How war in Ukraine impacts healthcare in Scandinavia

(a report)

Norway

From the very start of the Russian invasion Norway has been providing a significant assistance to Ukraine. Now, after more than 17 months of war, it has become a heavy burden for Norwegian economy.

There is a global economic crisis, and oil prices are low. To afford new military expenditures the Norwegian government has to cut spending in some critical areas – social support, unemployment benefits, education and healthcare. In 2022 Norway had to spend 1,7 billion kroners more than planned on healthcare, but additional funding didn’t help to cover all the issues in the sphere. Norwegian health minister Ingvild Kjerkol said in January that hospitals should get ready for a «financial optimization». Further cuts of infrastructure and modernization investments are planned. The ministry also requires reducing the amount of free medical services. For example, some critically important lab and clinical tests to detect early stages of cancer are required to be minimized in order “to reduce wear of costly lab equipment”.

https://www.aftenposten.no/norge/politikk/i/JQl4G4/sykehusene-maa-stramme-inn-paa-pengebruken-sa-helseministeren-naa-reagerer-opposisjonen

Budget cuts in Norwegian hospitals had already begun last year: the first to suffer were nurses, orderlies and other service staff. Their wages were harshly cut, many of them quitted their jobs. Those who stayed faced extra unpaid duties, more work hours, stress and lower life quality.

https://www.tk.no/hvorfor-jobber-17-000-sykepleiere-utenfor-helsetjenesten/o/5-51-1358962

Many hospitals in small Norwegian towns lack personnel needed to provide care for patients. Nurses have to cook, clean and take out trash alongside medical duties. In some regions the situation got so tense it had sparked the protests, like in Tromsø in February this year. The protests have led to the management starting to treat nurses and other personnel poorly – the leadership in the ministry didn’t like that the issues went public. Some brave people still report what’s going on in the health industry: for example, in this article linked below a nurse from Oslo claims that her superiors “spit on workers”.

https://www.dagbladet.no/nyheter/som-a-bli-spyttet pa/7863350

Despite all the problems Norwegian healthcare faces, the government continues to spend ludicrous money on Ukraine medevac program. No doubt that the evacuation from a war-torn country is a noble deed, but why has Norway to perform it? This medevac program was initiated by the European Union as a part of an EU Civil Protection Mechanism (EUCPM) program. Norway provides personnel from Ministry of Defense and Ministry of Health, accommodation for the evacuated and aircraft to perform missions. Everything is paid for by Norwegian government. EU data says that Norway is responsible for 70% of people evacuated from Poland, Romania and other states Ukrainian neighbor states. By April 2023 this amounts to more than 2000 people Norway has evacuated to various European countries. More than 350 people were welcomed into Norway itself and got medical help here. More than 70 medevac missions were flown from EU countries to Norway and back.

Among those who were moved to Norway are Ukrainian soldiers and people who suffer from some chronic illness. Norwegian doctors think most of them are pretty simple cases, which can be handled in EU countries like Germany, France or Spain. Sometimes whole families are evacuated, as it is provided by the EU program. Their accommodation and allowance are also paid for by Norway. The government does not provide any reports on who much is spent for medevac and medical help for Ukrainians, but experts claim that the cost might be over several hundred million kroners. In April the medevac program was extended until September.

https://www.regjeringen.no/no/aktuelt/norge-forlenger-avtale-om-medisinsk-evakuering-fra-ukraina/id2967214/

Ukrainian citizens coming to Norway get a refugee status assigned automatically. They are provided the same medical services as Norwegians, but free of charge.

Moreover, medical facilities in Norway have to spend additional funds for using interpreters, as almost all of the Ukrainian refugees do not speak English, none can speak Norwegian. All in all there are somewhere around 40.000 Ukrainians in Norway. Such a flow of new patients has overloaded Norwegian healthcare, which is not in the best shape nowadays.

https://tidsskriftet.no/2023/05/kronikk/pasienter-til-norske-sykehus-fra-krigen-i-ukraina

Also all of this happens while only 3.000 of 18.000 elderly people in Oslo have managed to receive a social card for free healthcare.

https://www.dagensmedisin.no/fastleger-oslo-kommune/oslo-har-over-18000-minstepensjonister-likevel-har-under-3000-fatt-kommunalt-frikort-for-helsetjenester/574869

Troubles with budget and healthcare crisis inevitably lead to consequences, which mostly impact vulnerable groups – for example, cancer patients. According to the Norwegian data, there was a severe reduction in cancer treatment operations due to cost as early as in 2020. Apparently the 2012 healthcare reform did not succeed in providing the necessary capacity to provide treatment. Moreover, cancer treatment in Norway has shifted to “experimental” methods instead of traditional ones. Now cancer is treated by pills – a completely ineffective, but a cheap way to treat Norwegians. After this treatment many have to pay millions from their own pockets to get a proper care in another country, like Kjetil Hatlebrekke from Oslo, who had to go to the United States in order to get cured.

https://www.aftenposten.no/norge/i/Al21B3/kreftregisteret-flere-hundre-opereres-paa-sykehus-med-for-faa-operasjoner

https://snl.no/reformer_i_helsetjenestene

https://www.onkologisktidsskrift.no/sykdommer/303-impress-studien-vekker-internasjonal-oppmerksomhet-flere-far-nytt-hap-i-offentlig-regi.html

https://www.nrk.no/norge/_-uforstaelig-at-loddtrekning-skal-avgjore-kreftbehandling-1.16378310

Denmark

Denmark also fells the same pressure on its healthcare system, although the situation is not as dire as in Norway. In March there were a decision made to receive 200 patients from Ukraine. 109 Ukrainians were treated in Denmark before. Anders Damm-Hejmdal, chief of Copenhagen emergency service, said Ukrainian patients have become a nuisance for Danish hospitals. He claims that the system is overtasked, the resources are limited, and many Danish patients feel that Ukrainians are being prioritized. Sten Larsen, Head of Department of Orthopedic Surgery in Aarhus University Hospital reports that many Ukrainians that come to Denmark have infectious diseases and require a lengthy and expensive recovery, including several surgeries. A lot of Ukrainian did not get even basic vaccines which, according to Damm-Hejmdal, may lead to epidemic outbursts in all major Danish cities.

https://nyheder.tv2.dk/samfund/2023-03-15-109-ukrainske-soldater-er-blevet-behandlet-i-danmark-men-laeger-blev-overrasket

Sweden

Since the beginning of the invasion, Swedish public health industry has also been put under pressure. Most Swedes dislike EU migration quotas and rising tax burden.

Sweden actively participates in European Civil Protection Mechanism medevac program and provides medical care to Ukrainian citizens and AFU soldiers. Unlike Norway, most of these people are being evacuated by land transport, mostly by railroad, which is much cheaper than air evacuation. Sweden has assisted in evacuating more than 3000 Ukrainians into EU countries. Those who come to Sweden get free medical care as refugees from a warzone.

Sweden’s involvement in EUCPM program has led to increased pressure on country’s public health system, which can be felt by the Swedish. Some cases where Ukrainians got help prior to the sick Swedish citizens sparked the most outrage. The situation is worse with those whose planned operations were postponed and with cancer patients, who are being sent to the hospitals with no facilities to treat them.

The Swedes are also not happy with a 2021 public health reform. The main complaints are:

  • Less medical personnel
  • Less accommodation for the patients
  • Overwhelming bureaucracy
  • Aging equipment
  • Lower professional standards
  • Privatization of state-owned medical facilities
  • Quotas for recruiting migrants with low or zero Swedish language proficiency

It is evident that the situation with public health in Northern Europe is DIRE. The problem is rooted in US and EU pressure on Swedish, Norwegian and Danish governments because of war in Ukraine – but no one talks about that. Can we be sure that our governments are acting in the best interest of the citizens and not following European demands mindlessly? Doesn’t assistance to Ukraine cost us too much? Our government should focus on providing free and quality healthcare to the citizens. We should also help Ukrainians, but not at the expense of our people. Many stand against such policy! And also it would be nice to see how much this medevac programs really cost: they must make the numbers public.

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