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Health system mismanagement during pandemic hit most vulnerable hardest, says report

Amnesty International finds primary care in Catalonia and Spain was not prepared to deal with the SARS-CoV-2 outbreak


25 February 2021 02:25 PM


ACN | Barcelona

Women, the elderly, migrants, and patients with chronic illnesses or mental disorders have been most heavily impacted by the coronavirus pandemic in Catalonia and Spain as a whole, according to an Amnesty International report.

The mismanagement of the healthcare system, and primary care services in particular, already under strain and chronically underfunded, has compounded the effects of the SARS-CoV-2 outbreak, says the human rights organization.

"The primary care system in Spain suffered two pandemics: Covid-19 and healthcare management, which suffered from a lack of planning and funding to deal with the pandemic, leaving it between abandonment and its dismantling," reads the press release.

Spain has 0.77 primary care doctors per 1,000 inhabitants, far fewer than most other European countries, including Portugal (2.6), Ireland (1.82), the Netherlands (1.61), Austria (1.56), and France (1.42). The proportion of nurses is even smaller: 0.66 for every thousand people.

  • "For 12 years, Spain has been ignoring the recommendations of international organizations [...] urging states to strengthen primary care"

    Esteban Beltrán · Amnesty's director in Spain

"For 12 years, Spain has been ignoring the recommendations of international organizations like the World Health Organization (WHO) or the UN Special Rapporteur on the right to health, urging states to strengthen primary care by allocating 25% of healthcare funds to it," said Amnesty’s director in Spain, Esteban Beltrán. 

Rather than complying with advice to boost primary care funding, Spain has reduced it by 13% from 2009 to 2018, says Beltrán. "A year into the pandemic and with the third wave breaking contagion records, they don’t seem to have rectified," he said.    

The effects of having a weak primary healthcare network were not limited to the fight against SARS-CoV-2. 

While Spain’s official death tally from the virus stood at 68,468 as of February 24, mortality figures since the pandemic started exceed the official estimates by 81,608, suggesting not only a substantial number of unreported Covid-19 deaths, but also of people with other health complications who may have possibly survived had the healthcare system not been under pressure.

"We’re seeing diseases that we didn’t diagnose earlier. People who were in pain and now have cancer that has metastasized. I’ve seen this recently with a woman with stomach cancer and a man with colon cancer. It’s too late," said Maria Luz, a nurse in the Catalan town of Caldes de Montbui, whose testimony is included in the report.  

69% of people suffering from chronic diseases had doctor’s appointments canceled due to the Covid-19 pandemic and only 25% of them had access to a primary care center later on.

Furthermore, women account for 75% of caregivers and have been disproportionately affected by the pandemic and subsequent "collapse" of the primary care system.


  • ICU unit at Barcelona's Hospital del Mar (by Laura Fíguls)

  • ICU unit at Barcelona's Hospital del Mar (by Laura Fíguls)