Spanish health workers are continuing to protest and strike against the capitalist offensive against health care. Strikes and protests have continued for over a year, and doctors, nurses and other health staff have taken separate action in regions across the country. Strikes were called in Cantabria in November, Catalonia in January, Navarra in February, and Valencia in March and April.

In Madrid, the epicentre of this struggle, strikes have proceeded intermittently since the end of last year. They culminated in a protest by half a million people in Madrid in mid-November in defence of the public health care system and against its dismantling and privatization under the right-wing Popular Party (PP) regional government of Isabel Ayuso. Organizers say 670,000 people took to the streets, one of the largest protests in Spain’s capital in decades.

Last week, hundreds of thousands joined a new rally in support of doctors and in defence of public health. According to the organisers, 1 million people were present, while the government claimed 250,000 joined. A petition with 50,000 signatures was delivered to the ministry of health. Meanwhile, 50,000 protested in Galicia’s capital, Santiago de Compostela, and 11,000 in Burgos.

It is part of the emerging revolutionary crisis, as the ruling class privatises, dismantles and sacks thousands of health workers, while providing trillions of euros in bank bailouts and military spending on NATO’s war on Russia in Ukraine.

Madrid’s 5,000 physicians and doctors have staged weekly walkouts since November and are currently on an indefinite strike. They say they are unable to provide adequate care under current expectations to see 60-70 patients a day. They are demanding at least 10 minutes to see each patient in general medicine, and at least 15 minutes for pediatric patients.

Madrid’s physicians have now been joined by hospital workers who are calling for a two-day strike on March 1 and 2. In the region of Aragon, the medical unions have called a strike for March 31. In Navarre, a strike by nurses and physiotherapists has been called for February 28.

Health workers are in a very powerful position. There are over 1.1 million health care workers in Spain. The country’s public health care is immensely popular among workers who depend on it for their care of their children, the elderly and themselves. Moreover, health workers were widely hailed for their enormous sacrifices in the ongoing struggle against the COVID-19 pandemic, which claimed over 160,000 lives and continues to kill dozens of people every week in Spain.

The Madrid health strike is part of an escalating conflict between the entire working class and the political establishment across Europe. However, to achieve its aims it cannot be won based upon a bankrupt and unrealistic perspective of pressuring the Ayuso government in Madrid; appeals to the PSOE-Podemos; or partial one day or indefinite strikes called by the union bureaucracies.

The Ayuso regional government has made clear that it will not respond to mass protests by changing policy. Instead, it is escalating repression. Directly attacking doctors’ freedom of speech, her government ordered random inspections to ensure doctors were not collecting signatures or putting up posters during working hours. Ayuso tried and failed to break the strike by requiring a “minimum services” requirement by health workers during the strike, of 50 to 100 percent of normal workloads.

Appeals to the PSOE and Podemos, who rule at the national level and in some regions where health workers are in struggle—such as Valencia, Aragon, Castile-La Mancha—are also a dead end. A counter-offensive demands a political and organisational struggle against the PSOE-Podemos government which colludes with the PP in their attacks.

Like Ayuso, the PSOE-Podemos government tries to break strikes using minimum services laws, particularly against airline workers and is preparing other repressive measures to block strikes.

In fact, the PSOE-Podemos government and Ayuso work together on anti-worker policies. In autumn 2020, they worked together to implement a murderous Covid-19 policy, with the PSOE-Podemos threatening to deploy 7,500 soldiers against protests of Ayuso’s order limiting lockdowns to only the working class districts of Madrid. The order, worked out between the Madrid regional and the PSOE-Podemos national government, required workers and youth to continue reporting to work and school. It imposed lockdowns only in working class suburbs.

The PSOE-Podemos is handing over billions of euros in state funds from the EU “Next Generation” bailouts to corporations and banks, while diverting the historic amount of €27 billion to the Spanish military. It has provided millions of euros in offensive military, including tanks and ammunition to the right-wing Kiev regime in NATO’s war against Russia in the Ukraine, while claiming there is no money for the public healthcare system.

Imperialist war abroad has gone hand in hand with class war at home. Last year, the PSOE-Podemos government deployed armoured vehicles against striking metalworkers, thousands of police to protect the NATO summit in Madrid last June and 23,000 police against the three-week nationwide truck drivers’ strike. It was the largest police deployment and scabbing operation against a strike ever in Spain.

Workers cannot rely on the union bureaucracy, which acts as the labour police of the ruling class. The systematic attacks on public health care over the past decades, have only been possible with the active collusion of the bureaucracy. Both medical and nursing unions and national union confederations like CCOO, UGT, CSIF or CGT have looked the other way for years without raising any real opposition.

Now, they are systematically sabotaging the struggle. The medical unions grouped in the State Confederation of Medical Unions (CESM) have refused to unify the different strikes carried out in various regions. They thus avoid a broader mobilization, cutting health workers off from their colleagues across Spain and Europe, and more broadly from the escalating strike movement in the European and international working class.

Even within the same union, they have called strikes on different dates. Within the same region, the unions have also worked to isolate different sections of healthcare workers in struggle. In Madrid, primary care and emergency doctors held separate strikes on different dates.

Besides maintaining this strategy of dispersing strikes on different regions and dates, wherever possible, the union bureaucracies shut them down after imposing agreements with the different regional governments that betray health workers’ demands. In Madrid, the Amyts doctors’ union watered down its demands last week, calling for a €400 pay increase instead of €479.77.

The struggle cannot be left in the hands of the bureaucracies, and the way forward is for workers to form democratically elected, rank-and-file committees in their workplaces, independent of the trade union bureaucracies. The critical question is to unify the growing wave of struggles across Spain and Europe into a movement to stop the mounting attacks on the working class and the rapid escalation of war.

Workers must respond to the policy of war and austerity of the ruling class by mounting a struggle against capitalism, against war and for socialism. They must organise themselves into independent rank-and-file committees, democratically elected, to unify the growing wave of struggles to bring down Ayuso and the PSOE-Podemos government. This fight must be waged consciously as part of the growing outbreak of the class struggle in Europe and internationally against the austerity and war policies of the world’s governments, including mass protests and strikes in the UK and France and strikes in Portugal, Italy, Belgium and Greece.