Dr. Romero remembers that the woman arrived “walking like a little penguin and dripping.” She had just given birth on her own and still had pieces of the placenta inside her. Two nurses rushed her into surgery, and an operation began to prevent her from bleeding to death.

Using a cannula, Dr. Romero carefully removed the remaining tissue and, in less than an hour, extracted it all with precision Kocher forceps.

It was not the first time Romero had performed such a procedure, but it was the first time he had done so in temperatures above 40°C (104°F), in the dark, illuminated only by the nurses’ cellphones, and while operating on a McDonald’s stool.

The fast-food restaurant has been turned into a field hospital amid the devastation in La Guaira, at the epicenter of Venezuela’s earthquake disaster. The makeshift facility, set up by volunteer doctors and supplied through donations from civil society, has become a symbol of the extreme needs, institutional abandonment and improvised response that persist a week after the worst natural disaster to strike Venezuela in more than a century.

The window of hope for finding survivors beneath the rubble is growing ever narrower, but the toll of the disaster continues to rise. One week on, the death toll has surpassed 1,900, with more than 10,000 people injured. According to the Venezuelan government, which issues brief daily updates with few details, 855 buildings have been affected, of which 189 have suffered a total collapse.

Jorge Rodríguez, the president of the National Assembly and the official leading the government’s sparse daily briefings, announced on Tuesday that 50 camps have been set up on the outskirts of the capital to shelter survivors. Authorities have also improvised eight new morgues, where bodies are piling up.

At the port of La Guaira, hundreds of bodies await identification by relatives, who queue for hours in lines stretching for blocks. While waiting to enter the port facilities, many rummage through mountains of clothing piled up in the street, searching for possessions recovered from the disaster.

The coastal state has borne the brunt of the disaster, with tourist towers more than 10 stories high reduced to mountains of rubble and countless victims buried beneath them. But there are also poorer neighborhoods where little, if any, aid has arrived.

The U.N. Refugee Agency (UNHCR) said on Tuesday that there has been a “dramatic surge in humanitarian and protection needs” in the hardest-hit areas, citing severe food shortages, the collapse of basic services and growing protection risks for displaced people.

In the face of the government’s inadequate response, a final-year medical student from Caracas who arrived in the disaster zone during the first days set up a makeshift clinic “with a blanket and two tarps tied to a tree” near the McDonald’s abandoned after the earthquake.

One of his first patients was a police officer suffering from low blood pressure.

“We stabilized him and I took the opportunity to ask him to let us use the restaurant so we could work in better conditions,” he says outside the building, which is cordoned off with yellow police tape.

The arrangement was that the doctors would be allowed inside while police officers would provide security against theft and looting, which have become increasingly common in the hardest-hit areas.

They gained access on Saturday and, the following day, after clearing away debris, converted the building into a functioning medical facility. The operating room — where they treated the woman who had just given birth — was installed in the first-floor dining area. The pharmacy was set up beside the counter where hamburgers were once served. Upstairs became a rest area, filled with worn mattresses where doctors and nurses can sleep.

Relations with the police have not always been easy. The student, who serves as a liaison with the officers, says he trusts “only the commanders.”

“The rank-and-file officers try to take advantage of the tragedy,” he says.

In the dining area, doctors have hung IV bags and vitamin drips from the ceiling using bandages. With an IV line in his right arm, Officer Nelson Guerrero, a heavyset 52-year-old, explains that he asked medical staff to administer insulin because he has only one kidney following a traffic accident.

“We’re here to stop people from taking advantage, to make sure nobody does what they shouldn’t,” he says, as the drip delivers insulin and sweat runs down his forehead.

Tension

Inside the McDonald’s-turned-hospital, the atmosphere is even more tense than usual. The medical team has just been warned that the building next door — a massive pastel-colored apartment block with more than 100 units that is still standing — is on the verge of completely collapsing.

It is one of the public housing projects built by the Chávez government under the Misión Vivienda housing program for low-income families. Residents recall that when former president Hugo Chávez came to inaugurate the complex more than two decades ago, he invoked a famous line from his political hero. During reconstruction efforts after the devastating 1812 earthquake that struck Caracas, Simón Bolívar declared: “If nature opposes us, we will fight against it and make it obey us.” Chávez repeated the same messianic rallying cry after the deadly mudslides that devastated this very region in 1999, the first major disaster his movement faced after coming to power.

“It seems we’re cursed,” says one resident, his face covered with a T-shirt to shield himself from the sun and the stench of decay.

The government of Delcy Rodríguez, which has been under U.S. supervision since president Nicolás Maduro’s capture in January, is also facing its first major test. Public frustration, already stretched to the limit, is growing by the day. With thousands of armed soldiers and police officers deployed across the disaster zone, the risk of social unrest is a latent threat with unpredictable consequences.

“We have had no news from the government. They certainly aren’t supporting us here,” says Dr. Miguel Romero, the surgeon leading the field hospital, although responsibility for directing operations rotates among the medical teams when they head out into the field.

Romero, 34, is pursuing a doctorate in neurology in Germany. He arrived in Venezuela one day before the earthquake to visit family in Coro, a coastal city. Since reaching the disaster zone after a bus journey of more than 10 hours, he has slept only a couple of hours a day.

The McDonald’s pharmacy is well stocked, the doctors say. It has intravenous painkillers, surgical supplies, anti-anxiety medications and even veterinary drugs, used to treat pets in the parking lot, where until a few days ago customers drove through to pick up their Big Macs.

Upstairs, the restaurant is also housing international rescue teams with nowhere else to spend the night. More than 2,300 specialists have arrived from countries including Mexico, China, Spain and Qatar.

Monday night was particularly difficult. It rained in La Guaira for the first time since the disaster, something many had expected given that it is the rainy season. The sky had been forgiving until then. Rain and mud have made everything even harder.

But Dr. Ramírez, who is close to completing his studies in Germany, remains hopeful: “I trust in the strength, resilience and stoicism of a people mobilized and clinging to life.”

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