GUARENAS, VENEZUELA —
Deep inside a hilly Venezuelan slum, Ericka Torres rocks her three-month-old son Jesus to soothe his near-constant crying.
Jesus was diagnosed with microcephaly, a birth defect marked by a small head and serious developmental problems, after his mother contracted what was probably the mosquito-borne Zika virus during pregnancy in the poor city of Guarenas.
Torres said her boyfriend left after scans showed their child had birth defects, and she now struggles to afford medicine, clothes and even diapers for Jesus in the midst of Venezuela's brutal economic crisis.
"It's intense. But I can't get stressed, because this struggle is only just beginning," said Torres, 28, a supermarket security guard who smiles easily despite barely sleeping because of Jesus' screams and convulsions, common traits of babies born with microcephaly.
The Venezuelan government, however, has not acknowledged a single case of Zika-related microcephaly in the country.
Beyond some health warnings and a handful of televised comments about Zika at the start of the year, the leftist government of President Nicolas Maduro has largely kept quiet about the virus even as neighboring Brazil and Colombia publish weekly bulletins.
Venezuela does provide data to the World Health Organization, which shows it has had some 58,212 suspected Zika cases and 1,964 confirmed ones since the virus emerged in Brazil last year and then spread rapidly through the Americas.
But it has not, however, declared any cases of confirmed congenital syndrome associated with Zika, such as microcephaly, and has not mentioned any suspected cases either.
To be sure, inadequate Zika testing has thwarted efforts to precisely diagnose Zika-caused microcephaly. But countries like Brazil have turned to clinical diagnoses and report "confirmed and probable cases" of Zika-associated congenital syndromes to the WHO, for instance.
Some doctors accuse Venezuela's unpopular government of hiding the Zika problem amid a deep recession that has everything from flour and rice to antibiotics and chemotherapy medicines running short and spurred fierce criticism of Maduro.
They also say government inaction means kids are missing out on targeted state-sponsored therapy programs that would help to stimulate them.
"This delays the patient's development, because no matter how much knowledge or drive you have, if you don't have the physical tools like materials, resources, medicines, well that delays everything," said Maria Pereira, a doctor in Caracas.
Local media have put the number of babies born with suspected Zika-linked microcephaly so far this year at around 60. Physicians in Caracas, the western city of Maracaibo, and the coastal state of Sucre, confirmed at least 50 cases in interviews with Reuters.
Venezuela's Institute of Tropical Medicine estimates the real number could be much higher by the end of the year - between 563 and 1,400. That estimate is based on the numbers in Brazil, which has more than 1,800 confirmed cases, and pregnancy rates in Venezuela.
Product shortages have likely aggravated the effects of Zika in Venezuela: lack of contraceptives lead to unwanted pregnancies; lack of bug spray and fumigations lead to bites; and lack of anticonvulsant drugs or state support add to the hardships of children with the birth defect.
Venezuela's health and information ministries did not respond to multiple requests for comment.
The government says it has one of the best health care systems in the world, pointing to free Cuban-staffed clinics in slums and social programs for maternal and child well-being. But it has stopped releasing data as the health sector has crumbled in the last two years.
Dozens of women and babies line up in the hot, dimly lit corridors of the J.M. de los Rios children's hospital in Caracas, often waiting hours before an overstretched doctor can finally see them.
In the last three months, doctors say some 25 babies with microcephaly have been examined at what was once one of the leading hospitals in Latin America, with the majority of their mothers reporting symptoms including rashes or fevers during pregnancy.
Physicians order exams and prescribe therapies, but the overwhelmingly poor families struggle to scrape together enough money in the face of triple-digit inflation.
That delays early intervention and the discovery of other potential syndromes that have been linked to Zika, like vision problems or joint deformities.
"You feel impotent that you can't provide anything more because there are no resources," said Pereira, who works at the J.M. de los Rios hospital. Her family has to send her food and money from the provinces because she only earns around $70 a month between her salary and food tickets.
Other poor Latin American countries have also been criticized for their response to Zika. Brazil was called slow to investigate the initial surge of microcephaly cases and doctors say Zika prevention was spotty in Honduras, which estimates it will have some 340 cases of microcephaly by the end of the year.
Doctors and opposition lawmakers say Venezuela is faring the worst and have called for foreign aid and a stronger stance from the WHO.
Venezuela has rebuffed requests for aid, with officials saying it is an attempt to justify a foreign intervention in the oil-rich country.
When asked about criticism it was not doing enough in Venezuela, the WHO's regional office for the Americas told Reuters its role was to provide technical cooperation to member countries and that it was working to strengthen that cooperation with Venezuela's Health Ministry.
In the meantime, families are feeling the squeeze.
Home-based hairdresser Isabel Jimenez, her unemployed husband, and their four kids had already stopped having breakfast before the birth of Joshua, who has microcephaly, two weeks ago.
Now the family in the isolated Caribbean peninsula of Paraguana is under further pressure and has to rely on relatives for help with diapers, milk and medical appointments.
"I cried a lot," said Jimenez, 28, of learning about Joshua's condition. "At first I had a lot of anger and sadness, but I have to keep going with my baby because I can't do anything else."