Unprecedented hospital layoffs and closures underway in US health systems

Max Jones

The crisis gripping the health care system in the US is intensifying, with unprecedented numbers of hospital closures on the horizon and new mass layoffs among health care workers. As the world enters the fourth year of the pandemic, and the mass infection policies of the Biden administration and governments around the world continue to ensure the pummeling of health systems, hospitals are also being flooded with children and adults suffering from respiratory illnesses such as respiratory syncytial virus (RSV) and influenza.

In the US alone, by official counts 1.14 million Americans have died from COVID-19, with 20,000 deaths occurring since the start of the new year. A staggering 450 people are dying each day, according to the current seven-day average. Despite President Biden declaring the pandemic over, those infected with the coronavirus are still presenting in hospitals. 

The US health care system is reaching its breaking point, exacerbated by hospital understaffing, particularly among nurses. When one hospital closes, the impact on an entire region is immense. The current rate of hospital closures and layoffs exposes a system organized on the basis of profit, and which lacks any significant planning to provide high quality medical care. 

ProMedica headquarters in Toledo, Ohio [Photo by Ohio Redevelopment Projects / CC BY-SA 4.0]

A recent report in Becker’s Hospital Review noted a vast array of “workforce reduction efforts or job eliminations that were announced within the past three months and/or take effect over the next month,” within health systems. The list includes: 

• Oklahoma University (OU) Health, a teaching hospital in Oklahoma City, which is eliminating “about 100 positions as part of an organizational redesign.”  

• Integris Health, another Oklahoma City-based health system, is “eliminating 200 jobs to curb expenses.”
• ProMedica in Toledo, Ohio, plans to lay off 262 employees, to take effect between March 10 and April 1. 
• On November 11, St. Vincent Charity Medical Center in Cleveland, Ohio, closed its emergency room and inpatient care services, laying off nearly a thousand workers. 
• Memorial Sloan Kettering Cancer Center is laying off 337 employees across 14 sites in New York City, or about 1.8 percent of the cancer center’s 22,500 workforce.
• Pikeville Medical Center in Kentucky laid off 112 employees at the end 2022. 
• Desert Springs Hospital Medical Center in Las Vegas is notifying its workers of upcoming layoffs with its transition to a freestanding emergency department, which will affect 970 employees.
• Kaweah Health in Visalia, California, aims to eliminate 94 positions after lowering its workforce by 106. 

In addition to mass layoffs across the industry, high-level hospital closures are on the horizon with hundreds of jobs at risk. 

A staggering 631 rural hospitals are at risk of closure, with more than 200 hospitals at immediate risk, according to the Center for Healthcare Quality and Payment Reform. Six states are facing the shutdown of at least half of their rural hospitals.

In rural Alabama, 48 percent of hospitals are at risk of closing, with 16 percent in immediate danger. Urban hospitals have been overwhelmed consistently throughout the pandemic due to chronic understaffing. Frank Thomas, CEO at Citizens Baptist Medical Center in Talladega, told the Birmingham Business Journal, “Another problem that has really been difficult through COVID and even as we’re coming out of COVID is the rural hospitals’ ability to transfer patients to a higher level of care in urban markets … When a rural hospital gets a sick patient who maybe needs a higher level of care that the hospital can’t provide, they need to transfer to that higher level of care. And it has just been very difficult for rural hospitals to transfer patients because the urban hospitals are full or either they’re suffering from staffing shortages.”

While rural hospitals are closing at faster rates, urban hospitals are not immune to the closures. Last November, Atlanta Medical Center (AMC), in Atlanta, Georgia, closed, leaving tens of thousands of patients deprived of health care and laying off hundreds of employees. These events, which result in a decline in available health care despite very high demand, illustrate the eroding health care infrastructure in the US.

A registered medical worker dons protective gear before entering a room at a hospital in Royal Oak, Mich. In 2021. [AP Photo/Carlos Osorio]

The impact on surrounding hospitals in Atlanta has been devastating, with the closure of AMC leaving a city with half a million people with access to only one level one trauma center, at Grady Memorial Hospital. Since the closure, there has been a 20 percent increase in trauma patients at Grady, and a 40 percent rise in obstetrics and NICU care, according to Chief Health Policy Officer Ryan Loke. Just three days after the AMC closure, the impact on surrounding hospitals was so immense that the emergency room at Wellstar Atlanta Medical Center was forced to close due to rerouted patients. Severe overcrowding was also reported in the emergency room at Piedmont Atlanta Hospital. 

In Washington D.C. in 2019, one year before the pandemic, the city council voted in favor of plans to close United Medical Center in January 2023. Arnel Jean-Pierre, a nurse who was working at the hospital told the Talk Poverty web site, “The end result is a lot of people are going to suffer.” UMC is the last hospital in nation’s capital not located in the northwest quadrant, the city’s wealthiest section. Jean-Pierre said, “They’re paying taxes just like the folks in Georgetown, [wealthy DC neighborhood]. Why should they have the delay in health care when they face a stroke?” While UMC remains open for the time being, it is unclear when it will shutter its doors. 

Although these trends increased under the pandemic, they are nothing new. According to Fierce Healthcare, the nonprofit Chartis Group, health consultants in Boston, “found that over the past 13 years, 143 facilities have closed and another 453 are vulnerable to shutting their doors.” 

These mass layoffs and closures could not come at a worse time, with potentially deadly long wait times at ERs across North America. Health Services Research journal examined 5 million discharge records from California between October 2015 and the end of 2017 and found a 5.4 percent increase in the chance of death from any cause when a hospital’s emergency room is overcrowded. 

These conditions are connected to the nationwide nursing shortage, with a report from McKinsey & Company last year predicting a shortfall of up to 450,000 registered nurses in the US by 2025.

While health systems in the US and Europe struggle with closures and layoffs, governments are pouring billions of dollars into the NATO proxy war in Ukraine. This past week in the UK, tens of thousands of nurses, EMTs and first responders struck against attacks on the National Health Service (NHS) and for safe staffing.

As death toll in Turkey-Syria earthquake rises, Erdoğan government seeks to cover up responsibility

Ulaş Ateşçi

Yesterday evening, the official death toll from the Kahramanmaraş earthquakes had reached 31,643 in Turkey and 4,614 in Syria. Nine days after the quake, search and rescue operations continue in a small number of places, and it is unknown how many thousands of people are still under the rubble.

International search and rescue teams have warned that the President Recep Tayyip Erdoğan government’s decision to use construction equipment to directly enter the rubble will lead to deaths, not rescues. “We will not be part of this,” a member of the Spanish team told RTVE on his way home.

The bodies of 1,302 Syrian refugees, who died on the Turkish side of the border due to the earthquake, were brought back to Syria, according to Al Jazeera. In Syria, ravaged by NATO’s war for regime change and imperialist sanctions, the risk of outbreaks like cholera is rising. “There was a perfect storm brewing before the earthquake—of increasing food insecurity, collapsing health care systems, the lack of access to safe water and poor sanitation,” Eva Hines, chief of communications for UNICEF in the Syrian capital, Damascus, told Al Jazeera.

In Turkey, Erdoğan’s government has launched investigations into several contractors of buildings that collapsed in the earthquake. A few have been arrested. The scapegoating of a number of contractors is intended to cover up the responsibility of the government, which did almost nothing to prepare for the earthquake before and after, paving the way for massive destruction and loss of life.

The Progressive Lawyers Association (ÇHD) filed a criminal complaint yesterday against those responsible for this cover-up. Its statement declared: “We filed a criminal complaint against ministers, governors and AFAD officials who are responsible for the loss of hundreds of lives due to their negligence and inadequacies in preparation before and response after the earthquake.”

The statement continued: “We have previously filed a criminal complaint against all those responsible for the destruction. [State] Institutions that clearly failed to prepare for the earthquake in terms of search, rescue, debris removal and post-rescue assistance are also responsible for the damage they deepened after the disaster!”

As the Chamber of Architects conducted inspections in the earthquake-hit provinces of Adana, Osmaniye and Hatay, Chamber of Architects Ankara Chair Tezcan Karakuş Candan said, “We observed that the destruction in the affected region was massive. In the provinces where the aftershocks continue, many heavily-and medium-damaged buildings endanger human life. People under serious threat are struggling to survive on the streets under very difficult conditions.”

Candan added, “We are very worried about how those who have not been able to reach out to earthquake victims under the rubble for 6 days will be able to raise these cities to their feet. Especially in Hatay, there is a serious destruction in the new buildings stock.” She added:

From the massive destruction in the new building stock, we have observed that the earthquake regulations issued after the 1999 [Marmara] quake were not implemented, and that no lessons were learned from the earthquakes. In our investigations, we found that our warnings on urbanization and construction in earthquake zones were ignored, and that geological and ground survey studies were incomplete during the preparation of zoning plans.

A Master’s thesis on Antakya, the central district of Hatay, published in 2019, found that “80 percent of the buildings in the urban area consist of risky structures. Although these facts have been put forward in reports, and it is known that this city is in urgent need of transformation, no significant work has been done on this issue to date.”

In his article yesterday, daily Cumhuriyet’s columnist Barış Terkoğlu quoted an earthquake warning letter and a scientific report sent by Hüseyin Alan, Chair of the Chamber of Geological Engineers, to several state institutions, including the Presidency and AFAD, in March 2021. The letter and report were about Maraş, which would be the epicenter of the 2023 earthquake.

“Maraş sits directly on live fault lines or zones. It is necessary to urgently initiate a series of studies to prevent our province of Kahramanmaraş from being affected by earthquake damages,” he wrote in his letter, before adding: “Many settlements in Kahramanmaraş sit on ground units with poor engineering properties.”

According to Terkoğlu, Alan suggested in his letter that “The city should be re-planned according to the map of the live fault lines. Existing buildings must be reviewed and urban transformation work must be carried out. An earthquake plan must be prepared in Maraş.”

The attached scientific report also stated:

Kahramanmaraş is expected to be damaged in an earthquake larger than 6.5-magnitude due to both the severe shaking and the danger of surface faulting. In this case, the wisest approach would be to bring the buildings up to code to withstand earthquake shaking.

But the vital warnings of Alan and many other scientists have gone unheeded. As the World Socialist Web Site explained in yesterday’s Perspective, it was not because the Erdoğan government lacked economic resources or any other material shortcoming. Rather, it was “entirely due to the financial considerations of Turkish and global capitalism, which reject spending on long-term infrastructure, such as ensuring buildings in major fault zones are able to withstand earthquakes, in favor of short-term maximization of profits.”

The fact that disregarding the lives and safety of the people is a ruling class policy can be seen in the latest “construction amnesty” vote in 2018. Eight deputies of the so-called “opposition” Republican People’s Party (CHP) voted “yes” to the regulation brought to parliament by Erdoğan’s Justice and Development Party (AKP) before the June 2018 elections to legalize buildings without the required safety certificates.

Although only five “no” votes came from the Kurdish nationalist People’s Democratic Party (HDP), 43 HDP deputies did not participate in the vote. While no one from the CHP voted “no,” 123 deputies did not participate in the vote. In short, the “opposition” MPs who did not participate in the vote and the bourgeois opposition parties as a whole allowed the law to pass and became accomplices to the government’s crime.

The first words of a survivor in Hatay were a striking example of how the lives and health of people are devalued by the entire political establishment in the service of the capitalist system. According to news reports, Emine Doğu, 51 years old, was rescued from under the rubble at the 138th hour. She told emergency health workers who examined her immediately after the rescue: “I have no money. Please don’t take me to a private hospital.”

Meanwhile, aid volunteer Ali Nusret Berker’s interview with the Independent Türkçe yesterday confirmed claims that tens of thousands of people were abandoned to their fate under the rubble in the quake-affected area, where 13 million people live in Turkey.

Berker said that after the earthquake, he and his friends came to the region on their own and tried to participate in rescue and relief efforts in Hatay’s Samandağ district. The AFAD team they contacted in the district told them, “We scanned all the buildings here. Most of them [under the rubble] are already dead. Don’t go in vain. Better you go back.”

According to the interview, they refused to accept this advice: “Berker and his fellow volunteers claim that at least 350 people were subsequently pulled alive from under the rubble of the buildings.

“If we had been provided with equipment support, maybe half of the people we lost would have come out alive,” he said, adding that there was only a team of 13 people with them in Samandağ, which has a population of 120,000. “We really began to rescue people with our own efforts. But during this time, we started not to hear the voices of the people we heard. We started to lose them. And every government agency we called refused us. We really can’t comprehend what kind of logic there is in leaving people to die.”

Sri Lankan health services “heading for total breakdown”

Saman Gunadasa

Last Thursday, the Sri Lankan Medical Association (SLMA), the peak body for all medical practitioners, held a press conference to warn that the country’s health sector is heading towards as “total breakdown.”

Addressing the media, leading medical experts said that the island confronts a serious emergency with shortages of around 300 essential medicines, including a complete lack of 160 specific items at the medical supplies division, the national distributor of drugs to public hospitals. These medicines include antibiotics, anesthetics and other surgery-related drugs, as well as prenatal, neonatal, pediatric and cancer-treatment medicines.

Doctors and other health workers demonstrating over shortages and higher taxes outside Apecsha cancer hospital, Mharagama, a Colombo suburb [Photo by Health workers]

The Sri Lankan government is implementing the savage budget cuts demanded by the International Monetary Fund (IMF), including slashing funding to the public health service. As part of this year’s budget President Ranil Wickremesinghe, who is also the finance minister, will establish “paying wards” in state hospitals as part of its moves to dismantle what remains of the country’s free health service.

SLMA president Dr Vinya Ariyaratne told the press conference that “the health sector is facing a severe crisis due to the shortage of medicines, surgical equipment and chemicals used in labs.” The costs of these items, he said, “have gone up tremendously,” adversely impacting on the entire health sector.

College of Anesthesiologists and Intensivists president, Dr. Anoma Perera, said the crisis was nationwide, not just affecting rural hospitals, the National Hospital of Sri Lanka or private hospitals. “It impacts you and me, and if we ignore it anymore, there is a looming critical situation,” she said.

“Whether it’s a patient in the Intensive Care Unit, someone who has undergone surgery, an expectant mother who has had a Caesarian section or a victim of an accident, a shortage or lack of medicines impacts on them all,” she continued.

Ongoing shortages and the lack of anesthetics and pain management medicines has limited options for doctors, Perera warned. “In the next few months, the health sector might be compelled to maintain only the most emergency services,” she said.

National Institute of Infectious Diseases consultant Dr. Ananda Wijewickrama pointed out that most hospitals do not even have the facilities to conduct basic blood tests. “Some hospitals can’t even print x-rays. They ask patients to bring a CD so they can burn the images into it,” he said.

The health ministry has responded to this dire situation as a promoter of death, not life. Health Minister Keheliya Rambukwella told the Daily Mirror last weekend, that the ministry has advised hospitals to delay “non-urgent” surgeries and give priority to urgent surgeries.

Health workers across the country—from doctors to junior staff—have been demonstrating outside hospitals for months over shortages of medicinal supplies and demanding improved facilities and working conditions.

Dr. Sanduni Perera protesting high income taxes and lack of medicine outside Apecsha cancer hospital in Mharagama, a Colombo suburb. [Photo by Health workers]

Dr. Sanduni Perera from Apeksha, Sri Lanka’s dedicated cancer hospital, spoke with the media last week during one of these demonstrations. “There is no point patients coming to hospitals if we don’t have facilities to do a surgery and cannot provide them with medicine. We have been demanding the government resolve these issues since last year, but the government has other priorities and the health sector is neglected,” she said.

A Chilaw provincial hospital doctor told the World Socialist Web Site (WSWS): “There are no medicines for patients who come to clinics with diabetes and hypertension. Some of the essential medicines needed for the labor room were obtained through friendly doctors in Australia. We’ve been working with utmost dedication to save the lives of our patients since the height of COVID-19 but there’s a limit to the aid we can obtain from outside.”

A nurse from the same hospital explained that much of the equipment and medicines, including for childbirth, is now being purchased by patients.

The WSWS also spoke to a nurse from the Jaffna Base Hospital. “All hospitals lack medicines, including in the North. We are all facing a dangerous situation,” she said. “We also lack staff, including doctors, nurses, and others, in our hospitals, but the government is not concerned,” she added. She also explained that ambulance services had almost ground to halt in the area because there were no funds to service the vehicles.

A Kandy National Hospital psychiatric ward doctor who spoke with the WSWS said: “We face a dire situation because we do not even have drugs to control the violent and suicidal behavior of aggressive, mentally ill patients.”

A schoolteacher explained that one of her students had been treated at Kandy National Hospital over complications with her kidney transplant. She was treated because she was young, the teacher said, but lots of older patients were still on surgery waiting lists.

Doctors and health workers protest outside Kandy hospital on 20 January 2023. [Photo: WSWS]

The teacher, who is a cancer patient, could not afford to buy the prescribed medicine she needed because it was too expensive. “I had to purchase some cheap alternative,” she said.

The catastrophic situation now facing the health system is a direct result of ongoing and intensifying budget cuts by successive Sri Lankan governments in line with IMF directives.

The run-down state of the health system drastically worsened following the outbreak of the coronavirus pandemic in 2020, which saw hospitals overwhelmed with patients. This catastrophic situation, however, has further deteriorated with cuts to the health budget in response to the country’s debt crisis, inflation and the economic impact of the US-NATO war against Russia in Ukraine.

This year’s allocation for the health sector is just 322 billion rupees ($US880 million) compared to 539 billion rupees for defence and the police. The government’s allocation for health, however, is only on paper. Successive Colombo governments have consistently provided only 1 to 2 percent of the country’s gross domestic product for the health service.

The Wickremesinghe government is currently collecting massively increased funds via its 15 percent value added tax on essentials, including food items, fuel and telecommunications. All monthly wages above 100,000 rupees are now subjected to a 6 to 36 percent pay as you earn tax and imports of all essential items, including medical supplies, have been slashed to minimum.

These increased taxes, however, are not to provide the life and death necessities for the masses but to pay back loans to global creditors organised by successive Colombo governments.

The health sector trade unions continue to make futile appeals to the government to resolve the health disaster while promoting the deadly illusion that the government can be pressured to change course.

The capitalist opposition parties, including the Samagi Jana Balavegaya and Janatha Vimukthi Peramuna, are likewise attempting to exploit rising mass opposition against the government to come to power. Notwithstanding their denunciations of the Wickremesinghe government, these organisations have no fundamental differences with the austerity measures and would impose the same budget cuts if they won office.

Billions of rupees are immediately needed to prevent the collapse of the public health service and to provide free, high-quality health services to the masses. The health service must be urgently provided with the necessary medicines and infrastructure, along with more health workers at all facilities.

Airstrikes on Yemen using UK and US weapons “part of a pattern of violence against civilians”

Jean Shaoul

Britain and the United States provided the Saudi-led coalition with the weapons used in hundreds of attacks on civilians in Yemen between January 2021 and the end of February 2022, according to a recent report by Oxfam.

Martin Butcher, Oxfam’s Policy Advisor on Arms and Conflict, said that the Saudi-led coalition were responsible for at least 87 civilian deaths and 136 injuries, 19 attacks on healthcare facilities and 293 attacks that forced people to flee their homes—39 percent of all attacks causing displacement. “Our analysis shows there is a pattern of violence against civilians, and all sides in this conflict have not done enough to protect civilian life, which they are obligated to do under International Humanitarian Law.”

He added, “The intensity of these attacks would not have been possible without a ready supply of arms. That is why it’s vital the UK government and others must immediately stop the arms sales that are fueling war in Yemen.”

Houthi detention center destroyed by Saudi-led airstrikes that killed at least 60 people in Dhamar province, southwestern Yemen, in September 2019. [AP Photo/Hani Mohammed, File]

The Oxfam report came just days before the Campaign Against Arms Trade (CAAT) launched a lawsuit aimed at ending the British government’s multi-billion pound arms sales, including Typhoon fighter jets, missiles and bombs, as well as ongoing maintenance and support, for use in the Saudi Arabia and United Arab Emirates (UAE)-led war in Yemen.

The UK government’s own rules, adopted in 2014 when it signed the Arms Trade Treaty, prohibit arms sales where there is a “clear risk” that a weapon “might” be used in a serious violation of International Humanitarian Law (IHL). Despite the overwhelming evidence that the coalition has repeatedly breached IHL, the government has continued to promote and protect weapons sales. According to CAAT, the UK has supplied arms worth over £23 billion to Saudi Arabia, when “open licences” are taken into account, several times the official figures provided by the government, since the war in Yemen began in April 2015.

UK special forces are believed to have played a role in the war, while the British military maintains the Saudi warplanes that attack Yemen and provide intelligence support for the coalition.

The British government has persistently rejected calls from the United Nations and other international bodies for a ban on arms sales to Saudi Arabia and the UAE. It boasts of being the second largest exporter of defence items worldwide, after the US, based on the value of orders or contracts signed, with more than half by value going to the Middle East.

The venal Saudi monarchy, which routinely assassinates its opponents, tortures, imprisons and beheads oppositionists and dissidents, and the repressive UAE provide the major props for Britain’s defence industry—one of its few remaining manufacturing sectors. They serve as key custodians of Britain’s geostrategic interests in the energy-rich region and as allies in the Washington-led campaign to isolate Iran and its regional allies in Iraq, Syria, Lebanon and Yemen, as part of broader preparations for war with Russia and China, with which Tehran has forged close relations.

Prime Minister Rishi Sunak’s government is intent on maintaining the barbaric House of Saud’s control over the Arabian Peninsula. It is suppressing any information that Riyadh or its backers are committing war crimes and avoiding accusations that the UK is violating its own rules against supplying arms.

In June 2019, a Court of Appeal ruling, following legal action by CAAT, concluded that the Government’s decision-making process for granting export licences was “irrational” and therefore “unlawful.” It forced the government to stop issuing export licences for weapons that could be used in the war in Yemen pending a review of how these weapons had been used and to ensure that future arms sales complied with the government’s own rules and procedures.

But in July 2020, then Trade Secretary Liz Truss resumed arms sales, claiming any violations of IHL were only “isolated incidents.” Since then, the British government has licensed at least £2.2 billion additional weapons sales to the coalition, while cutting its 2021-22 aid to Yemen by more than half.

CAAT’s latest case in the High Court challenges the government’s claims that there were only a “small number” of IHL violations by coalition forces that did not form part of a “pattern,” citing overwhelming evidence to the contrary. Even if there were only “isolated incidents” of violations, this could still involve a clear risk of further violations.

For the last eight years, Saudi Arabia and the UAE have been waging war in Yemen, the Middle East’s most impoverished nation, condemned as near genocidal by rights’ organisations and charities, against rebels that overthrew the hated Saudi-imposed government. At the end of 2021, the UN estimated that the protracted onslaught had claimed the lives of 377,000 Yemenis, 150,000 as a direct result of the war and the rest through “a lack of food or access to healthcare, as well as by the lack of basic infrastructure to provide these services.”

Some 4.3 million people have been displaced, while horrific social and economic conditions, including a cholera outbreak that has raged since 2016 and the pandemic, have prevented people from returning to their homes. The war has destroyed much of Yemen’s public health system, leaving only 50 percent of health facilities operational, with most of these barely functioning due to damaged infrastructure and lack of healthcare workers. Last year’s heavy seasonal rain, windstorms, landslides, and flooding added to the catastrophic conditions, causing deaths and injuries that affected more than 210,000 people.

More than 21.5 million Yemenis are in need of assistance and 17.3 million are suffering from acute hunger, including over two million children with acute malnutrition.

Despite a six-month-long ceasefire and a significant drop in fatalities, the slaughter has continued, with at least 643 Yemeni civilians killed in 2022, including at least 102 children and 27 women, of over 3,000 casualties recorded, according to data published by the Yemen-based Eye for Humanity Centre for Rights and Development. The destruction of over 14,300 homes, 12 hospitals, 64 schools, and 22 power stations has added to the suffering.

The British government has refused Freedom of Information requests from the website Middle East Eye for the release of documents surrounding its arms sales to Riyadh between October 1 and 15, 2016. A Saudi-led coalition’s air strike on a crowded funeral hall in Sanaa killed more than 140 people and injured over 500 on October 8, 2016, an attack UN monitors found violated international humanitarian law. It rejected the requests after lengthy delays, firstly citing exemptions for policy-making decisions and decisions prejudicial to the UK’s foreign and commercial interests and, when that was shown to be incorrect, then claiming it would be too costly to retrieve the documents.

The government’s refusal to provide the information testifies to the widespread and deep hostility of the British public to the government’s arming of the coalition.

The British government supports some of the most barbaric and repressive regimes on the planet. Its continued supply of arms to the Saudi-led war on Yemen explodes its claims to promote human rights and democracy on the international arena, including the torrent of hypocrisy seeking to justify NATO’s military intervention against Russia in Ukraine.

UK survey shows nurses’ mental health is at its lowest point in the pandemic

Erik Schreiber

In the fourth year of the COVID-19 pandemic, the psychological state of a significant section of the health care workforce is at its lowest point. In a survey conducted by Nursing Times, 40 percent of nurses reported that their mental health is “worse” or “much worse” now than it was in 2020 or 2021. Participants also characterized their colleagues’ morale as “poor” or “very poor.” 

These stark findings reflect the heavy personal toll that the crisis in health care is taking on workers. Nursing Times is published in the United Kingdom, but nurses and other health care workers in every country face the same conditions. Surveys conducted around the world would doubtless yield similar results. 

Illness, burnout and retirements have increased sharply during the pandemic, and all these factors have contributed to understaffing. Unable to cope with increased workloads, higher patient acuity and a lack of workplace support, many nurses are leaving the profession entirely. The problem of understaffing afflicts not only NHS nurses, but health care workers around the world. Nurses and other health care workers in the United States, Turkey, Sri Lanka and other countries have conducted major strikes in recent months.

National Health Service nurses picket line in Bath during the national strike on December 15, 2022 [Photo: WSWS]

One of the almost 1,000 nurses who responded to the survey told Nursing Times that he or she had “never felt so lonely and anxious” as now. “We are all different people from who we were before the pandemic,” said the third-year student nurse. 

A nurse with 26 years’ experience called 2022 the hardest year of his or her career. “Recent years have required sustained high levels of resilience. I cannot sustain that level much longer—it is exhausting.” 

About 61 percent of survey respondents said that their mental health had worsened since the beginning of the pandemic, and 20 percent reported symptoms of post-traumatic stress disorder. One community nurse reported having flashbacks to a previous redeployment to critical care. Another respondent reported frequent work-related nightmares. Anxiety and a tendency to cry if reminded of a painful moment were also mentioned.

Most alarming are nurses’ reports of suicidal thoughts. “I have recently had a period of time off feeling suicidal,” said a hospital nurse. “I believe as a result of PTSD combined with the current staffing pressures, and not being able to do my job to a decent standard because of this.” 

The survey also revealed that most hospitals are doing nothing to alleviate nurses’ mental suffering. While 29 percent of respondents said that workplace mental health support had improved since the pandemic began, almost half (49 percent) said that it had not changed. Moreover, 21 percent said that workplace mental health support had worsened. 

About 79 percent of nurses cited understaffing as the primary factor worsening their mental health. The increased burden that this situation places on the workers who remain is causing anxiety. “I worry about making mistakes or omissions due to the heavy workload,” a National Health Service (NHS) nurse told Nursing Times. “We are unable to care for our patients properly, putting lives at risk,” said another. 

Other factors taking a toll on nurses’ mental health include the increasing cost of living (which was cited by 65 percent of respondents) and insufficient pay (56 percent). “I am not making enough money to meet utility bills once other essentials are covered,” one NHS nurse told Nursing Times. In addition, 45 percent of nurses said that their mental health was affected by their inability to take all their breaks, and 39 percent cited ongoing challenges related to COVID-19. Insufficient supplies of personal protective equipment (PPE) are also a source of stress. 

Respondents pointed to one major change that would vastly improve their psychological state. “If I came in to work on a fully staffed and safe ward, and was able to do my job fully and leave feeling that I had done everything I needed to do for my patients and colleagues, my mental health would not be as bad as it is,” said an NHS nurse. 

Fundamental political and economic processes underlie the health care staffing crisis. In the UK, the NHS has been underfunded deliberately for years by both Labour and Conservative governments and can no longer provide the level of care that patients need. Labour leader Sir Keir Starmer, a declared opponent of strikes, has denounced NHS workers’ pay demands as unrealistic and is committed to an austerity agenda in government.

The pandemic has been used as an excuse to funnel NHS funds to private companies (many of which have ties to members of Parliament) to purchase faulty PPE and other supplies. In addition to enriching well-connected companies, the government aims to privatize the most lucrative sectors of the NHS and reduce the rest to an empty husk. This agenda jeopardizes the very existence of the NHS as a public service. 

In the US and elsewhere, the major hospital corporations have maintained inadequate staffing levels to cut costs and increase their profits. This policy was in place even before the pandemic, which has only exacerbated the problem. Last year, major health systems laid off employees to maintain profits amid rising supply costs. Layoffs have taken place at Ascension St. Vincent Dunn in Indiana, Blessing Health System in Iowa, Shriners Hospital for Children in Florida, Sparrow Health System in Michigan and Trinity Health in Massachusetts and Pennsylvania. 

Health systems are being deprived of staff and resources at a time when public health is facing unprecedented threats. The needs of patients and health care workers are being sacrificed in the interests of the major hospital corporations’ profits. These developments illustrate the fundamental irrationality of for-profit medicine, which is incapable of providing a high standard of care. 

Rather than fighting against austerity on behalf of nurses and their patients, the trade unions are striving to suppress workers’ rebellions and enforce the agendas of governments and hospital management. In the UK, Pat Cullen, general secretary of the Royal College of Nursing, has been limiting NHS workers’ strikes to one or two days instead of waging an indefinite struggle. She also has announced her willingness to accept a contract that includes a raise of 7.5 percent, when inflation is greater than 13 percent. In the US, the New York Nurses Association recently divided striking workers at several hospitals and stampeded them into accepting contracts that neither ensure safe staffing nor provide acceptable wages.

As death toll rises past 35,000, earthquake in Turkey and Syria now one of the greatest disasters in the 21st century

Patrick Martin

Cranes remove debris next to destroyed buildings in Antakya, south-central Turkey, Friday, February 10, 2023. [AP Photo/Hussein Malla]

The twin earthquakes that devastated south-central Turkey and northern Syria last Monday have produced a disaster whose toll in death, destruction and mass suffering is apocalyptic. Nearly 35,000 are dead, according to official figures, and that number is rising steadily. Entire cities have been leveled. And millions are now facing deprivation and further death in mid-winter weather, with aid that is grossly inadequate compared to the enormous need.

United Nations relief coordinator Martin Griffiths said that the reported death toll is likely to “double or more.” He added, grimly, “Soon, the search and rescue people will make way for the humanitarian agencies whose job it is to look after the extraordinary numbers of those affected for the next months.” According to the World Health Organization, nearly 26 million people have been directly impacted by the quake, and many of these will face the threat of hunger, disease and physical and psychological trauma.

The colossal scale of the disaster is difficult to grasp from the reports in the corporate media, which inevitably focus on a handful of successful rescues rather than on the thousands of bodies hauled out of collapsed buildings. Even the aerial photos of mass graves, taken by drone-mounted cameras, only give a glimpse of the dimensions of this tragedy. 

The tremor exploded along 300 miles of fault line—roughly the distance from Detroit to Chicago, or Paris to London. According to a NASA geophysicist, “This generated extremely strong shaking over a very large area that hit many cities and towns full of people. The rupture length and magnitude of the 7.8 earthquake were similar to the 1906 earthquake that destroyed San Francisco.”

Entire cities have been laid waste, some of them steeped in millennia of history. The ancient city of Marash, a crossroads of the Near East, now the modern city of Kahramanmaraş, with a population of 600,000, was the epicenter of the quake. The ancient city of Antioch, now the modern city of Antakya, population 400,000, has been virtually destroyed.

A few comparisons: the February 6 earthquake is already the fifth-worst natural disaster of the 21st century in terms of death toll, and will likely soon be third-worst, behind only the 2010 earthquake in Haiti, which killed as many as 316,000 people, and the 2004 Indian Ocean tsunami, in which an estimated 228,000 people died across 14 countries, with Indonesia, Thailand, Sri Lanka and India hardest hit.

Those areas were among the poorest in the world: Haiti, the poorest in the Western hemisphere, but also the regions around the Indian Ocean where the tidal wave struck with full force. Turkey, however, is a country of middle income, with a large industrial base, a fully qualified candidate for entry into the European Union, although blocked for political reasons. Millions of Turkish workers make up a substantial component of the working class in Germany, Europe’s economic powerhouse.

The manifest failure of the Turkish government’s response is therefore not due to lack of access to technology or skilled labor or economic resources. It is entirely due to the financial considerations of Turkish and global capitalism, which reject spending on long-term infrastructure, such as ensuring buildings in major fault zones are able to withstand earthquakes, in favor of short-term maximization of profits.

The right-wing government of Turkish President Recep Tayyip Erdogan is more concerned about the potential political impact of the disaster than its human toll. A handful of building owners have been arrested to serve as scapegoats for systematic government corruption in the oversight of the construction industry, and to cover up the regime’s record of refusing to heed the warnings of scientists about earthquake dangers. There are bloodcurdling threats against looters, and reportedly more police sent to the region to suppress the population than relief workers to save lives.

While the Erdogan government certainly bears responsibility for this catastrophe, blame must be focused on the imperialist powers, and above all the United States, which has devastated the entire region in pursuit of global domination.

In Syria, the imperialist blockade has had such a savage impact that Griffiths of the UN said the world has “failed the people in north-west Syria… They rightly feel abandoned. Looking for international help that hasn’t arrived.”

US sanctions on Syria have blocked the flow of relief supplies, while US troops occupying parts of the country to control its oil production have stood by rather than provide aid to the victims of the earthquake. Amidst the devastation, the “mission” of the US military is to continue its regime-change operation, while subjecting tens of thousands of Syrians to barbaric conditions of imprisonment.

The pathetic sums offered in aid from the wealthy countries are dwarfed by their vast expenditures on the war against Russia over Ukraine and on the overall military build-up towards World War III, which would turn the entire world into a replica of the hellish scenes in the earthquake zone, and worse.

The US and European powers are presently flooding Ukraine with tanks and fighter jets, but when it comes to a massive social catastrophe, a pittance is offered. So much for the pretenses of “humanitarian” imperialism.

On Friday, the Pentagon comptroller confirmed that in its budget to be delivered March 9, the Biden administration will request the largest amount of military spending in American history, close to $900 billion. Meanwhile, the administration will provide $85 million, one-ten-thousandth that amount, for the relief of Turkish and Syrian survivors of the quake. Even this will be utilized in a way to advance the interests of American imperialism in both Syria and Turkey.

Only in the working class is there evidence of the enormous sympathy and solidarity of ordinary people for the plight of their brothers and sisters in Turkey and Syria. Aid workers from throughout the world have rushed to the scene, joining the tens of thousands of survivors seeking frantically to dig their spouses, children, parents and neighbors out of the mountain of rubble. Coal miners, who themselves risk death daily from cave-ins and explosions in Turkey’s notoriously dangerous mines, have trekked to the region to lend their assistance and expertise. 

But these efforts have been held back by the drastic shortage of the necessary equipment and technical expertise to conduct successful rescue operations—the responsibility of the major imperialist powers, which enjoy a near-monopoly in that sphere.

European powers prepare delivery of fighter jets to Kiev

Johannes Stern

The European powers used the European Union (EU) summit in Brussels at the end of last week, in which Ukrainian President Volodymyr Zelensky participated as a guest, for a massive escalation of the war offensive against Russia.

Earlier in the week, at a meeting with British Prime Minister Rishi Sunak, French President Emmanuel Macron and German Chancellor Olaf Scholz, Zelensky demanded the delivery of F-16 fighter jets. At the summit, numerous European leaders responded favourably to this demand, which vastly increases the risk of a comprehensive war with Russia and thus a third world war fought with nuclear weapons.

European Parliament President Roberta Metsola, who welcomed Zelensky in the European Parliament, stressed the importance of fighter jet deliveries to Ukraine: “Now, as the next step, states must consider rapidly deploying long-range systems and aircraft.” The European “reaction” must be “appropriate to the threat—and the threat is existential.”

Others spoke along similar lines. “All options are on the table, including the delivery of F-16 jets,” said Dutch Foreign Minister Wopke Hoekstra. And Estonian Prime Minister Kaja Kallas said, “If we had them, we would help Ukraine with all the means at our disposal.” She added, “The price to be paid in the face of Russian aggression increases with every hesitation.”

Although no European government has yet made concrete commitments, it is clear that the delivery of fighter jets is being prepared behind the backs of the population. At a joint press conference with EU Commission President Ursula von der Leyen and EU Council President Charles Michel, Zelensky boasted that his visit to the UK had already brought decisions on the supply of long-range weapons and the training of pilots closer and was “really a step towards the supply of fighter aircraft.”

Zelensky said that at the EU summit, he was told by several leading EU representatives in bilateral talks that they were prepared to supply Ukraine with “the necessary weapons.” This included “aircraft.” He initially avoided going into concrete details of his talks in London, Paris and Brussels. When asked about them by a Ukrainian journalist, he said, “There are certain agreements that are not public but that are positive.”

The procedure is following the same well-known pattern. The delivery of battle tanks was also decided long before the public announcement. Germany, which has been portrayed as hesitant for a long time, is currently assembling an entire army of tanks against Russia. Following the initial announcement that 14 Leopard 2 battle tanks would be delivered to Kiev, the German government released the export permit for an additional 178 Leopard 1 battle tanks last week.

On Thursday, the German arms company Rheinmetall also announced that it is planning to deliver Lynx and Panther tanks to Ukraine. These are “the most modern armoured vehicles and battle tanks,” boasted the head of the group, Armin Papperger, in an interview with the Handelsblatt. The tanks could be built in Germany and Hungary, but they are “ready to build a plant for the production of the Panther in Ukraine.”

The tank deliveries are being advanced aggressively. During his inaugural visit to Kiev earlier this week, the new German Defense Minister Boris Pistorius announced that he would send the promised Leopard 2 battle tanks by the end of March. By this summer 20-25 Leopard I tanks will follow and another 80 by the end of the year. “The goal is to reach over 100 Leopards by the first or second quarter of 2024, which means at least three battalions—including the materials to be procured for spare parts and ammunition and, of course, training,” he said. 

Training for “600 sergeants” has also begun. And by the end of the month, there will be “more guided missiles, another five Cheetahs (self-propelled anti-aircraft guns), another five Dachs tankdozers and five Biber bridge-laying tanks,” explained Pistorius. 

German Chancellor Olaf Scholz also assured Kiev in his government statement before the EU summit of further massive arms deliveries and boasted that “in continental Europe,” Germany is “far ahead in the supply of weapons and ammunition” to Ukraine. “We have always worked closely and confidentially with our allies, whether it was on the delivery of self-propelled howitzers or multiple rocket launchers, to provide Ukraine with anti-aircraft weapons, or on our decision to deliver armored personnel carriers and, ultimately, battle tanks.” 

The Chancellor absurdly claimed, “We don’t make decisions that make NATO a war party.” This is an obvious lie. In fact, NATO has long been at war with Russia and is now escalating it. Representatives of the federal government openly say this. “We are fighting a war against Russia and not against each other,” Foreign Minister Annalena Baerbock (Greens) recently said at the Parliamentary Assembly of the Council of Europe in Strasbourg.

The fact that German imperialism, in particular, which already tried twice in the 20th century to subjugate Russia militarily, is again striking out against Russia underlines the real character of the German-European war policy. It is not about defending “freedom” and “democracy” but geostrategic and economic interests and the struggle for world power in the 21st century.

Germany's ruling class has long pursued the goal of rearming and organizing Europe under German leadership. The reactionary invasion of Ukraine by Russia, which was provoked by the NATO powers, has served as a welcome pretext. In his government statement, Scholz called for the necessary unity of “a geopolitical European Union” to be “an organising power in the multipolar world of the 21st century.”

The entire war summit in Brussels shed light on the reactionary character of the ruling class. It is responding to the deep crisis of capitalism and the growing revolutionary movement of the working class on the continent with a desperate turn to war and fascism. When Zelensky ended his provocative war speech in Brussels with the cry of the Ukrainian fascists “Slava Ukraini,” the entire EU Parliament rose to applause. 

Initially, the focus of the EU summit was supposed to be on tightening refugee policy. With the measures adopted at the summit, the EU is implementing the programme of far-right parties, such as the Alternative for Germany or the Italian ruling party Fratelli d'Italia. While in the Turkish-Syrian border area countless refugees fell victim to the earthquake disaster, the EU states committed themselves in the final declaration to the massive expansion of “Fortress Europe.”

Among other things, the EU reiterated its “full support” for the notorious border protection agency Frontex, also in order to “support increased repatriations.” In addition, “border protection capacities and infrastructure” will be expanded and additional “means of surveillance, including air surveillance, and equipment” will be made available. 

Opposition to this militaristic and anti-working class policy is developing all over the continent. In France, millions protested again over the weekend against President Macron’s planned pension reform. In Madrid, hundreds of thousands took to the streets for better health care. In the UK, millions of workers from different sectors have been taking part in a massive strike wave for months. In Germany, 11 million workers are engaged in collective bargaining and their demands are underlined by strikes and demonstrations. 

Strikes are also increasing in other European countries against job and wage cuts, and the devastating effects of inflation and the sanctions against Russia, which were strengthened at the EU summit.

Disney announces 7,000 layoffs after exceeding Wall Street profit estimates

Kevin Reed

The media and entertainment monopoly Walt Disney Company announced 7,000 layoffs on Wednesday as part of a corporate restructuring aimed at increasing profits and improving investor earnings by cutting $5.5 billion in costs.

The Walt Disney Company announced it would be laying off 7,000 workers as part of a “strategic transformation,” announced by CEO Bob Iger on Wednesday, February 8, 2023. [AP Photo/Richard Drew]

In an earnings call with investors, Disney CEO Robert Iger presented the jobs massacre as cause for celebration, saying, “It’s time for another transformation.” Meanwhile, Iger said, “I have enormous respect and appreciation for the dedication of our employees worldwide,” even though 3 percent of Disney’s 220,000 workers will be losing their jobs.

The layoffs are connected with a reorganization that Iger said was necessary to dramatically cut costs that will “fully materialize” by the end of 2024. Of the $5.5 billion in cost savings, $2.5 billion are in “non-content” aspects of the corporation, such as marketing (50 percent), labor costs (30 percent) and technology (20 percent).

It is significant that Disney is taking advantage of the climate of mass layoffs hitting the technology, financial and other sectors that had huge losses in the past year to go after the jobs of its employees while the company had a profitable quarter.

The 7,000 job cuts were announced even though Disney reported revenues of $24.5 billion in the quarter that ended in December, an 8 percent increase compared to last year, and earnings rose to $1.28 billion from $1.1 billion a year ago, beating analysts’ projections. However, the all-important per share earnings category fell to 99 cents from $1.06 last year.

Uppermost in the minds of Disney’s investors is the fact that the entertainment company’s streaming service Disney+ lost 2.4 million subscribers in the last quarter, primarily with losses in India and parts of Southeast Asia, and this direct-to-consumer business lost $1.05 billion, which was also below Wall Street projections. Since it was launched in 2019, Disney+ has lost a total of $9 billion in the battle to attract subscribers in the overcrowded video streaming marketplace.

Like nearly every publicly traded company in 2022—among the exceptions are the oil and health care industries—Disney lost more than 40 percent of its stock value last year. Its major investors, such as Vanguard Group (assets under management of $8.1 trillion) and Black Rock (assets under management of $8.5 trillion), are demanding draconian measures aimed at getting their money back.

Typical of business news reports on the Disney reorganization plan is the one published by The Motley Fool which said, “But perhaps the most important piece of information from the report for dividend investors was news that the company plans to reinstate a regular cash payout later this year.” The report quoted Disney’s Chief Financial Officer Christine McCarthy at the investor call who said the dividend payout would occur at the end of 2023.

While thousands of employees are about to lose their only source of income, McCarthy told investors not to get too anxious about the size of their payouts. “The amount will likely be a small fraction of our pre-COVID dividend with the intention to increase it over time as our earnings power grows.”

Among the areas hardest hit by the layoffs are the Disneyland Resort theme park in Anaheim, California; Walt Disney World in Orlando, Florida; Disney cruise lines and the company’s international parks. In an email to hourly frontline workers, Josh D’Amaro, Disney’s Parks, Experiences and Products chairman, said, “As was shared on the earnings call, the company is targeting significant savings across all businesses, and the reorganization will result in necessary reductions to our overall workforce.”

The theme parks division was the most profitable of the Disney properties, with a revenue increase of 21 percent to $8.7 billion and a profit increase of 25 percent to $3.1 billion from a year ago. This was largely attributed to a 19 percent increase in theme park ticket prices in December. The average hourly wage of a Disney World employee is $18.88, according to the website payscale.com.

Iger, who has a personal net worth of $350 million, said his cost cutting plan—which reduces the structure of the conglomerate to three divisions: Disney Parks, ESPN and Disney Entertainment—will “re-establish the direct link between content decisions and financial performance.”

Late Wednesday and Thursday morning, Wall Street joined in Iger’s enthusiasm over the job cuts and pushed the $200 billion company’s stock value up sharply. However, the stock price fell later that morning when activist investor Nelson Peltz of Trian Fund Management withdrew his proposal for a more severe plan of cost cutting.

On behalf of all the major Disney investors, Peltz had launched a campaign to win a seat on the company board of directors so that his plan to attack the workforce with layoffs and increased exploitation of the remaining workforce could be forced through any lingering opposition within management. In the end, as Peltz told the Wall Street Journal, “He [Iger] said all the things that we would want him to do. Now they’ve got to execute.”

Corporate media reports have been ecstatic about Iger’s return as CEO in November, after the firing of Bob Chapek, as though he had some kind of magical powers to return Disney to profitability. Actually, Iger was brought back because he was seen by Wall Street as more reliable at wielding the axe than the man he had personally picked as his own successor in 2020.

This year is the centenary of the firm, which was founded by Roy and Walt Disney as Disney Brothers Studio in Hollywood, California, in 1923. It is significant that in all the reports about stock performance, earnings, dividends, layoffs and returning “creativity to the center of the company,” not a word can be found from Iger or the press about Disney’s 100th Anniversary Celebration.

It is a measure of the financialization of society, in general, and the takeover of the film and entertainment industry by billionaire parasites, in particular, that the legacy of the Disney brothers, who pioneered animated film and created the first sound cartoons ever made, has not even been mentioned.

However, the truth of what is going on is not lost on the workers and public at large. Responding to the layoff announcements, one New York-area Facebook user, who is obviously familiar with Disney’s treatment of its employees, known internally as cast members, said of Iger, “He needs to give himself a pay cut and increase all the cast members’ pay. No reason for layoffs other than greed by corporate.”

Another Facebook user said, “Greed! Disney go back to the recipe of Walt Disney and tunnel his inner vision of joy, happiness and magic!” And a former Disney employee commented, “Bob Iger I hope that includes mostly high paying executives and not the poorly paid hourly employees that do most of the work!!!”