The unrelenting hemorrhaging of medical personnel in Nicaragua
In La Prensa, August 10, 2025
After nearly 18 years the Ortega Murillo dictatorship has not been able to address the lack of medical staff. On the contrary, it has gotten worse: there are hospitals and propaganda, but a lack of doctors and medicines.
A devastating report from the World Health Organization (WHO) from June 2025 laid bare the health crisis of Nicaragua: the country is among the three nations with the least amount of medical staff in Latin America.
The effect is already felt by patients who report long waits of years for surgeries, appointments with specialists and special treatments.
“Dr. Pérez”, a fictitious name for an internist who provides services in public hospitals and private clinics, stated from Managua that the health conditions of the public sector “are worse than ever for the patients and medical staff.”
He says that he has received patients in private clinics who come from public hospitals or Social Security clinics with orders for exams or appointments with dates as far away as 2027 and 2028.
Waiting to die
“Usually, they are adults over 45 years of age, who require some surgery or exams with specialists. But they come with fear, concerned: `Doctor how am I going to wait three years to have an endoscopy, in that time I will develop cancer´”, he says.
He said that a year ago a 56 year old patient arrived with intense abdominal pain who was only given a prescription for pain, gastritis, and an appointment for October 2025.
“They did not order any exams, nor an in-depth screening of her. She had an intestinal blockage, and her family had to send her money from the United States for the surgery. Without that intervention that woman would not have lived even three months,” “Dr. Pérez” said.
The doctor cited another case which showed up last January from a Social Security clinic in Masaya. A man close to 60 years of age with back pain, a burning sense while urinating and a fever.
He was only given a prescription with medicine for three days and an appointment for General Medicine for the 20-something of November of 2025.
“The man showed up with a severe kidney infection. Again, exams, ultrasound, treatment, observation, follow up appointment and release. I do not know how he could have put up with that for the nearly 11 months before his appointment,” says Pérez.
Where are the doctors?
According to international recommendations, the WHO suggests that a county should have at least 44.5 health workers for every 10,000 inhabitants to meet the basic needs of the population.
Nevertheless, Nicaragua is at half of that goal, with an average of 20.4 health workers in the public and private sector, way below international standards.
According to the population projections of Nicaragua, in 2022 the Nicaraguan population reached 6.7 million people. Based on that figure, the country should have 29,815 health workers to meet the minimum recommendations of the WHO.
Nevertheless, the Nicaraguan health system only has approximately 20,467 workers in the public sector, which means a deficiency of 9,348 professionals to reach the standards of that organization.
This alarming deficit reflects, according to the criteria of Dr. José Antonio Delgado, an exiled doctor, the profound health care crisis which the country has been experiencing since 2008, made worse by a series of political, economic and social factors.
17 years of abandonment and repression
“That year the Government changed the General Health Care Law, which allowed the doctors and health care staff to be treated as public administration officials instead of health care professionals.”
“The Civil Service and Administrative Law was applied to them, which meant that doctors and other health workers were then treated in the same way as Court or Treasury officials, which was not in alignment with the demands and protocols of medical practice, “ he pointed out.
Since then – he said – the regime began to persecute and arrest doctors for not being politically aligned with the regime.
“Between 2008 and 2010 a large number of doctors and nurses abandoned the public health system due to political pressures and the lack of working conditions, given that a climate of hostility was perceived toward professionals of the sector,” he recalled.
Delgado remembered that starting in 2010 a rupture of irreversible policies happened. “Many doctors began to study their specializations outside the country, but the regime implemented an unwritten policy that established that those who returned with specializations were fired because they ended up being expensive for the Ministry of Health.”
Internal doctor drain
“This is due to the fact that the Government was afraid that these doctors, by having better formation, would demand better salaries and working conditions, which could generate more demand within the public health system,” he said.
He explained then that the obvious reaction emerged: many doctors, on seeing the difficulties within the public system and the restrictive policies of the Government, saw themselves forced to look for other alternatives.
“A considerable number of them were received in private and social security hospitals like the Baptist Hospital, Salud Integral and the Military Hospital. As massive layoffs were added, many doctors decided to leave the country, in search of better working conditions or out of fear of reprisals,” he said.
Starting in 2018 with the new massive firings, the exodus of doctors intensified and reached its peak between 2020 and 2022.
“The situation of the doctors who remained did not improve, given that many saw themselves forced to devote themselves to private practice due to the lack of labor stability and the overload of work in the public sector,” he added.
Firings, resignations, persecutions and exile
According to Dr. Ana Quirós from the Center for Health Information and Consultancy Services (CISAS), the exodus of medical staff in Nicaragua can be divided into three key moments.
The first began with the social protests in April 2018. At least 686 doctors were fired by MINSA due to their participation in the protests, treating people wounded by state repression, expressing their support for the demonstrators and expressing criticisms of the governmental order to deny treatment to the wounded.
Then came the second cycle of firings and resignations in March of 2020 with the COVID-19 pandemic, says Quirós.
“The dictatorship not only minimized the seriousness of the virus but persecuted those doctors who denounced the reality of the health care crisis and revealed the lack of appropriate protection measures,” the doctor remembered.
Quirós will never forget the fact that the regime forced the doctors to work without the necessary protection measures, which resulted in a massive increase of infections and deaths among the health care staff.
It is estimated that during the pandemic at least 300 people from the hospital system died, and their cases were concealed or reported as natural deaths, in an attempt to minimize the impact of the health crisis.
In addition, the official data was distorted and those professionals who dared to share true information on the pandemic were repressed.
At that time, according to denouncements of independent medical organizations, the dictatorship fired more than 200 doctors and approximately 500 left the practice, while the health care system fell apart.
Confiscations and closings
Then came the third wave of firings, exile and banishment: between 2021 and 2022 the dictatorship began the massive closing of medical organizations and confiscations of clinics and treatment centers.
In that period – Quirós recalled – the closure of at least 218 medical organizations happened, including NGOs that offered gynecological attention to women, as well as health centers run by Catholic churches and charity organizations.
This situation left approximately 9,000 health care workers without access to training programs, seriously affecting the quality of health care in the country.
The dictatorship took advantage of the confiscations to turn communications media, office buildings, schools and homes of individuals into state clinics.
Propaganda celebrated the opening of these centers, painted and with some remodelling done, as progress in public health care attention. But the problem persists: patients almost never find doctors or treatment in those places.
“It is useless to confiscate a thousand more buildings, paint them and put up a hospital sign, because they do not have anywhere to get doctors. It is a fallacy to believe that inaugurating clinics, without doctors or medicines, is going to resolve the crisis,” said Dr. Salgado.
And the doctors?
On the contrary, he said, what they have done is put the burden of medical attention on a few specialists, distribute it on new places, and repressing or firing those who complain.
“The firings and closing have never stopped,” Salgado said and pointed out the most recent case: the sudden closure of the AMOCSA clinic in León, Chinandega and Corinto, which treated more than 46,000 patients insured by the Nicaraguan Institute of Social Security.
That closure left thousands of people without medical attention, interrupted treatments, and caused an enormous uncertainty with the patients, especially those who needed urgent treatment or were in the midst of procedures.
Here the question, Salgado says, is not where they are going to refer these patients, but who is going to treat them. And when.
