Frontline health workers have labelled the field hospital assembled in Madrid’s IFEMA event centre a “disaster.” The site is intended to provide 5,500 beds for Coronavirus patients, easing the burden on Madrid hospitals during the COVID-19 pandemic.

Since opening on the 21 March, the field hospital has received 1,400 inpatients, of which 535 have since been discharged. But complaints from health professionals and unions have been steadily mounting.

Insufficient protective protocols for staff and logistical disorganisation have, it seems, plagued the set-up from its inception.

On Sunday, a section of the hospital known as Hall 5 was forced to close for failing to comply with sanitary requirements. Some 200 COVID-19 patients were displaced, while health workers warned of refusing to continue working in overcrowded conditions feared to favour the spread of the COVID-19 virus.

Sanitary standards were well below acceptable in Hall 5, where there were “barely two steps between the beds [and] one bathroom for all the patients,” a health worker told El País. “They hadn’t showered for 13 days until they installed a shower on Friday.” Another IFEMA nurse added that there was “more chance of infection than being cured,” calling the set-up “a disaster.”

Professionals across the board – from nurses to administrative personnel – have forcefully criticised those running the IFEMA site for outright failure to comply with personal protection protocols designed to safeguard medical professionals dealing with the COVID-19 pandemic.

A video published by El País shows an IFEMA health worker describing the woeful lack of personal protective equipment (PPE). Gesturing to her makeshift get-up, she says “this is what we have right now as protection, there isn’t anything apart from [plastic] bags on our heads, aprons, bags on our feet, masks – these were the last ones that we have to keep for as long as we’re coming here because there aren’t any more.”

Having to suit up in whatever PPE-like items are available – plastic bags, mostly – has generated, according to the same health worker, “the feeling that [the authorities] have half abandoned us, really.”

Current IFEMA PPE supplies fall far short of the protocols implemented to try to curb the spread of COVID-19. The infection risk faced by frontline medical staff is incredibly high; effective PPE is essential to ensuring they can safeguard their own health, as well as that of other patients, their own families and the wider community, while treating COVID-positive patients.

Understandably, IFEMA volunteer medical staff have aired potential refusal to continue working in areas with high infection risk until they’re provided with adequate supplies of PPE.

The Madrid branch of CCOO – the largest trade union in Spain – has also stated it “will not permit threats directed towards professionals for refusing to work without adequate personal protective equipment in spaces with COVID-19.”

Another major issue is a lack of space on the IFEMA site, leading to overcrowding of medical staff. Nursing syndicate Enfermería Satse Madrid claimed “the changing rooms aren’t designed to accommodate the high number of healthcare professionals working every day… which leads to the possibility of infection among them.”

One complaint received by the CCOO detailed the effects of this on the ground: “They’re crowding us into waiting areas or changing rooms with the scrubs, caps and personal protective equipment which we’ve just been using to treat infected patients. There’s barely a metre of distance between one person and the next.”

In response to this mounting criticism from both healthcare professionals and their representative syndicates, Antonio Zapatero, one of the IFEMA field hospital’s medical directors, indicated that the centre is working on creating “new changing room circuits.”

The lack of logistical organisation is unfortunately mirrored on the IFEMA facility’s technical front. Sources from anti-health privatisation syndicate CAS reported that “the IT program isn’t installed and there’s no way of taking a patient’s history.”

According to CAS, confusion regarding patient status extends even further back. Patients “without a COVID-19 diagnosis” are apparently being admitted to the IFEMA site, as hospitals rush to free up capacity and struggle with a lack of testing kits.

El Mundo also quoted an IFEMA worker’s complaints that “there are no shift spreadsheets,” meaning overburdened staff aren’t being relieved, even when there are replacements ready and waiting.

According to Sheila Justo, president of specialist medical exams at the Madrid Association of Doctors and Qualified Professionals (Amyts), last Friday there were 60 trainee doctors called: “Only 10 went in to work, so 50 stayed crowded together in a waiting room.”

Failing to coordinate staff means exhaustingly disorganised shifts. One IFEMA nurse told CCOO Madrid there are two nurses for 50 patients: “It’s the third night in a row that we’re working without a break… where I am there aren’t any replacements, there are only a few of us… and the patients are in a bad way.”

Overwork and understaffing are, in these times of unprecedented crisis, taking a significant emotional toll on medical staff.

The same nurse told CCOO: “The difficult thing is not having the time to talk to [patients] even a little. There are devastating cases, like a 30-year-old patient whose father died last Saturday from COVID-19. She’s in a serious state and there are so many more cases like that.”

The CCOO has publicly criticised the authorities managing the COVID-19 crisis in Madrid, as the reality experienced by so many frontline staff differs so starkly from the official-line “propaganda” shared in the media.

Following the tumult of the weekend, ABC Madrid reported that IFEMA’s Hall 7 has now opened, providing 500 new beds. But, these will primarily take in the patients previously admitted to Hall 5, which was forced to close for failure to comply with sanitary and protective protocols.

Bruce Aylward, WHO Chief of COVID-19 Experts, also called the work undertaken to establish the IFEMA facility “extraordinary.” Aylward, who supervised set-up of the field hospital in Wuhan, China, the epicentre of the COVID-19 outbreak, recognised the more critical stakes at play on the IFEMA site. In Wuhan, “the patients were mild cases and here more complicated [cases] are being treated and that’s very difficult.”

There is no doubt that the IFEMA site is dealing with an incredibly complex, stressful situation. Yet the fleeting media boost provided by a glowing assessment from the WHO falls far from overshadowing the IFEMA site’s flaws.

Fundamentally, Madrid authorities opened a COVID-19 field hospital where, according to CCOO, working conditions for medical personnel failed to comply with all the safety measures designed to avoid infections and the spread of the virus. 

The IFEMA management recognised that problems peaked last Sunday, but denied that complaints of chaos were “generalised.” CCOO has stated Madrid authorities are “putting staff at risk and bypassing safety protocols, which will continue increasing infections in the region.”

The Madrid authorities simply cannot afford mistakes that threaten medical volunteers’ ability to treat patients. As CCOO outlined in their statement: “If the teams treating [patients] aren’t protected, these teams will become new patients, there will be large-scale reductions [in medical staff] and we won’t be able to flatten the curve.”

Based on recent CCOO data – which is lacking input from 12 hospitals in the Madrid area – there are 4,371 medical professionals already on leave. Some have tested positive for COVID-19, while others have merely come into contact with infected patients. 

The CCOO has stated that, of course, “patients will continue being treated… by professionals who are giving their all in this crisis.”

Volunteer workers will not refuse their aid unless they are absolutely forced to: as one IFEMA doctor told El País, they “came to do whatever’s required.” But, as one nurse aptly put it: “Work ethic won’t protect us and willingness won’t provide a cure.”

Frontline health workers cannot avoid constant exposure to an infectious disease that’s already caused 10,003 deaths in Spain. Nor can they evade the tremendous emotional pressures of the pandemic. But administrative chaos, failure to effectively allocate willing staff and shortages in vital PPE are fixable errors.

The Madrid authorities need to show their frontline health workers that their safety is a priority; they’re allies they cannot afford to lose in this time of need.