Sweden’s NATO membership a challenge for Swedes’ struggling health system [Advocacy Lab Content]

NATO’s Secretary-General, Jens Stoltenberg, says Sweden needs to increase its health capacity to respond to a crisis or war. As NATO-focused plans are prepared, cutbacks and a lack of healthcare staff could limit national preparedness.

In NATO’s treaty, members such as Sweden must be able to tackle a mass casualty event, regardless of whether the cause is a military attack on Swedish soil, or an attack on Swedish or allied troops abroad.

In a recent interview on Swedish radio Stoltenberg said Sweden needs to improve its military and civilian infrastructure, noting more investment is needed in roads, railways and the health care system.

“Sweden is a country with a developed healthcare system and can, as such, improve and increase its capacity, not least, improve its ability to operate in a crisis situation. This will mean investing more. But also extent preparedness, information and coordination, in order to be prepared in front of a crisis situation,” he said.

As the Swedish Health Minister told Euractiv, efforts are on the way to address a need for 2,300 more care beds.

Scaling up

Stoltenberg’s comment is in line with a proposal from the Swedish Defence Commission (a broad parliamentary committee), which, in a report in December last year, said Swedish healthcare needed to be strengthened in order to increase war preparedness. It suggested that some emergency hospitals across the country should be able to swiftly scale up with more staff and beds.

Despite Swedish health care generally considered of high quality, the ambitions of preparedness seem to clash with today’s reality. Many Swedish regions struggle with financial deficits, while more than 6,000 hospital staff in Sweden risk losing their jobs in 2024.

Even in peacetime, there are shortages of intensive care beds, which are much needed if major casualties occur. Some regional hospitals’ emergency care centres have had to close, or will close soon, due to a lack of funding. The latest example is the internal medicine emergency clinic in Köping.

A year ago, the Swedish Medical Association and two other unions wrote in a debate article that: “We must speak clearly about what NATO membership requires of the healthcare system.”

Regions barely cope in peacetime

Swedish regions, they claimed, “can barely cope with the task in peacetime,” and called for a rapid increase in war preparedness, more state governance and more training in disaster medicine.

“Work is underway to strengthen capacity, but healthcare preparedness is currently anything but good,” Sofia Rydgren Stale, the chair of the Swedish Medical Association (the doctor’s union), told Euractiv.

According to Rydgren Stale, “Sweden does not fulfil the requirements set by NATO.”

“The main reason is a lack of personnel, which is now being exacerbated by cutbacks in many regions. Large parts of the Swedish healthcare system go into staffing mode every year during the industrial holidays. I think this says a lot about our capacity to cope with major crises,” she explains.

“There is no doubt that we need to invest more in healthcare. It is the regular healthcare system that will take care of both civilian and military healthcare needs in the event of a mass casualty incident,” she said.

Investing €435 million this year

When asked by Euractiv about the NATO chief’s statement, the Swedish Health Minister Acko Ankarberg Johansson replied that the government would spend SEK 5 billion (€435 million) this year to improve the health capacity and create more care beds.

“On top of that, we added another SEK 6 billion (€522 million) recently to maintain capacity due to inflation, so this work is ongoing. Last summer, the Swedish Board of Health and Welfare reported a need for 2,300 more care bed, so that is something we are trying to achieve ahead and also will readdress in next autumn’s budget,” she told Euractiv.

She also noted that the government has given many assignments to Swedish authorities regarding how to handle a mass causality event, including a commission to the National Board of Health and Welfare to implement a Nordic cooperation project on mass causality management.

Johan von Schreeb, a well-known Swedish surgeon, professor in disaster medicine and director of the Centrum for health crises at the Karolinska Institutet in Solna, close to Stockholm, tells Euractiv that the current situation, where, for example, local hospitals are being closed, emergency trauma care needs to be reconsidered.

Trauma care has to be readily available

“In the event of a crisis or an attack, a basic demand is that we have widespread hospitals that can perform trauma surgery. That is not something to be invented from nothing in a crisis; these must be readily available even in peacetime and scaled up in case of mass casualties,” he said.

Today, Sweden has the capacity at certain, but not at all hospitals, to manage a mass casualty attack, like a terrorist attack, he said.

“But what we see in Ukraine is a war of attrition which has been going on for two years, and that is something completely different from a terrorist attack.”

Sweden now needs to train staff to work with limited resources and develop a health system, resilient in managing trauma and conflict injuries, according to Johan von Schreeb.

On 26 April the Swedish Defence Commission presents its final report on the defence policy for the next five years. After that, this autumn the Swedish Parliament will take its first huge defence policy decision as a NATO member.

[By Monica Kleja, edited by Vasiliki Angouridi, Brian Maguire | Euractiv’s Advocacy Lab]

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