‘Victory’ at what cost? How Covid-19 exposed cracks in France’s cherished healthcare system

A nurse at the Robert Ballanger hospital in Aulnay-sous-Bois north of Paris, among the area's hardest hit by Covid-19 in France.
A nurse at the Robert Ballanger hospital in Aulnay-sous-Bois north of Paris, among the area's hardest hit by Covid-19 in France. © Gonzalo Fuentes, REUTERS

Days after French President Emmanuel Macron declared a “first victory” in the country’s battle against Covid-19, health workers protesting in cities across France told a very different tale of a crisis that has rattled a healthcare system long touted as the world's best.

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Anne-Sophie has had to swallow many bitter pills over the past three months, but there is one that still sticks in her throat: She cannot accept the government’s flattering assessment of its own response to the coronavirus pandemic.

“The French people are not being told the truth,” said the 42-year-old head nurse at a care home for the elderly east of Paris, who declined to give her full name. “It is simply not true to pretend we were not overwhelmed.”

France’s nursing homes account for more than a third of the nearly 30,000 fatalities attributed to Covid-19 in France  the world’s fifth-highest confirmed death toll. Despite government claims that French hospitals “coped” with the pandemic, there has been ample evidence of emergency rooms turning away elderly patients for want of beds.

“Those who made it to hospital were saved. But eight of our residents were turned away and five of them died,” she told FRANCE 24. “It’s a failure in our duty to help those in danger.”

Anne-Sophie’s tale of the crisis mirrors the accounts that have emerged from hundreds of care homes across the country: a skeleton staff, a desperate shortage of protective gear, infections spreading like wildfire and residents dying in solitude, their families kept at bay.

The head nurse was among thousands of health workers who gathered in central Paris on Tuesday to vent their anger at decades of budget cuts that have weakened a public health system once touted as the envy of the world. Thousands more rallied in cities across France, determined to turn the broad public sympathy enjoyed during the pandemic into tangible advances for hospital and nursing home employees  those Macron has lauded as "heroes in white coats".

“We’ve long known that our health system is no longer the world’s best  that’s just a slogan for the government,” said Bruno Franceschi, an emergency room nurse at the Hôpital Bicêtre south of Paris. “We’ve been saying for years that our hospitals are chronically ill.”

"The silver lining from this crisis is that, now, the French public knows it too.” 

Parliament grilling

Tuesday’s protest came two days after Macron heaped praise on France’s health workers and defended his own record in handling the crisis during a televised address to the nation that critics decried as “an exercise in vindication”.

A short distance from the rally, behind row after row of police officers in riot gear, French lawmakers in the National Assembly began carrying out their own assessment of the country’s pandemic response, a process that will see them quiz top officials, ministers and their advisers over the next six months to shed light on the state’s possible “failings”. 

Opposition parties had placed high hopes in the cross-party inquiry, keen to earn some political dividend from the particularly acute criticism France’s government has faced compared to many other administrations. On Tuesday, the panel of 32 lawmakers began by questioning Jérôme Salomon, the director-general of French health services, whose daily briefings made him one of the public faces of the pandemic in France.

Salomon had warned Macron that France was unprepared for a pandemic when serving as his adviser during the 2017 presidential campaign. But he steadfastly denied any shortcomings by the government in its response to the crisis, which he hailed as “extremely rapid”.

Grilled on the hot-button issue of masks, Salomon blamed past administrations for the crippling shortage. Asked why the government initially said the public need not wear masks, he said this was in line with World Health Organization recommendations. Challenged on the lack of testing, he suggested the French were reluctant to be tested  conceding only that “perhaps we could have been more didactic”.

On four occasions Salomon was asked whether he had any regrets and each time he sidestepped the question, repeating instead that the “unprecedented, massive, rapid, brutal and global” crisis had simply caught everyone off guard. 

“He answers nothing and evades every question,” raged one lawmaker taking part in the inquiry, according to French daily Le Monde. “We still don’t know in what areas [Salomon] thinks France wasn’t ready, nor what he did to prepare the country.”

From ready to unready

The astonishing lack of preparedness with which France and other Western countries weathered the coronavirus storm has been widely documented, with experts noting that the lessons of past epidemics  such as SARS and the H5N1 bird flu  had been largely forgotten.

Last month, an investigation by Le Monde uncovered the extraordinary chain of events that led successive French governments to build an ambitious pandemic response strategy and then dismantle it almost entirely, leaving the country to face the novel coronavirus "disarmed".

Addressing senators on March 19, three days into a nationwide lockdown ordered to stem the spread of Covid-19, Health Minister Olivier Véran summed up the bewildering haemorrhage of equipment that had left France so desperately exposed.

“In 2010, the state had a stock of one billion surgical masks,” he said. “When I took over at the ministry, there were 150 million.”

As he spoke, and in the months preceding the crisis, millions of masks were simply being torched, based on the assumption that they had expired or were ineffective.

The result of this stunning fiasco is well known: a desperate shortage of protection for even frontline workers, a frantic – and costly – race to fly in masks from China, and a belated effort to revive a national production capacity that had been abandoned in recent years. 

From emergency rooms to courtrooms

Two days before Véran’s Senate hearing, his predecessor Agnès Buzyn spoke candidly about the extraordinary twist that had seen her plucked out of the ministry a month earlier, despite the worsening outbreak, to lead Macron’s party in Paris mayoral elections.  

“I knew the tsunami wave was coming for us. (...) We should have stopped the elections, it was a travesty,” she said, referring to the government’s controversial decision to go ahead with the first round of municipal elections on March 15, despite the fast-spreading outbreak. 

That decision is one of several grievances that are being carried to French courts this week, with a range of complaints targeting Salomon, his ministry, the Santé Publique France health agency and France’s prisons administration, among others. 

Mayoral candidate Chafia Zehmoul, from the Lyon area, was the first to sue the French state for failing to inform the public of the dangers of campaigning.

“I shook hands and hugged people throughout the campaign, then after the vote I lost touch with several members of my team,” she recalled in an interview with FRANCE 24. “I later found out they had been taken to hospital. Two have died and another two of their relatives have perished too. I was shocked.”

On Tuesday, the Paris chief prosecutor said he had opened a probe into the French state's handling of the coronavirus outbreak, with possible charges including "involuntary homicide" and "endangering life".

The preliminary investigation is not aimed at determining "political or administrative responsibility," Prosecutor Remy Heitz told AFP, but whether national decision-makers had committed "possible criminal offences".

Macron, as head of state, has immunity from prosecution and is not a target of the inquiry, nor are government ministers who can be held accountable only by the Court of Justice of the Republic (CJR), an administrative tribunal, which has itself received 80 complaints.

Plaintiffs who have taken their case to the CJR include a group of general practitioners (GPs), known as the Collectif C19, who accuse Health Minister Véran of breaking a promise to equip all health workers with the more protective FFP2 masks. According to the French Order of Doctors, which does not include hospital workers, some 30 GPs have died in France after contracting Covid-19.

Another group, dubbed Collectif Inter-Blocs, has filed a complaint against 32 French hospitals for failing to equip frontline staff with FFP2 masks, leaving them with less protective surgical masks instead.

Hospital beds, not medals

The failure to provide France’s Covid-19 “heroes” with adequate protection was a recurrent theme at Tuesday’s protest in Paris, where some health workers recalled having to beg dental surgeries, chemical labs and cosmetics factories to donate blouses, gloves and other equipment.

“They put our lives in danger and consequently those of our patients too,” said 28-year-old Inès, a nurse at a dialysis clinic in Paris. “The government must be held accountable for this.”

Though her clinic was relatively spared, Inès stressed the knock-on effects of the crisis throughout the health system, including “surgeries cancelled, beds requisitioned, transplants postponed and nurses dragged out of retirement”.

Like many other protesters, she said the pandemic had merely exposed chronic vulnerabilities that health workers have long denounced  and which are turning more and more people away from the profession.

“We rely on China for our masks, America for our thermometers and rubbish-bag manufacturers for our makeshift blouses  and all went missing,” said Céline Philippard, a care-giver at the geriatric unit of the Hôpital Paul Doumer in the hard-hit Oise department, north of Paris.

“When it came to saving lives, patients were sorted; we were told there would be no room for those from our unit,” she added. “It’s inhuman, it’s unthinkable.”

Tuesday's protest marked the climax of a series of demonstrations in favour of hospitals in recent weeks. It was designed to heighten the pressure on the government as it leads broad consultations on healthcare reform.

Macron’s government has promised to invest massively in French hospitals. But no figures have been put on the table so far, including on the contentious issue of health workers’ salaries, which rank among the lowest in the Western world and have steadily decreased over the years relative to inflation.

Hospital workers also want assurances that there will be no more of the hospital closures that have turned swaths of rural and suburban France into so-called “medical deserts”.

“As a result of this crisis, we finally have the attention of the government and the public,” said Anne-Sophie, the head nurse at the care home. “It’s now or never to obtain what we’ve been asking for so long.”

She and her colleagues were heartened by the presence of many people from other professions  like 41-year-old Julie Adore, an artist who had never rallied with health workers before. 

“It’s not enough to clap from our windows once a day,” she said, a reference to the daily round of applause the French gave their healthcare workers during the lockdown. “We must show our support by standing side by side with doctors and nurses. They don’t need government medals. They need beds, masks and money.”

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