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REYKJAVIK, Iceland — In the halls of Landspítali, the larger of Iceland’s two major hospitals, the sense of exhaustion is palpable. The emergency wing is supposed to have at least 10 nurses on each shift. But for three weeks in late May and early June, the ER had to make do with just eight. “Of course, you’re just very tired,” said Hrönn Stefansdottir, one of the nurses at Landspítali. “I’m working now for 33 hours this weekend, and for the last three days there’s been this little tightness in my stomach, just wondering how it’s going to be.”
The sudden crunch was the result of a work stoppage organized by thousands of members of Iceland’s nurses’ union, to protest low wages and a health care system that is already buckling under the weight of budget cuts and a nationwide brain drain. For many nurses working inside the small country’s hospitals and clinics, it feels like the whole system is decaying.
“I think the nurses have waited for too long to put our foot down. Because that’s our nature, to help people,” said Björg Thorhallsdottir, a part-time classical singer and part-time nurse who has joined the strike. “And we had done it for so long, just running faster, working harder, until we had passed the limit of what’s safe.”
Parliament brought the June strike to an end with legislation compelling the nurses to return to work. But work stoppages aren’t the only way that Icelandic medical professionals have been registering their discontent. Dozens have resigned in the aftermath of the strike, including an entire shift of nurses in Landspítali's Intensive Care Unit, according to local press accounts, and nearly half of the nurses in the cardiothoracic surgery department.Many others have been leaving the country for better paying jobs abroad, joining a wave of health care workers from Iceland who have packed their bags and left the country in search of better pay.
Margrèt Gudmundsdottir, 26, has only been a nurse for five months but she's already applying for a work visa in Edinburgh, Scotland. “I'm young, I don't have any children, and I'm not liking the environment and the payment here,” she said. “So I'm going.”
As with so many things, the trouble for Iceland’s hospitals began after the 2008 financial collapse. Funding for Landspítali, when adjusted for inflation, dropped by nearly half between 2007 and 2009; while it has since begun to increase again, it has not yet reached its pre-crisis levels.
The budget cuts had an immediate effect on nurses’ wages. Although they had risen by 8.6 percent between 2005 and 2008 according to the OECD, they only went up by 0.2 percent between 2008 and 2011 — an effective cut when inflation is factored in. Workers in many other industries experienced the same cuts, which is why in recent months Iceland has been deluged by one wave after another of labor strikes from workers demanding sharp pay increases.
Doctors affiliated with the Icelandic Medical Association led the charge in late 2014; by striking, they successfully pressured the government into awarding them pay increases of 20 percent or more.
In part because Iceland is such a small country — the total population is about 320,000, or half the size of Boston — doctors typically go abroad to complete their residency. The difference now is fewer of those doctors are coming back. A 2013 poll of students at University of Iceland’s medical school — including those studying to be doctors, nurses, and radiologists — found that roughly half were thinking of seeking work abroad.
Icelandic Medical Association president Thorbjörn Jónsson told Al Jazeera over email that his union hoped a wage increase would prevent more attrition in the ranks. “The number of doctors had declined by about 10 percent in Iceland in recent years, and such a situation would be intolerable in the long run,” he said. “Higher wages should ensure better staffing and quality in the health care system.”
Hospitals abroad, sensing the discontent among Icelandic health care workers, have worked at luring them away.
Last year, Norwegian recruiters somehow obtained the phone numbers of nurses working at Landspítali and began sending text messages inviting them to apply for better-paying nursing jobs in Norway. According to Stefansdottir, some Landspítali nurses received texts from the Norwegians on a daily basis.
Iceland lags behind its Scandinavian neighbors when it comes to wages across most industries, and health care is no exception. As of 2014, the average Icelandic worker in the “human health and social work activities” sector earns a little under $32,000 per year according to data from the government agency Statistics Iceland. In contrast, the average Norwegian worker working in what Statistics Norway calls “health enterprises” collects upwards of $60,500 annually. The average registered nurse in the United States makes an annual salary of more than $65,000 according to the U.S. Bureau of Labor Statistics.
Not every nurse is willing to abandon Iceland. Stefansdottir, who lived in the United States for seven years before returning to Reykjavik, said she and many of her colleagues feel personally invested in the success of their nation’s health infrastructure. “I think most people who work for Landspítali, they want to build it up,” she said. “We have a lot of younger people that have been studying abroad but are coming home.”
If the state of the Icelandic health care system continues to decay, several nurses expressed fears that it would eventually adopt some attributes of the American system and become more privatized. But Sveinn Magnússon, director general of Iceland’s Ministry of Welfare, told Al Jazeera, by email, “We have not seen any indicators pointing towards deterioration.”
Nurses such as Stefandottir disagree. “It’s sad,” she said. “We’re not that many. We should be able to take care of our population.”