We translated this <a href="https://trabajadoresenred.es/index.php/2026/01/11/huelga-en-la-urgencia-general-del-hospital-la-paz/">short strike notice</a> from Madrid and will try to interview the fellow workers in the near future &#8211; watch this space! The interesting aspect is that all job categories &#8211; doctors, nurses, porters, admin workers &#8211; went on strike together&#8230;
The Tere (Trabajadores en Red) union called a one-day strike at the La Paz University Hospital General Emergency Department in Madrid. The strike took place from 8:00 a.m. on Wednesday, the 21st of January, until 8:00 a.m. on Thursday, the 22nd of January 2026.
The strike was approved in a vote held among the workers of the department, with 157 votes in favour and 3 against, reflecting majority support for the action in a situation that has become unsustainable. The strike is in response to the continuous overcrowding of patients and the lack of staff, direct consequences of the general deterioration of Madrid&#8217;s public health system. 
The increase in pressure on healthcare services, waiting lists for consultations, tests and surgeries, and the lack of structural reinforcements have led to an extreme situation. In the last three years, the number of people attending A&amp;E has increased by 10% annually, without any effective measures being taken to address this.
The main demands of this strike are:
<ul>
<li style="font-weight: 400;" aria-level="1">Implementation of the ‘No Patients in the Corridor’ plan, with an establishment of safe capacity limits in A&amp;E </li>
<li style="font-weight: 400;" aria-level="1">Provision of additional space when these limits are exceeded.</li>
<li style="font-weight: 400;" aria-level="1">Definition of clear staffing ratios per patient</li>
<li style="font-weight: 400;" aria-level="1">Automatic protocols for opening additional space and hiring staff when capacity limits are exceeded</li>
<li style="font-weight: 400;" aria-level="1">Sufficient staffing in primary care emergency services (PAC, SAR and SUAP) throughout the year, with full teams of doctors, nurses and porters</li>
<li style="font-weight: 400;" aria-level="1">Real reinforcement of the capacity of La Paz Hospital to reduce waiting lists for consultations, tests and surgeries: Rejection of referrals to private healthcare, public resources should be allocated to public healthcare</li>
<li style="font-weight: 400;" aria-level="1">Immediate hiring for all vacancies in health centres in the Northern Health Area</li>
</ul>
The strike includes all staff categories: assistant doctors, resident doctors, nursing staff, nursing technicians, porters and administrative staff. The strike committee is made up of representatives from all professional categories and members of neighbourhood movements in defence of public healthcare.
Call for a rally
Tere (Trabajadores en Red) calls on hospital workers, patients and the general public to support the rally that will take place in the square in front of La Paz Hospital on Wednesday, 21st of January at 12 noon.
Defending public healthcare means defending a basic right. The current situation is not inevitable: it is the result of political decisions that must be reversed.
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Strike at La Paz Hospital General Emergency Department in Madrid

We translated this report from our friends of the collective <a href="https://kon-flikt.org/%D1%81%D1%82%D0%B0%D1%82%D0%B8%D0%B8/%D0%BA%D1%80%D0%B0%D1%85%D1%8A%D1%82-%D0%BD%D0%B0-%D0%BE%D0%BA%D1%80%D1%8A%D0%B6%D0%BD%D0%B0-%D0%B1%D0%BE%D0%BB%D0%BD%D0%B8%D1%86%D0%B0-%D0%B2%D1%81%D0%B8%D1%87%D0%BA%D0%B8-%D1%81%D0%B0-%D0%B2%D0%B8/">Konflikt</a> from Bulgaria, who told us about recent protests in front of the hospital.
February 4, 2026
In Varna, we started the new year with the announcement that our city is losing its pediatric surgery department in the most important hospital in the city and the region—St. Anna Regional Hospital. Since the beginning of the year, nurses, doctors, and paramedics have had their salaries cut, with their pay falling below even the minimum wage for the country. The medical staff responded with a protest in front of the hospital on the 15th of January, in which almost all workers of the medical facility took part. This prompted media reactions from the hospital director and the management of the National Health Insurance Fund (NHIF), from whom we learned that, once again, no one was to blame. The director blamed the NHIF, saying there was no money for salaries because the hospital&#8217;s excess activity had not been paid for. The NHIF claims that it has paid everything. Lawsuits are pending, and in the meantime, there are no salaries. This is not a precedent. The hospital, like most state hospitals in the country, has been collapsing for years. Salaries are humiliating, the material base is crumbling, there is no money for basic consumables, and suppliers refuse to work with the hospital. St. Anna lacks basic amenities, with staff buying dishes for patients with their own money, and the only income for improvements coming from charity campaigns, Norwegian foundations, and individual donors.
The theft of the already meager salaries of the medical staff was simply the last straw. This led to the 2nd of February, when the doctors and nurses from the pediatric surgery department at St. Anna Hospital collectively resigned and the department closed its doors to young patients. The medical staff, some of whom had been working in the public hospital for more than 30 years, were immediately hired by a private hospital in Burgas, and Varna lost its pediatric surgery department. What&#8217;s more, this is not the first department we have lost – three departments have been closed in recent years, including vascular surgery and internal medicine.
As we wrote above, what is happening now is not an accident, but another episode in an ongoing tragedy in which the victims are both the doctors and all the residents of Varna and the region. We must stop the collapse of our public hospital &#8211; all working people contribute part of their salaries to the maintenance of this hospital every month and we and our children need it. After decades of decline, it is clear to all of us that the solutions will not come from hospital directors or the Ministry of Health. The solutions can only come from those directly interested in saving public healthcare in Varna – the hospital staff and all of us, the patients. However, in order to develop solutions, we need to know exactly what is happening with our hospital. There are many problems, and they overlap. Let&#8217;s start with the aforementioned financial relations. 
Hospitals are financed by our health contributions through the clinical pathway system (specific amounts for specific activities, &#8220;money follows the patient&#8221;) allocated by the National Health Insurance Fund. They were introduced as part of the market reform of Bulgarian healthcare, which turned hospitals into commercial companies competing for money from the fund. This system created the conditions for massive corruption and opened the door to the massive draining of the health fund by hospital directors and part of the medical elite, many of whom have become multimillionaires in recent decades, while their hospitals are falling apart, doctors live in poverty, and patients pay not only with their health insurance contributions, but also with their lives and health. This is how hospital limits were introduced. Their stated goal was to curb theft by placing limits on each individual hospital based on its previous activity. Thus, regardless of its activity and the number of patients it has treated, a hospital cannot exceed the limit set by the NHIF. This is exactly the case with St. Anna Hospital in Varna. The NHIF sets a limit, say 5 million leva, and the hospital treats patients for 6 million leva. This generates a debt of 1 million leva for the hospital, which, in the long term, puts the hospital in serious debt and makes it unable to pay salaries and suppliers. However, this scheme directly contradicts the hospital&#8217;s obligation to treat all emergency patients, not only from Varna, but also from the region. This is a right guaranteed to patients by the Constitution. Thus, the limits set by the NHIF leave the hospital unable to fulfill its basic obligations without generating more and more debt. And this is no exception; it is happening in many state hospitals throughout the country. At the same time, private hospitals are raking in money from the most profitable clinical pathways, while the entire social function is left to public hospitals. Privatization of profits – socialization of losses.
This paradox is, in fact, the way our healthcare system currently &#8220;works.&#8221;
But let&#8217;s get back to the District Hospital. The hospital is headed by Krasimir Petrov, hospital director and former MP of the GERB (‘Citizens for European Development of Bulgaria’ &#8211; a centre-right political party), who has been in charge of the hospital for nearly 20 years. While the hospital is falling apart and medical staff salaries are shrinking, Petrov is amassing a fortune and, in the meantime, has managed to indulge in aggressive tourism, receiving an award for being the first Bulgarian to visit all UN member states. But the problem here is not the individual, but the system that concentrates power in his hands. A key element of the aforementioned market reform in healthcare was giving the director absolute power over the distribution of salaries in the hospital. Thus, although operating with public funds and in the public interest, hospitals are managed as private companies, and the director is given full ownership powers. Concentrating enormous financial resources in the hands of one person is naturally a recipe for corruption, and we see its effects in all state hospitals—millionaire directors and miserable salaries for medical staff. At the same time, workers have no control over their remuneration and are left entirely at the mercy of the director. Even the formal mechanisms at the state level do not function. No national collective labor agreement in the healthcare sector has been signed since 2022. Due to pressure from protests by young doctors and nurses, the government was forced to accept an increase in basic salaries, with the minimum set at €1,550 for nurses and €1,860 for young doctors. Due to the lack of a working mechanism for setting minimum wages in the sector, such as a collective labor agreement, the government included these minimum rates in an unusual place in the fall of 2025 &#8211; the National Health Insurance Fund budget law. In any case, where exactly the wage increases were included is irrelevant, as following protests by the PPDB (‘We Continue the Change’ &#8211; electoral coalition) and industrial capital, the budget was withdrawn, and with it the planned wage increases. As a result, healthcare workers were left without any salary regulations – no collective bargaining agreement, no budget. In practice, this means that the director can easily keep healthcare professionals on the minimum wage, as we are already seeing happen not only in Varna.
So, faced with a collapsing healthcare system and without any institutional protections, what can workers like Anna do, and what can we all do as patients to save what remains of our public healthcare system?
The problems in the healthcare system are fundamental and require urgent and radical reform – abolishing the commercial status of hospitals and protecting their social function. Our hospitals are not businesses, our health is not a commodity! Abolish the corrupt system of clinical pathways and guarantee fixed and decent wages for healthcare workers. Doctors should not be forced to rely on schemes or handouts from corrupt directors. Nurses should not be forced to work three jobs. Limit the sole power of the director. Healthcare professionals must have a say in the management of the hospital and the allocation of funds. But in order to exercise this right, healthcare workers must be organized. We see that traditional unions are useless for this purpose. Medical professionals face the challenge of creating their own organization, in a way that suits their conditions, which is capable of changing the balance of power in the hospital and effectively representing their interests. Individually, each worker is weak. When united, they are an unstoppable force.
Redirecting all public resources to public healthcare. We must stop financing the profits of private hospital owners with our salaries.
This list could go on. Of course, this reform is far beyond the power of the workers at the district hospital and the residents of Varna who support them. But there are measures that are within our power and that we must insist on – now! First – an increase in the minimum salaries of young doctors and nurses at the District Hospital to the minimum provided for in the NHIF budget – €1,550 for nurses and €1,860 for doctors. There are now rumors in the hospital that nurses&#8217; salaries will be increased to&#8230; €1,000. This is grossly insufficient and will in no way stop the exodus of staff from the hospital. We also hear the same mantra from the leadership of the Bulgarian Medical Association (BMA) and the director of the District Hospital that the solution to all problems is&#8230; to increase the prices of clinical pathways. Every time the disaster in Bulgarian healthcare hits the news, the same healthcare lobbyists come out with the same prescription: give us more money. But in fact, there is no guarantee that the money for clinical pathways will reach where it is most needed – for the salaries of doctors and nurses. Much of this money will sink into the pockets of those who have the sole power to distribute it – the directors.
It is precisely the distribution of money from clinical pathways that is at the heart of the corruption model in Bulgarian healthcare, and pouring more money into this mill will lead to the same results as before. Therefore, the only way to address the problems is with a fixed increase in the basic salaries of medical professionals. Everything else is just smoke and mirrors for workers and bonuses for healthcare profiteers.
Second – organizing medical professionals at St. Anna Hospital. And here we are not talking about dysfunctional state-controlled unions, but an organization of all hospital workers, beyond professional and union divisions. Only with such an organization will hospital workers be able to effectively defend their interests, which coincide with the interests of all residents of Varna—to have a regional hospital where medical workers receive decent salaries and working conditions.
Due to public and media interest, it is very likely that the state or the municipality will provide a financial injection to the hospital. The inclusion of worker representatives in the distribution of funds is the only guarantee that these funds will not be yet another patch used to temporarily appease discontent until the next crisis. Neither social assistance from the ministry or the municipality, nor an increase in clinical pathways, can contribute to solving the problem. These &#8220;more of the same&#8221; measures only serve to perpetuate the corrupt model of Bulgarian healthcare and benefit lobbyists from the Bulgarian Medical Association and hospital directors. We should not believe the promises of politicians who are currently in the election race and are more than generous with their promises. They do not want to change the model because some of them benefit from it. They cannot change it because they are dependent on the healthcare lobbies. But they also do not know how, because they are incompetent. And above all because they are all united by the market ideology that society should be run like a business. The only ones who can initiate real change in healthcare are the same ones who can and will save the district hospital, namely the doctors, nurses, and orderlies who work there, with the support of the patients who finance the hospital—the residents of Varna. The time is now.

The collapse of the Regional Hospital – Report from Varna, Bulgaria

We spoke to fellow health workers in Sao Paulo about their initiative to defend public access to health services and good conditions for workers and patients. You can follow the activities of Viva SUS on Instagram: vivasus_
We are a health workers group from Sao Paulo, most of us working in mental health care. We started our group in 2022. Sao Paolo is a large city, we already had a group of health workers in the northern part of the city, which formed around a so-called ‘health reform’ introduced by the local health secretary. This legal reform for the Sao Paulo area obliged us to adhere to fixed productivity rates. The law was a kind of prototype or model that might also be applied in other regions in the future. Before the law, consultations should be no longer than 20 minutes. The reform further reduced this to 15 minutes, so four patients an hour. This means we have even less time to understand what our patient’s life is like, beyond the symptom, e.g. what their daily routine is like, what their social relationships are like, what kind of food they have access to. We organised a bigger meeting to discuss the reform and around 100 workers attended. From this initial meeting smaller local groups formed. 
The public health system
There are some particularities regarding the health system of Brazil. The public health system, called SUS, was established with the national constitution of 1988, after the end of the military dictatorship. During the struggle against the dictatorship in the 1980s many independent health initiatives developed in industrial and working class areas. In 1988 these initiatives were institutionalised in the SUS. But actually, this health system was never really implemented nationally, its implementation depends on municipal or city laws. We have three governmental levels in Brazil: cities, states and federal government. In Sao Paulo, Brazil’s largest city, the SUS is actually not public, it is primarily run by so-called ‘non-profit’ or third-party organisations that get a lot of money. These third-party organisations have been set up by private corporations to get contracts from the public health system. Other organisations were initially set up by medical professional associations and the university of medicine, but they also have turned into important private players. This process of privatisation is also supported by the Lula government. Another aspect is that if you use services of the SUS with a private health insurance cover, which only richer people have, the money that is paid for the treatment by the insurance is supposed to stay within the SUS. But actually, all this money goes into the pockets of the third-party organisations. The Lula government now says that if you don’t pay the insurance money into the public system, then at least provide additional services, such as examinations or surgeries. We fear that this is an even more obvious form of privatisation than the establishment of the third-party organisations themselves. 
The outsourced sector
In our area there are four or five major organisations and they employ more than 80% of all health workers. Only a few public hospitals are left that are owned by the city. These are the only workplaces where the unions are still present, but due to their minoritarian position within the wider health sector they have lost influence. They continue their symbolic protests or appeals to the law makers, but this type of struggle doesn’t work anymore. In contrast, nearly all primary health care in Sao Paulo is run through third-party organisations. We have more than 600 primary health care units in Sao Paulo alone. These organisations have become majoritarian in the health system from about 2012. From 2012 onwards vacancies for civil servants in the local public health care administration have not been filled anymore. This means that there is no municipal public body that would organise or plan local public health. All this is left to these allegedly non-profit organisations in collaboration with the governing political parties. They control the health system. This opens the door for the intensification of corruption. In terms of numbers, the largest of these organisations in Sao Paulo is paid nearly 1 billion USD every year. The disastrous state management during the COVID pandemic demonstrated to which extent public administration and the integration of health services had been undermined by this process. Health workers don’t see themselves as public sector workers anymore, but as employees of individual corporations. Or they see themselves and fight only as an individual profession, like the doctors. This makes it more difficult to create a unity, also because the labour contracts with the organizations are precarious and workers can be fired relatively easily, as they are not covered by the CLT (Consolidated Labour Laws).
The current &#8216;productivity reform&#8217;
The recent law concerning productivity targets created a lot of anger amongst health workers, but it was difficult to turn that anger into organised resistance. On paper the SUS gives workers and the wider population a lot of rights of participating in the decision making process, but in reality these rights don’t exist. The mayor and the owners of the organisations decide. The reform doesn’t specify any ‘positive’ parameters, for example, the reduction of child mortality or the reduction of certain illnesses in the area &#8211; they just create productivity parameters for each category of treatment. Time is allocated only for direct treatments, not, for example, for conversations within your team how to organise and improve care. The logic is not anymore one of prevention of disease, but of productivity management. There is no logic of universal free health care anymore, but a business logic. There are no parameters for the organisations or the governing bodies themselves, e.g. you have to provide x number of doctors for a population of size y. The parameters of the reform just target the workers. All governments support this attack, the right wing government in Sao Paulo city, but also the left wing government of the federal system.
The resistance
At the beginning, at the first meetings to discuss the new laws, there were many workers and patients. The majority of workers are from these multi professional teams like physiotherapist psychologists, occupational therapists, some are doctors. Initially we were very much focussed on addressing the institutions, e.g. we organised a meeting with the mayor about the new law. We wrote a lot of letters. All this was not effective and it was very frustrating for us. We referred to legal rights, but nothing happens if we don&#8217;t have political power to implement or enforce them. People who referred to their constitutional rights were actually fired. So then we started to turn around and look for another way of acting. We put the word out on social media, and we start to go to areas where there are other forms of movements, struggles or initiatives happening, mainly in the neighbourhoods. For example, we linked up with an initiative to defend access to a local accident and emergency department that was threatened with closure. We went on protest marches with them and joined meetings primarily with local women and children. We are also in touch with other independent groups that focus on workers’ struggles in other sectors, for example in public transport and education. These public services are also affected by the proliferation of these third-sector organisations, as a means of privatisation. The unions there are still stronger than in the health sector. We organised two wider assemblies for workers and the local population, where we talked about the logic of public health and the current attack on it. We explained our idea that everyone should be hired by the municipality directly. We are still at the beginning of our struggle, we haven’t built the power yet, for a strike for example. 
There was a public health workers strike in Rio de Janeiro recently, but it happened because the city wasn&#8217;t paying them. It was a defensive struggle, it was not about the logic of our work. So we are getting paid. In Campinas, the mental health workers went on strike, too, after the local government wanted to shift work from a cooperative to a private business. It was a powerful movement because it wasn&#8217;t just about nonpayment of wages. It was a struggle to maintain the logic of public health. In Sao Paulo, we don&#8217;t have this kind of power and union between workers yet. We are still building that power. We are producing a magazine that promotes self-organization and self-defense. We spread them in health clinics. We propose that workers make public the situation they are facing. People are angry, but they don’t believe that they can change something. That’s why we organise assemblies. We also go to universities and speak to medical students there, mainly psychology and physiotherapy students.
Historically the best organised group of patients in terms of resistance are mental health patients. Like in many other countries they organised struggles 50 years ago against the conditions in mental asylums, which were like prisons, and for the implementation of a public health system in the community. This was similar to the anti-psychiatric movement in Italy. Another group that organised recent protests are mothers of children with autism. They advocate for specific care for their children. Then there are movements from the LGBT community for better HIV treatment and by women groups for better access to abortion services. There are many struggles on the level of neighbourhoods for better local health provisions, which question the so-called third-party organisations. One of the big issues are lack of appointments and long waiting times. This is devastating for us as workers, too. At the end of the day, you decide who will have access to healthcare today and who will not, who will have to go home without treatment and continue living a half life. 
We are preparing for our third independent workers’ assembly and the launch of our magazine. We talk about taking back the SUS, but throughout our reflections we have concluded that it was never really ours. Perhaps we have to raise awareness, to equip ourselves, to collectivise, to organise in order to transform the system and propose access to healthcare that makes sense for society in general.
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Strike at La Paz Hospital General Emergency Department in Madrid

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