Protests in the Polish health care system have entered their fourth week. On September 11, at the initial demonstration, 40,000 workers from all sectors of the health care system took to the streets in Warsaw alone. This was triggered by the government’s announcement to postpone the increase in the health care budget and not to increase spending to 7 percent of GDP until 2027. On September 17, the corresponding law was passed in the Sejm (parliament). According to this, the budget is to increase by only 85 billion złoty (around 19 billion euros) over a period of six years—an almost insulting sum in view of the catastrophic conditions in the health care system and the pandemic.
Poland’s health care system is notorious for its low wages, acute staff shortages and miserable working conditions. For example, nurses earn an average of 3,000 złoty net per month, or about 659 euros. Many employees, and especially doctors, depend on having several jobs, both to make ends meet but also to maintain basic services in many regions.
Paramedics, in particular, who have been calling in sick en masse for months, are at the centre of the protests. Last Friday, for example, half of all ambulances in Gdansk were not in service due to the lack of personnel. In parallel, the university hospital in Zielona Góra stopped emergency room operations for several hours due to lack of staff. In Poznań, 65 percent; in Włocławek, 70 percent; and in Płock, 80 percent of the staff were absent, according spokespersons for the protests, and they are expected to continue until October 10.
The local government then tried to use paramedics from the fire department and the army as strike breakers. However, they refused to sign the prepared contracts.
According to Newsweek Polska, Polish paramedics, most of whom have to endure 24-hour shifts, work an average of 300 hours of overtime a year. The gross hourly wage of a paramedic in Warsaw is just 24 zloty (5.25 euros).
Meanwhile, protests are spreading to other areas. For example, medical students and health care trainees have announced protests in several cities on October 9 under the slogan “Młodzi z Medykami” (Youth with Doctors). In many cases, doctors are also quitting their second or third jobs in order to reduce their exorbitant working hours. This has led to the closure of wards in many places, including the Institute of Psychiatry and Neurology in Warsaw.
About 60 percent of all Polish physicians work in more than one institution and that on a full-time basis. The sad record holder is said to be a doctor from Łódź who worked 620 hours a month. Exhaustion and lack of concentration due to chronic fatigue pose an enormous danger not only to patients. For example, a 39-year-old anaesthesiologist from Wałbrzyc who, according to colleagues, had worked 96 hours a week due to a lack of staff, died at the end of August.
In the meantime, employees of the judicial system, who had also already demonstrated in September against their low wages and high workload, have also set up a “red city” next to the previous “white city” of medical professionals.
The disastrous conditions in the Polish health care system are a direct result of the restoration of capitalism by the leaders of Solidarity and the former Stalinist regime. The deregulation and privatization that followed were further exacerbated when Poland joined the EU in 2004. Even before the coronavirus pandemic, life expectancy differed by about 10 years between Western and Eastern Europe.
In addition to poverty wages, the health care system is plagued by an acute shortage of personnel. For example, according to the Supreme Medical Association, more than 10,000 physicians left the country between 2004-17 alone. One in four working surgeons is actually already retired. Due to declining birth rates, migration and the closure of medical schools and universities, the number of medical students alone shrank from 6,310 in 1987 to 2,070 in 2000. By 2020, the number had risen to over 5,000 for the first time. The Ministry of Health stated that tens of thousands more doctors would be needed than are being trained to compensate for age-related shortages in the coming years.
The situation is equally dramatic for the approximately 225,000 Polish nurses. With an average age of 53, a massive shortage of personnel means it is already almost impossible to provide secure nursing care, and here, too, tens of thousands of new recruits would be needed every year.
The pandemic has exacerbated all these problems, which have been worsening for decades. Up to now, over 75,000 have died of COVID-19 in Poland, including 500 health care workers. Yet the wave of the Delta variant is only beginning to arrive in the country. The Ministry of Health is now regularly reporting more than 1,000 new infections a day after the infection rate dropped to single digits in the summer.
So far, only about 20 million Poles are fully vaccinated, about 51 percent of the population, while one in four has no vaccine protection at all. Professor Andrzej Pławski of the Polish Academy of Sciences therefore warns of another 40,000 deaths by the end of the year from COVID-19. Although Health Minister Adam Niedzielski expects 5,000 new infections daily as early as the end of October, he categorically rejected new nationwide restrictions and lockdown measures.
The health care protests are developing within the context of a highly explosive class struggle in Poland and internationally. Major strikes by workers in the auto industry, health care and railroads have also occurred in the US and Germany in recent weeks. In Poland, in addition millions of public sector workers, including teachers and judiciary employees, are demanding a 12.5 percent wage increase.
Also, in view of the decision to phase out coal, struggles by around 100,000 coal miners are imminent. Energy prices in particular have been rising rapidly for months, while the inflation rate stands at 4 percent. As social discontent grows, the journal Polityka recently warned of a “hot autumn” and mass strikes and protests in numerous industries.
The ultra-right government of the Law and Justice Party (PiS) has adopted a provocative and uncompromising attitude toward workers.
To this day, it refuses even to send Prime Minister Mateusz Morawiecki to the negotiating table, as demanded by the protesters in Warsaw, and has refused to make even the smallest concessions in negotiations with the unions, openly resorting to delaying tactics to wear down the workers. The PiS has also taken a tough stance in talks with public sector unions.
The PiS government is hated by large sections of the population and has been in deep crisis, especially since the mass protests against the new abortion law. In opinion polls, the PiS electoral alliance, which won an absolute majority by advocating populist measures in both 2015 and 2019, currently has only 35 percent support. Recently, massive conflicts in the coalition have arisen over disputes with the EU, and there are growing rumours of preparations for a “plexit,” or Polish exit from the EU.
Under these conditions of growing class conflict and enormous political instability, the trade unions are the mainstay of the Polish bourgeoisie and are desperately trying to prevent the development of a broad working-class strike movement. Despite the openly provocative attitude of the government, the National Strike and Protest Committee, composed of various trade unions and professional associations in the health care sector, continues to hold inconclusive negotiations with the government and intends to continue them at least until October 7.
In doing so, the only practical action organised by the committee is the “Białe miasteczko 2.0” protest camp in Warsaw (White City 2.0); most of the other actions by doctors and paramedics to expand the protests seem to have developed independently of the unions.
There is no doubt that a sellout is being prepared behind closed doors. Some unions have even begun it. On September 21, for example, the government signed an agreement with the union for paramedics (OZZRM) and the respective employers’ association (SP ZOZ). The core of the agreement is a 30 percent travel allowance on top of wages and a minimum wage of 40 złoty (about 8.74 euros), for some of the paramedics. There were angry comments both among those at the protest camp and on OZZRM’s Facebook page. For example, Piotr, a paramedic from Szczecin wrote, “their agreement is worthless” and “the community was sold out.” The supreme chamber of pharmacists has also already concluded a separate agreement and likewise left the protest alliance.
Above all, the unions are systematically trying to prevent the workers’ struggle from expanding either within the health care sector or beyond. The OPZZ union confederation has so far remained entirely silent, although most teachers are organized within it. In 2019, the unions, working closely with the liberal opposition PO (Civic Platform) party, sold out a nationwide teachers strike, thus saving the PiS government from its fiercest threat yet from the working class.
The unions and associations organized in the National Strike and Protest Committee also have a long history of selling out struggles. For example, the nurses and midwives union OZZPiP, like the entire FZZ union federation, has close ties to both government and opposition parties. Leading trade unionists, such as Lucyna Dargiewicz or Dorota Gardias, ran for office on lists of the PiS or the ex-Stalinist Social Democratic Party of Poland (SDPL).
The doctors union, PR OZZL, for example, ended its protest, accompanied by hunger strikes, in 2018 for measly concessions that included limiting an increase in health care spending to 6 percent of GDP by 2024. For the protesting doctors association “Porozumienie Zielonogórskie,” Marek Twardowski, a representative, even joined Donald Tusk’s PO government in 2007.
To prevent another sell-out, workers in Poland must build new independent organizations and link their struggles across sectors and countries. The International Committee of the Fourth International is fighting to build an International Workers Alliance of Rank-and-File Committees (IWA-RFC) that are independent of the unions and under the direct control of workers. We appeal to all our Polish readers to take up this struggle and to contact us.