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Austerity, the destruction of the health system and the urgency of a debt moratorium

Sunday 26 April 2015, by Charles-André Udry, Louise Irvine

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A meeting of the Red Network was held in Athens on April 4, 2015. One of the three workshops brought together about a hundred people who are active to varying degrees in the health sector: doctors, nurses, paramedics, those responsible for hospital pharmacies, cleaners, members of local committees who have prevented the closure of a primary care centre, one of the doctors responsible for the social dispensary at Hellinikon. The discussion combined testimony, analysis and initiatives. A common thread ran through all the interventions: we should stop waiting for the results of the permanent and highly-mediatized negotiations of the government, which maintain the population in a passive attitude; we must build initiatives that ensure the connection between caregivers, population, the trade-union structure (META) influenced by Syriza and the members and supporters of Syriza. Given the massive and continuous state of decay of the health system, a slogan has to be put forward: immediate refusal to pay the interest on the debt and repayments that are presented as unavoidable, and the immediate use of these funds for the health sector.

The decision of the Tsipras government to abolish the €5 charge for medical visits is largely illusory, because the sums represented by the one euro to be paid by patients when buying medicine are much greater. In the interventions of caregivers, one fact stood out: the vast majority of managers in the health system and the hospitals have not been changed. The bureaucratic and clientelist apparatus of New Democracy and PASOK remains in place. Ministers can always make statements - they do so every day and in every way – but changing a structure depends on having a real plan and on social mobilization. No new model of effective control of hospitals has been established. The government, of course, does not support any mobilization. The acceptance of the so-called European constraints forms the corset that holds together the different elements of this government, who each play their cards, sometimes in conformity with their convictions. This helps to create illusions among observers about the possible effects of so-called internal contradictions. We witnessed the same illusions at the time of the first government, called "in dispute", of Lula in 2003, although the government structure of the PT was more solid.

The leadership of Syriza in its formal majority can make a declaration, but it does not take any initiative that would make the link between the crucial issues of the health system and the payment of the debt. However, the social emergency is starting to be used – admittedly for the moment in a propagandist way – by the Right, indicating that the government is not only failing to keep its promises, but it is allowing the situation to deteriorate.

In contrast, all the experience of open meetings of the local structures of Syriza show the interest and the readiness of the population to reopen a primary care centre, to prevent a hospital closure, to increase the number of doctors, to create the conditions for a return of doctors who experience their expatriation as a deportation. One after the other, people recount how in such and such a department the number of doctors has gone down from twelve to four and the number of nurses from has fallen from ten to two. Moreover, a survey is going to be published concerning the situation of the major hospitals in the Athens area and of primary care facilities. A neurosurgeon who has worked in the two main hospitals described the sharp increase in nosocomial infections (infections contracted in a health establishment) and indicated the effects over the long-term (two, three generations) of this situation. What he said was reinforced by the intervention of a pediatrician.

The debates on the illegitimate debt and its origins are admittedly very important. But the question is posed within another human temporal framework: today, tens of thousands of men and women, Greeks and migrants, are starving, are sick, and are not cared for. The answer cannot be that the government spends €300 million for so-called humanitarian measures (reconnection of electricity, distribution of food stamps), in the style of World Bank safety nets, at the same time as it votes to spend €500 million to renovate the anti-submarine air force, a proposal pushed forward by its Minister of Defence.

Admittedly, this minister, Panos Kammenos, of the Independent Greeks, did not confine himself to only this task, a priority for him. He was present on April 4, when the establishment of an audit committee on the debt was presented. An initiative that deserves all our interest. Moreover, the President of the Republic, Prokopis Pavlopoulos, stressed its importance. He expects the results in several months. Prokopis Pavlopoulos, given his record in New Democracy and in various governments, in particular from 2004 to 2009, is aware of the explosion of debt in the 2000s, as illustrated by the recent article by Michel Husson [1]. Something that, out of pure opportunism, representatives of the Democratic Left (DIMAR) took the opportunity of recalling, highlighting the career of the President during the period of indebtedness under Karamanlis [2].

As Antonis Davanellos pointed out in a recent article for the really radical left, faced with the disastrous record of the government, initiatives to change as far as possible the relationship of forces within Syriza - and also in the trade union movement, in its militant sectors - are paramount. [3] This is in view of deadlines that are coming up in the short term (June 2015). This battle to change more clearly the relationship of forces, primarily in Syriza, must be combined with massively putting forward concrete demands whose implementation is only possible to the extent that a moratorium on the payment of interest on the debt is decided on immediately. The forces of the Left (from Syriza to Antarsya, including those members of the Greek Communist Party (KKE) who appreciate the acuteness of the social crisis), who want the immediate implementation of the programme of Thessaloniki agenda, presented on behalf of Syriza by Tsipras on September 14, 2014 [4] expressed this in multiple forms during the meeting on April 4, when the radiograph of the health system was in fact that of Greek society.

The following article by Dr. Louise Irvine, whose data are from the end of 2014, already gave the alarm signal in January 2015. She was not the first. The Lancet had already made a real audit of the health system in February 2014. It reflected the needs of the population and therefore the universal rights that flow from that.

What ’austerity’ has done to Greek healthcare – “What I witnessed appalled me - and brought tears to my eyes”

The shocking ’austerity’-imposed destruction of Greece’s once proud healthcare system is a key reason Greeks have turned to Syriza, finds London GP Louise Irvine in an eye witness account.

In October I visited Greece to see the impact of austerity on the Greek people, in particular on health and healthcare.

I joined healthcare workers and the Greece Solidarity Campaign to visit hospitals, clinics and food markets. I spoke to healthcare staff, volunteers, politicians and local government officials.

What I witnessed appalled me - and brought tears to my eyes.

In Greece’s biggest hospital, the Evangelismos Hospital in Athens, conditions were worse than those I have seen in developing countries.

The moment the hospital doors open on ‘emergency’ days, people flood in. The collapse in official primary and community health care services means everyone who needs healthcare comes to A+E - whether for a major accident, medication for a long term condition or to get their child immunized. Staff told me that serious trauma cases often have to wait hours for X-rays and treatment due to understaffing and that, if too many cases come in at the same time, people die before they can be treated.

The ‘austerity’ conditions imposed on Greece by the Troika (European Commission, European Central Bank and IMF) as the price of its debt bailout have closed many hospitals (including three psychiatric hospitals) and primary care clinics. Those that remained face drastic staff cuts. Thousands of health workers have been sacked.

30% of the Greek population is living in poverty, with no access to affordable healthcare. Healthcare is funded through insurance paid by employers and when people lost their jobs they lost their health insurance. The Government claimed to have reinstated health care for the neediest but doctors and nurses told me it was a sham. The promised tribunals to assess and means test the claims of those who can’t afford health care have yet to be established.

At Evangelismos I saw 50 psychiatric patients crammed into a 25 bed ward, sharing two toilets and just one psychiatric nurse. Psychiatric patients of all ages and both sexes lay apathetically on trolleys on both sides of the long corridor. I turned a corner and saw another corridor similarly lined. These narrow uncomfortable beds, crammed together, were all the personal space patients had. Nurses and doctors told me it was impossible to do any therapeutic work.

Despite the overcrowded conditions, the ward was eerily quiet. I got the impression most patients were sedated, or perhaps had just given up in despair.

‘Austerity’ and cuts have led to a sharp rise in depression. Suicide is up 45%. The patients in Evangelismos were the lucky ones - many others who need beds have been abandoned on the streets, with no community based support.

As we were leaving a doctor appealed to me to tell people in the UK what I had seen and heard. He said they wanted “solidarity, not charity”.

People are organizing to resist and defend their communities against the worst impacts of austerity. One expression of this is the mushrooming of community based “solidarity” structures to help people who lack food or healthcare.

Social solidarity health clinics have been set up all around Greece staffed by volunteers who try to provide basic care for those with no access to healthcare. Doctors, nurses and pharmacists volunteer in these clinics, but not nearly enough to meet the needs.

I visited the Social Solidarity Clinic in Peristeri, a district of Athens with a population of about 400,000 people. The volunteer staff, doctors and nurses who worked there told me that most local state run health clinics had been shut. The government had closed all the polyclinics then reopened some recently but with only 30% of the doctors that they need. Whereas previously there had been 150 doctors providing services to the district, there were now only 50. A polyclinic for a population of 400,000 people had no gynaecologists, no dermatologists, and only two cardiologists.

“We want our doctors back” – said one of the volunteers I spoke to. Thousands of doctors have left the country. Those that remain – including senior hospital doctors - earn about €12,000 a year.

The Peristeri social solidarity clinic had been running for 1.5 years and had 60 volunteers including about 25 doctors who offered their services free. There was a simple consulting room and a small pharmacy with donated medicines.

Clinic volunteers said that people with long term conditions like diabetes or with cancer had particular problems getting the treatment they needed. Uninsured cancer patients can’t afford chemotherapy. The solidarity organisations appeal to people on chemotherapy to donate one day’s worth of medication for patients who can’t afford to the drugs themselves.

The Greek government passed a law in January allowing so that if people get into debt their property can be confiscated. Some people decline further treatment rather than accrue debt from healthcare costs that might lead to their family losing their home.

Greek mothers are now charged €600 to have a baby and €1200 for a Caesarian or complications. It’s twice that for foreign nationals living in Greece. The mother has to pay the fee on leaving the hospital. When the charges were first introduced, if the mother couldn’t pay, the hospital kept the baby until the payment was made. International condemnation led to that practice being discontinued and now the money is reclaimed through extra tax - but if the family can’t afford that then their home or property can be confiscated. And if she still can’t pay she can be imprisoned. An increasing number of newborn babies are abandoned in the hospital. One obstetrician I spoke to called it the “criminalization of childbirth.”

Contraception is unaffordable for many – health insurance does not even cover it. There are many more abortions – 300,000 a year –and for the first time the death rate in Greece is outstripping the birth rate. People can’t afford to have babies. It’s hard enough to feed and care for existing children.

A recent report compiled by Unicef and Athens University estimated that 34% of Greek children were at risk of poverty. An article in the Lancet (Greece’s Health Crisis: from Austerity to Denialism 22 Feb 2014 [5] reported that the stillbirth rate had risen by 21% and the infant mortality rate by 40% between 2008 and 2011. Many families are living off the meager pensions of a grandparent– typically about 500 Euros a month. The collapse in primary care systems means that thousands of children are not being immunized. It costs about 80 Euros for a course of childhood immunizations and many families cannot afford that.

Collapse of the public healthcare systems has led to a doubling of TB rates, the reemergence of malaria after 40 years and a 700% increase in HIV infections.

Food poverty is also worsening people’s health. 1.7 million Greek people, nearly one in five of the population, do not have enough to eat, according to the OECD. We visited a food market in Athens organized by the social solidarity movement, which organizes the distribution of food direct from farmers to the population. The social solidarity food markets cut out the middleman so the food is cheaper than in the supermarkets while the farmers get a good price. In return the farmers donate a percentage of their product, which is distributed free to local families in need.

Across the market a banner was strung saying “Putting hope into practice”. This, for me, epitomized the spirit I encountered everywhere I went – hope for change combined with a very practical approach to creating support structures. People I spoke to were clear these were not intended to be a substitute for state provision – they can’t be – but a means of sustaining life and resilience to prevent people sinking into destitution and despair. They said that what was needed was action at government level.

The success of the Syriza party is no surprise. We met Alexis Tsipras, Syriza’s leader, who said that rebuilding the healthcare system would be a priority for his government if elected.

The Greece Solidarity Campaign has launched an appeal for medical aid for Greece, prioritizing the purchase of immunisations for children. [6]

26 January 2015

Republished from Open Democracy. 26 January 2015.


[2See I Efimerida Ton Sintakton (“Editors’ Daily”) April 6, 2015.

[5See here.

[6See their website. See also the work of the France-Greece health solidarity campaign The right to healthcare.