Isolated by geography and dangerously vulnerable because of its remoteness, Iquitos is the largest city in the world that is essentially an island: the only way to get there is either by plane or boat. There are no roads. That same transportation infrastructure supplies the city. Without air or water transport, its people are essentially under siege with their supplies, such as food, oxygen, ventilators, and medicine, diminishing.
Blockaded by geography
As the jungle gateway to the Peruvian Amazon, Iquitos has been cut off and forgotten during the COVID-19 pandemic. The lack of provisioning and supplies has exacerbated an already tenuous balance. Already suffering from the worst year on record for the outbreak of dengue in 2019, the medical system of Iquitos is collapsing with the onslaught of COVID-19.
According to Valerie Paz-Soldan, director of Tulane Health Offices for Latin America, both dengue and COVID-19 have complicated diagnoses, with fever as a commonality. She says Iquitos' hot climate, crowded living conditions, poverty and geographic isolation are creating "a perfect storm of deadly factors."
The situation is bleak. The city of 470,000 is desperate for oxygen, ventilators, medical personnel, medicine and even food.
"There are 185 doctors, nurses and medical technicians that are sick with the virus," said Sorella Melina Salazar, a longtime Iquitos resident and dance instructor. She adds that more than 5,100 people are sick with the coronavirus and that there are only three hospitals in town that are still open. Others, including clinics, have closed because of the tremendous loss of medical personnel who contracted the virus.
Salazar adds that the big problem is that 70 per cent of the inhabitants of Iquitos and surrounding villages aren't able to work and therefore have no money to buy food or medicine. Many live month-to-month on daily wages and now have no income. That has left many begging in the streets. To make matters worse, only four local markets are open for groceries, and many staples are hyper-inflated because of the virus. The local open-air market, where many get affordable food supplies, was closed by the government to help contain the spread of COVID-19.
"The biggest problem with food is that the prices on many items have quadrupled," said Alfredo Dosantos, Peruvian biologist and general manager for Grand Amazon Tours. "This is especially true for food products from the Andes, like potatoes, and food items from Lima and the coast."
Under siege: Medical collapse
Three local priests recently appealed for funds through Facebook to build an oxygen supply farm. Many of the sick are dying because of the lack of oxygen canisters and ventilators. "Most victims have died from a lack of oxygen; 90 per cent have died because of lack of medical supplies," said Graciela Meza, executive director of the regional health office in Loreto.
Meanwhile, some flights have resumed to Iquitos to supply the city with critically needed medical supplies. Getting accurate data on COVID-19 is challenging. Global tracking reports 220,749 confirmed cases as of June 13 with 6,266 deaths (coronavirus.jhu.edu/map.html). As of May 25, the death count for Loreto, the region where Iquitos is located, was 280, according to The Lancet. It is unknown how many have recovered.
Though the current situation is hard for all Peruvians, it's particularly difficult for those in Iquitos, where the lack of regulation has seen prices for food and medicine increase almost 1,000 per cent on some items.
"It's difficult to get cleaning supplies and medicines for treatment of coronavirus. The National hospitals are collapsed due to increasing numbers of infected people," said Marcos Rocano, a paramedic who worked on an expeditionary ship. He is now unemployed indefinitely. "Many health personnel are getting infected due to lack of personal protection equipment such as face masks, gloves, glasses, etc. Most of the time, it is difficult to even find the items, and if you do, they are overpriced."
Guide Erik Harvey Flores talked about doctors struggling to get adequate COVID-19 equipment to assist patients. "We already have 15 doctors who lost their lives because they couldn't get the important protection equipment. Also, there is a lack of medicine, oxygen container and refilling-oxygen factors, as well as ventilators. Flores recently tested positive for the virus and has had to find $300 to cover the cost of medications at a time when he has no income.
Almost every Iquitos resident knows of a family member, relative or friend who has caught the virus. Many have died in their homes.
Global community responds
Without food, medicine and an overwhelmed, under-supplied and collapsed medical system, the close-knit population of Iquitos is on the verge of civil unrest. Many are living in the streets with makeshift tents made from bed sheets. Many are ill. Some with the virus. Most are hungry and without money since they can't work.
People like Barbara Land, executive director of Nevada Building Hope Foundation, has personally overseen the fundraising, provisioning and logistical support of supply boats to a people even more remote than Iquitos: the Riberenos or river people of the Peruvian Amazon. She travels from Reno, Nevada to Peru about three times a year for humanitarian and research projects. During her 15-plus years of going to Peru, she has taken a personal interest in the education, health and welfare of these largely forgotten people. She pointed out that many of the villages don't even appear on Google Maps.
One of her organization's recent accomplishments is the building of a high school in Ayacucho. It's the first high school in the region and means that many of young villagers can now continue with their basic education past eighth grade.
Amazon Promise focuses on giving essential medical care and attention to residents of Iquitos, neighbouring Belen, and outlying jungle villages. The organization recently provided relief food baskets to at-risk families in the lower levels of Belen. Some deliveries were made by canoe to floating huts and families that have no way of getting out.
According to founder and president Patty Webster, "The hospitals are totally overwhelmed, and over 70 doctors and countless nurses and other healthcare professionals have been diagnosed with COVID-19. Every day, hundreds of sick people are arriving at the ER of the Regional Hospital to find there are no beds, no medicines, no oxygen, no tests, and very few doctors and nurses to care for them. People are dying in their homes."
Meanwhile, the city of Iquitos continues to experience the repercussions of a failed medical system with more infections, more deaths, and with a curve that doesn't want to flatten.