National Sections of the L5I:

Pakistan: Junior doctors take up the struggle again

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In June 2012, junior doctors in Punjab province went on strike for three weeks over low pay, long hours and staffing shortages.

A courageous and militant struggle erupted. Despite the widespread public appreciation of the doctors' work, the bourgeois media - including newspapers, TV channels and radio talk shows - viciously condemned the strike as immoral, claiming that the striking doctors were responsible for the deaths of ordinary people, that their pay was already high enough and the state had no funds to increase it. The media accused them of blackmailing society and called on the state to use a heavy hand to control the situation. In reality, the media was just repeating the line of the Punjab state government.

In this situation, the doctors’ movement faced isolation – a situation the provincial government took advantage of to unleash brutal repression against the young doctors. Four hundred and fifty were arrested and several badly injured.

At the end of June, the judiciary stepped in. It ordered the government to negotiate – and the doctors back to work. Any strike action was ruled out as illegal during July. Throughout that month, the government refused to make any concessions to the young doctors, hoping that the forced return to work would break their morale and determination.

They were wrong. Despite the reactionary ban on the strike for a whole month, despite the media slanders and repression, the doctors discussed and prepared to restart the struggle.

Over the last few weeks, they have held mass rallies and demonstrations. They have not yet launched an all out strike, obviously for fear of being heavily repressed and isolated once again. But, in order to build up pressure, they have changed their tactics. They are aiming not only to link up with other workers in the hospitals, but also to involve the patients and their families in their protest actions, bringing them to demonstrations and rallies. In this way, they hope to widen public support and expose government and media lies about the junior doctors.

Health system

Throughout the dispute, the authorities and bourgeois press presented the struggle as just one between the individual doctors and the rest of society. They demagogically claimed that doctors could only strike at the expense of their patients.

The government’s propaganda, putting the responsibility for saving lives onto individual doctors, is itself a deception. In modern conditions it is the whole health system that saves a human life. The majority of doctors – and in particular the young ones - have ceased to be bourgeois or middle class and more or less privileged, increasingly they work under conditions and contracts similar to the working class.

In some respects, their and other medical staffs' pay and conditions are even worse than those of other public sector employees. Generally for Pakistan state employees, the longer one’s service, the higher one’s salary grade – but this does not apply to medical staff. That is why the doctors demand a similar “career structure” to other professions.

On the other hand, the working class and the poor do not get modern scientific health care in Pakistan and have to rely on traditional, unscientific methods of treatment. This has nothing to do with doctors’ failing their patients. It is because the government’s expenditure on health care is so low, currently less than 1.2% per cent of the total budget. But there are billions and billions of rupees available for the military budget and servicing the foreign debt. The health care system is seriously deteriorating with, on average, just one doctor responsible for eighteen thousand people.

During the strike in June, doctors and unions in the health sector calculated that providing a decent health service for all, building and improving hospitals in town and countryside to a decent level, increasing staff, raising pay and conditions, would amount to raising the budget for health services to about 8 per cent of the total budget.

In this situation, the young doctors demanded

1) a new career structure for doctors
2) an increased health budget.
3) an end to the privatisation of health services
4) the building of more hospitals and the employment of more doctors
5) nurses and paramedical staff should also be granted a new career structure

Movement to spread

The hue and cry against the young doctors’ movement, however, is easy to understand. The government thinks that if it accepted the young doctors' demands, similar movements could erupt in other parts of the public sector and the situation could get of control.

In reality, the doctors' movement is directed against neo-liberal economic measures - and it challenges the division of surplus within the profit system between the capitalists and landowners, on the one hand, and the working people of town and country, on the other. If it succeeds, this could generate a mighty struggle from the working class to raise pay and improve services. That explains why the Punjab government is using every method to destroy the movement, instead of responding to its demands. In June, they even used military doctors as strikebreakers, but this failed to resolve the problem.

Instead, there have been signs of spreading militancy. The struggle is getting support from young doctors in other provinces and also the nurses and paramedics who are threatening that they will go on strike if government does not release the doctors and accept their demands.

Movement's success

If the strike movement is to start again and win this time, the struggle of young doctors needs solidarity from the nurses, paramedics and the rest of the labour movement.

In these circumstances, it is important that doctors make contacts with trade unions, students, lawyers and working class and poor communities to give them a real understanding of what they are fighting for.

The “Revolutionary Socialist Movement”, the Pakistani section of the League for the Fifth International, stands solidly with the movement even though we get criticism from many of the left for this position. Doctors, they claim, are highly paid and we should “side with the poor patients”. We think this is a complete capitulation to the hegemony of neo-liberal ideology. The struggle is not between doctors and patients, it is between the doctors and the government – and any leftist should understand which side they are on in that struggle! Or should we oppose every struggle and strike that affects the ordinary people? Should we oppose railway workers who strike? Or strikes in the Water and Power Development Authority (WAPDA) and other service sectors? No! Revolutionary socialists have to stand with these workers' struggles that are erupting due to the crisis of the system. They have to point out that the rich, the corrupt politicians and military must be made to pay and that the interests of the service workers (including doctors) and those of the service users are one.

We demand:

- a proper career structure for the young doctors

- a rise in the health budget by 8 percent in order to improve wages and the whole health system

- free public health care for all – paid for by taxing the rich, the profits, income and wealth of big capitalists and landowners.

- open the books and contracts between drug companies, hospitals and state authorities to workers' inspection. The health sector to be reorganised and run under workers' control.

In order to win the demands, we need an indefinite strike in the heath sector. Of course, this could also include providing emergency care during the struggle, but this should be organised under control of the striking workers, in close co-operation with the patients.

In order to prevent the isolation of the junior doctors' struggles, we call on all trade unions in the workplaces to join the fight. We argue for mass workplace meetings, including all employed – doctors, nurses and all other staff, including all the different unions, unionised and non-unionised workers. These assemblies should elect strike committees, which need to be co-ordinated throughout the country.

As the ruling of the high court demonstrated, all institutions of the state are used against the strikes. The whole labour movement must join in the struggle, to demand the dropping of all charges against the doctors and to fight for an end to all restrictions on the right to strike.