The coronavirus crisis starkly highlights the true value of care work, its gendered and regionalised nature, and the scarcity of its supply in an economy which fails to recognise these factors.

On 26 March, only a couple of weeks into the introduction of border closures across the EU in attempt to contain the spread of the coronavirus, the Czech and Austrian governments have come to an agreement that Czech care workers will be able to resume commuting to Austria for work. On 30 March, based on a similar agreement, two planes have brought Romanian care workers to Vienna. These exceptions, made at a time when European governments are trying to reduce individuals’ mobility to limit the spread of the virus, highlights how crucial East-Central European (ECE) care workers are to the functioning of the health and broader care systems in core EU countries – estimates for Austria alone suggest that 80% of the care workers in the country come from East-Central Europe.

German numbers appear to be even higher and nursing associations warn that by mid-April, up to 200,000 people who need it will no longer be able to be cared for at home. The care workers who have been providing these services, the vast majority of whom come from Poland, Slovakia and other ECE states, have returned home or are unable to cross the borders closed due to the coronavirus crisis. The contingent of 75 Filipino nurses who have been recruited to meet the surge demand in professional healthcare are hardly able to provide a long-term solution, never mind the ethical implications of bringing an even cheaper, even more precarious workforce from even further afield, who may at the end of their assignment bring the disease back to their country and its weak healthcare system. At a time when the elderly most need a strong and resilient care workforce, we see that the economy which has been providing this at the expense of imported, undervalued, underpaid and predominantly female labour does not pass the test.

While they have been closing the care and health provision gap in Western EU countries for decades, migrating ECE workers have been deepening the same gapcback at home. Poland provides a stark example: it is the country with the fewest doctors per 1000 inhabitants in the EU – 2.4 (the EU average is 3.4). According to estimates, in 2015  around 10% of Polish doctors emigrated, mainly to the UK and Germany (2.9 and 4.3 doctors per 1000 inhabitants respectively). The same trend is visible with regards to the nursing profession – the average age of a nurse working in Poland is above 50 years old. East-Central Europe, where life expectancy and mortality continue to be worse than in the West, this reality spells disaster for healthcare systems should the spread of the coronavirus continue at its current rate. There are already reports that despite the region being comparatively less affected than many Western EU countries, patients with clear symptoms of respiratory distress are being denied access to hospitals, at times resulting in death. There are simply not enough staff, not enough personal protective equipment, laboratory capacity or hospital beds to meet the demand – even without an unprecedented crisis such as the one we are currently in.

A result which is a combination of factors

For instance, in Poland, subsequent governments’ low levels of public investment into healthcare, resulting in low staff pay, lack of adequate facilities and resources certainly play a central role. On the other hand, Western governments’ explicit efforts to attract a care workforce to address the needs of their ageing societies are a substantial pull factor for healthcare workers’ migration. The niche is so lucrative, that outside of Warsaw a private company has set up a campus providing doctors with intensive language and soft skills courses preparing them for jobs in the healthcare systems in Western European countries.

Some ECE governments have tried to bridge these gaps in the same way their Western neighbours do: by extracting care labour from even poorer countries. Just last year, the Polish government has introduced simplified pathways for Ukrainian doctors’ degrees to be recognised in an attempt to address the shortages within its own system. However, applying the logic of outsourcing to care labour can only be successful to a limited degree, as it endlessly replicates the same model, placing countries and social groups engaged in these exchanges into a power hierarchy based on economic and labour market capacity. The (predominantly female) care workers who migrate to fill a care gap in another country create one in their own, which in turn needs to be filled by the labour performed by another (again likely female, and certainly poorer) employee or member of their family, and so on. The care workers in such dire demand in Austria and Germany have long been closing the care gap in those countries while creating one within their own counties’ economy and in their own families. As the numbers of patients suffering from COVID-19 grows in the Czech Republic, or as extra staff are needed to look after elderly people to replace those who have been taken ill, the lack of the individuals who are crossing the border to Austria on a daily basis might begin to be felt very painfully.

Also a gender issue

The coronavirus crisis makes plainly obvious the futility of measuring gender equality by official employment rates, in view of the substantial segments of labour market being invisible due to their semi-informal nature. The work of cross-border female care workers is often not captured by statistics, although it enables the labour market participation of women in receiving countries. This may create an illusion of emancipation for women in core EU countries but leaves gender inequality fundamentally unaddressed. The absence of men in the performance of care work, either as unpaid care givers in their own homes, or as underpaid care migrants, is indicative of what can at best be termed distorted emancipation

Replicating Western European approaches in ECE by extending the care chains from further into the east and south is not the solution; nor should ECE countries be lectured on a lack of European ‘solidarity’ for failing to supply care workers to the West in this time of crisis. Massive investments into all social sectors are needed across the EU, and in the ECE in particular, to address these cross-border care dependencies and the regional inequalities that make them possible. Solidarity would be funding these through a collective mechanism such as jointly issued corona bonds, although this idea is currently being opposed by the Western European countries that benefit from perpetuating these regional inequalities. Crucially, both the remuneration received, and the social status of care work must be raised across the EU for the predominantly female workforce in this sector to be recognised as indispensable in our ageing and mutually dependent societies.

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