United States before returning to a chaotic scene in Caracas’s main airport where his aides were set upon by Maduro supporters.

“Who is weaker, and who is strong? I’m here showing my face to the people,” Guaidó said recently in a defiant interview with the Associated Press, suggesting that, while he can walk freely among Venezuelans, Maduro cannot. “I’m free.”

But he is hardly on the verge of supplanting Maduro, and his international tour, Venezuelan political commentator Francisco Toro observed, was “designed, in good part, to raise the cost to the regime of jailing him.” President Trump is reportedly frustrated with the seeming inefficacy of U.S. efforts to force Maduro out. Last week, the administration slapped new sanctions on the regime, targeting Russian state-owned oil company Rosneft, which effectively manages a significant chunk of Venezuela’s oil industry.

The regime’s opponents hope that these measures, as well as efforts to choke off other sources of revenue for the regime, including illicitly smuggled gold, will make Maduro’s grip on power untenable. During his meetings this week with Indian Prime Minister Narendra Modi, Trump was also expected to press Modi to curb India’s reliance on Venezuelan oil imports. “The pressure is rising diplomatically and financially on the corrupt financiers and human rights violators,” Guaidó told the AP.

Still, Maduro is proving resilient. A recent New York Times piece examined how the regime has enabled a tacit opening up of the country’s tightly controlled economy by quietly handing companies and major properties once expropriated by the state back to private operators. They are allowing “de facto capitalism in order to stave off collapse and assure [Maduro’s] continued grip on power,” noted the Times.

Moscow, too, may be able to soften the blow of the new sanctions. “The Russians knew this was coming, and they’ve already started taking steps for sanctions avoidance,” Russ Dallen, a managing partner at Caracas Capital Markets, a financial and consulting firm that tracks Venezuelan oil, told my colleagues. “This is a chess game, and the Russians are good at chess.”

Trump, meanwhile, has hardly been full-throated in his support for Guaidó. The president has privately grumbled about the zeal of his hawkish advisers and the overtly aggressive strategy the White House adopted last year in backing the opposition’s challenge against Maduro.

Meanwhile, millions in the country struggle each day to survive. “Guaidó remains a powerful symbol of hope for Venezuelans,” wrote Toro. “But symbols alone are powerless against brutality on the scale that Venezuelans are suffering.”

“Two years ago the worry was that the Maduro regime would stay in place, the economy would tank even more, health care would collapse and more and more Venezuelans would leave,” Shannon O’Neil, vice president at the Council for Foreign Relations in New York, told the Financial Times. “The worst-case scenario has happened.”