Alejandro López
For a week now, 11,000 doctors and health workers in Madrid, Spain’s capital and most densely populated region, have been striking in defence of staffing levels and services, as well as for better pay and conditions in the sector.
Around the world, strikes are erupting against conditions created by over two years of the COVID-19 pandemic, as well as decades of privatisations and subordination of health care to profit. In Los Angeles, thousands of health care workers have been on strike at Cedars-Sinai Medical Center for safe working conditions, improved staffing and better wages. Throughout the United States, tens of thousands nurses have mobilised to defend nurse RaDonda Vaught from being jailed for a medical error in 2017.
In Germany, the strike by nursing staff at university hospitals in North Rhine-Westphalia has spread to university hospitals in Aachen, Bonn, Düsseldorf, Essen, Cologne and Münster. In Turkey, 20,000 doctors went on a nationwide strike last week, demanding better wages and benefits.
During the COVID-19 pandemic, nurses and other staff internationally have worked without proper personal protective equipment and under horrific conditions. The ruling class’s “profit before lives” policy jointly implemented by governments and trade unions led to constant overwork taking care of an endless stream of deathly ill patients, with no end to the pandemic in sight.
This criminal COVID-19 policy has led to close to 20 million deaths worldwide. Many health workers have contracted COVID-19 and died. Many more have endured the psychological and emotional trauma of witnessing death on a mass scale.
The Madrid strike was sparked by the decision of right-wing Popular Party (PP) Madrid regional government of Isabel Díaz Ayuso to unexpectedly call new civil service exams, allowing her to sack several thousand health workers. Many have worked for years or decades in health care, amply demonstrating their qualifications for the jobs they currently hold as temporary contract workers. Ayuso’s move would be unprecedented, leaving thousands of experienced medical staff jobless.
Last month, Ayuso refused to renew the contracts of over 6,000 health workers who had been contracted as reinforcement health personnel during the pandemic.
The PP Madrid regional government has for decades abused the temporary employment contracts for its public hospitals, using national labour reforms passed by successive Socialist Party (PSOE), PP and now PSOE-Podemos governments with the support of Spain’s main trade unions, the social-democratic General Union of Labor (UGT) and the Stalinist Workers Commissions (CCOO).
Among the 12,000 doctors in public hospitals under the control of the regional government, 55 percent have been on temporary contracts for years, including 82 percent of the doctors in ICUs. More than 6,000 doctors in the Madrid region do not have a long-term contract and have been going on temp contracts for years. In some specialties, civil service examinations required to obtain greater job security have not been called for twenty years.
Last year, after years of protests and strikes, the PSOE-Podemos government passed the National Law 20/2021 on the Reduction of Temporary Employment in Public Employment. The aim was to reduce the temporary contracts of 800,000 civil servants who were at risk of losing their jobs after 10, 20 or 30 years of going on temporary contracts. The new law, however, allowed each region to choose how it wanted to proceed. Jobs, minimum working conditions and staffing levels, and professional development were never guaranteed.
Days before the law passed, the PP regional government called for civil service examinations for 4,726 positions. This is a reactionary measure. Applicants will have to fill in multiple choice questions, based on memorisation of general medical knowledge. Doctors are demanding that the PP-run regional government suspend the traditional civil service examinations and replace them with a merit contest.
The indefinite strike has been called by the platforms of Doctors United for their Rights, Non-fixed Doctors and Physicians of Madrid, Somos Urgencias (We are Intensive Care Units) and the Amyts medical union. The unions CCOO, UGT, CSIT and Satse called off the strike after the region’s Ministry of Health reached an agreement with them to make 1,600 health professionals permanent through a merit-based examination. Amyts considers this 'insufficient,' as' it does not cover the thousands of temporary doctors.'
The PP regional government has reacted by attempting to crush the strike with draconian minimal service requirements. In outpatient consultations, 50 percent of workers are required to go to work; in urgent care units, this rises to 100 percent. Such units include dialysis, emergency, resuscitation, critical care, hospitalization, operating rooms, pathological anatomy, oncology day hospital and AIDS, pharmacy, diagnostic imaging, laboratories, organ extraction and transplantation, radiotherapy, hemodynamics, and admission and filing.
Effectively, doctors’ right to strike has been de facto outlawed. The trade unions, including the smaller Amyts that has continued the call to strike, have refused to mount a struggle against the minimum services and to expand the struggle to other civil servants facing similar struggles, such as in education.
Nonetheless, strikers have organised large demonstrations and rallies in front of several hospitals in the city of Madrid. Last Tuesday, hundreds of doctors gathered in front of the Madrid Assembly shouting 'We take care of you, we are mistreated' and 'Professional dignity, permanent contracts now.'
At the Doce de Octubre Hospital in Madrid, large group of about 200 doctors, with green suits and white coats, occupied the entire wide entrance staircase and the doors of the hospital. There, they shouted against job instability, megaphone in hand, behind a large banner that reads “Professional Dignity”. These protests have been repeated in front of each major hospital in the region in recent weeks.
Another indefinite strike in Ciudad Real of “home help” workers who assist those with disabilities or complex health care needs living at home resumed again last week, after it was suspended by the CCOO and UGT last week “as a sign of good faith.” Workers are fighting low pay and widespread abuse by employers of part-time, precarious contracts. As in Madrid, minimum service requirements of 50 to 100 percent of staff during strikes were imposed.
Such attempted union sabotage must be taken as a warning by health care staff and broader layers of workers in Spain and internationally. A powerful, international movement of health care workers is emerging. Fighting for its demands requires, however, breaking with the trade union bureaucracies and opposing reactionary pseudo-left parties such as Podemos, which in government has pursued a policy of accepting mass infection with COVID-19.
Spanish unions have isolated and allowed police forces to violently attack mass strikes by steelworkers in Cadiz and by truckers across all of Spain. Politically affiliated to the two ruling parties, they are implicated in all the policies that have needlessly made health workers’ lives intolerable during the COVID-19 pandemic.
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