CUCUTA, Colombia -- Marili Gomez was eight months pregnant with twins in her hometown of Valencia, Venezuela, when her doctor gave her stark advice: She could either take an 18-hour bus ride and seek care in neighboring Colombia or lose the babies.
Gomez said she didn't have to think about the decision very long. Just weeks before that doctor's visit, she'd lost her 16-year-old son to Venezuela's violence -- he was stabbed more than a dozen times in what police believe was a robbery.
"I had no choice," she said of the dangerous journey. "I wanted my babies to live."
Venezuela's economic collapse -- going from one of the hemisphere's most prosperous countries to the region's basket case -- is starting to have ripple effects in neighboring nations.
In particular, its crumbling health care system is generating waves of medical refugees. And while Colombia doesn't keep track of such figures, hospitals along the border say they've been swamped with cases.
Juan Alberto Bitar, medical director for the Colombian border state of Norte de Santander, said the hospitals under his purview received at least 5,000 Venezuelans in 2016, and the vast majority had no way to pay for their care. As a result, in recent months, uninsured Venezuelans have racked up more than $1.2 million in medical bills in his state alone.
"The issue is that we don't know how long the problems in Venezuela are going to last," he said. "And at some point the health system here is going to implode because there's no one to pay the bills."
Under Colombian law, hospitals can't turn away patients in life-or-death situations, regardless of where they're from. And while the institutions are supposed to bar uninsured foreigners with lesser problems, they often bend the rules.
At the Erasmo Meoz hospital in Cucuta on a recent weekday, administrators were trying to find a way to give Colombian citizenship to a 7-year-old girl so her leukemia treatment would be covered by public health insurance.
Sandra Sanchez, the girl's mother, said she had no choice but to take her daughter across the border. In Venezuela, doctors told her they could only treat her if the family provided everything they needed, from gauze and alcohol to syringes, sheets and medicine.
"I couldn't afford to buy everything they asked for, and my daughter wasn't doing well. She kept having fevers," Sanchez said as she waited nervously outside an operating room where doctors were implanting a catheter, or port, in her daughter's chest ahead of cancer treatment.
Venezuela's currency and revenue crisis have decimated the country, where almost everything is imported. Shortages of food and other basic items sweep the nation, and the pharmaceutical industry has been hit particularly hard. At times, even aspirin is scarce, and many lifesaving treatments are unavailable.
The Pharmaceutical Federation of Venezuela, an industry group, said more than 85 percent of all drugs are either impossible or difficult to find in the country.
Gomez said she was having a complicated pregnancy that was going to require a cesarean section -- a common procedure. But her doctor in Venezuela said the hospital didn't have the drugs or equipment to do the surgery.
The cases that go through Colombia provide alarming insight into the state of Venezuela's hospitals, Bitar said.
A few months ago, a young boy was flown from Venezuela's capital to Cucuta for dialysis. The fact that this Colombian city of 600,000 could provide medical care not available even in Caracas, whose population is more than 2 million, was startling and revealing, Bitar said.
"They brought him by plane to San Cristobal, and then he crossed the border in an ambulance, just for dialysis," he said. "That's completely pathetic."
Juan Agustin Ramirez, director of the 470-bed Erasmo Meoz public hospital, said many of the pregnant Venezuelan women who've arrived have never had prenatal care, so cases of congenital HIV and syphilis, which are rare in Colombia, are beginning to resurface.
And he worries about how long his institution can stand the strain.
"We can't keep working at a loss," he said. "At some point the hospital is going to collapse, and because we were trying to benefit a minority population, this entire region will be left without proper medical attention."
Venezuela repeatedly closed its border with Colombia in 2016, saying the measure was needed to punish smuggling "mafias" on this side of the frontier. But in recent days, the 1,274-mile border has been open to foot traffic. And even when the border is closed, guards will often let those with medical emergencies go through.
Most of the people seeking care, however, are stuck in a gray area. While they may have serious conditions, their cases often are not considered emergencies that will get them admitted to the hospital. That's where aid groups are stepping in.
For years, the Jesuit Refugee Service in Cucuta has been working with Colombians displaced by the violence between the government and rebels. In the past two years, however, they have turned their attention to desperate Venezuelans streaming across the border.
Oscar Calderon, the project coordinator, said his organization has been so overwhelmed that it has had to resort to triage. The agency now focuses on pregnant women and sick children.
In some ways, new definitions are needed to deal with the crisis, he said. Even as Venezuela has one of the highest murder rates in the world, there's no recognized conflict taking place there.
But the Venezuelans traveling to Cucuta "are de facto refugees, whether or not they're recognized by international law," Calderon said. "They're fleeing to save their lives."
The migratory flow is also a stark reversal for Venezuela. In the previous decade, millions of Colombians fled to their less-violent and oil-rich neighbor.
Yannacelys del Carmen Reyes, 31, spent five months fruitlessly searching for Metrotexate, her monthly lupus medication, in her hometown of Coro on Venezuela's northern coast.
Desperate, she crossed the border into Colombia in October, and thanks to the help of the Jesuit organization, began receiving the medication again. The prolonged gap between doses, however, made all her hair fall out.
"When you're feeling well, you can think about your future and take care of your children," she said, as she ran her fingers through her short, curly hair that was just growing back.
"But when you're not feeling well, nothing else matters. You just feel like you want to die."
Venezuelan President Nicolas Maduro has refused to acknowledge that there's a health care crisis and has even barred shipments of donated medicine.
In recent weeks, the desperation has been compounded as the government began pulling currency out of circulation without immediately replacing it. That has led to looting and violence in some cities.
As she looked at her twins, Gomez said she didn't think they would have a future in Venezuela.
"I didn't ask for them, but God gave them to me, so they must have a purpose," she said. "I'm just asking for strength to continue moving forward with my babies, and that my son in heaven helps us."
SundayMonday on 01/01/2017