The government is making significant efforts to conceal the problems Hungarian hospitals are facing, but it is still possible to gather information about them. One public authority publishes official documents on its website that include the reasons why hospital departments are being shut down.

There aren’t muchmore depressing things to read in Hungary today than these documents, which, in their stark, bureaucratic language, reveal more clearly than anything else the desperate situation in which Hungarian public health institutions find themselves.

For example, at the Uzsoki Utcai Hospital in Budapest, surgeries were suspended in July 2024 because “the temperature in all operating rooms had become unbearable due to a failure of the institution’s liquid cooling system”. At the hospital in Cegléd, in January 2022, “the Otolaryngology became inoperable due to the illness of the doctors” and only “one doctor is currently working, who is in charge of outpatient care”. At the Szent Imre Hospital in Buda, the emergency department was unable to receive patients on a night last July because of “the eradication of bedbugs shown up in large numbers”.

These are just a few examples. Since the beginning of 2020, we have found more than 770 cases of hospital departments being closed or certain services suspended for similar reasons in Hungary. If a department becomes temporarily inoperable, patients are sent to another hospital, and an official document, a designation decision is issued. These occasionally appear in the press, but so far, there has been no comprehensive analysis of them.

Direkt36 has now built a database based on these decisions, using artificial intelligence. The analysis of this data and months of research have resulted in a series of articles entitled “Hemorrhaging Hospitals”, the main findings of which are as follows:

• A third of closures are due to a lack of doctors or nurses or a shortage of medical equipment. There are also examples where a ward receives too many patients and cannot accommodate more.
• It is not only departments in small, rural hospitals that are closing, but also large county hospitals are struggling with shortages of specialists and capacity.
• Using our database, we found that the hospitals most often asked to close a department in the country were Hetényi Géza Hospital in Szolnok, Szent János Hospital and Jahn Ferenc Hospital in Budapest,
• Stroke care is often blocked, even though patients in these cases must receive appropriate hospital treatment as soon as possible.
• In addition, CT diagnostics and neurological care are often suspended, and paediatric wards and maternity wards are the most frequently closed due to a lack of medical staff.
• The major hospitals in Budapest have been the most affected by the closures with the Szent János Hospital being one of the most notable.

In addition to building a database of over 1,000 rows, we conducted a total of 31 interviews with doctors, paramedics, health professionals, politicians, and relatives of patients who have been affected in some way by a hospital deparment closure. An artificial intelligence programmer and a biostatistician helped our work.

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Our research has also shown that 15 years ago, the Orbán government recognised that the hospital infrastructure in Hungary was unsustainable and that the ageing and emigration of healthcare workers would cause problems, yet no serious action was taken. Now, the government is watching hospital wards close spontaneously. In the absence of conscious reform, however, what often happens is that deparments are closed at random or under the influence of local political lobbies. It also puts patient safety at risk, as we will demonstrate with personal stories in the following parts of our series.

The Ministry of Interior, responsible for healthcare, declined our request for an interview, and neither they nor the National Centre for Public Health and Pharmacy (NCPHP, NNGYK in Hungarian) responded to our questions. In addition, we sent enquiries to all the hospitals concerned, but most of them did not reply.

Faulty equipment, shortage of specialists, bed bugs

Hospitals request the temporary closure of departments for a variety of reasons: for example, due to faulty equipment, a contagious virus spreading in the ward, or simply because they have run out of staff to care for patients. In such cases, the hospital must notify the National Public Health and Medical Products Agency, which designates one or more other healthcare institutions to take over the tasks of the inoperable department. An official document is also issued, called a designation order.

These documents and the orders amending or revoking them have been available on the NCPHP website since 2020. The official documents reveal not only where patients are sent to but also why hospitals close their departments.

These brief explanations—such as those quoted at the beginning of our article—reveal the daily struggles of Hungarian hospitals. They are also a valuable source of information because the Ministry of the Interior, responsible for healthcare, rarely communicates openly about internal hospital issues.

More than a thousand such decisions have been on the NCPHP website since 2020. With the help of an artificial intelligence programmer Direkt36 downloaded the documents relating to inpatient care and organized them into a table of nearly 1,200 rows. The resulting database shows which hospitals suspended care, when did it happen and and for how long did it take, the reasons for the closure, and which hospitals took over the patients. We listed the temporary closures into several categories based on whether it was due to a shortage of specialists, epidemics, or the repair of a malfunctioning device. (You can read more about how we created the database at the end of our article.) We then performed statistical analyses, partly with the help of an artificial intelligence programmer and a biostatistician.

Based on the available documents, the hospitals that have closed wards most often since 2020 are the Hetényi Géza Hospital in Jász-Nagykun-Szolnok County, the Szent János Hospital in North Buda, and the Jahn Ferenc Hospital in South Pest. The next in line is visible in this chart:

We have also marked these hospitals on a map, with the larger circles indicating those with frequent interruptions in care:

The above ranking clearly shows that the functioning of certain departments is most often disrupted in institutions that are required to provide truly comprehensive and high-level care. These are central hospitals serving entire counties or even the whole country. These hospitals have more expensive, specialized equipment, the maintenance and repair of which can disrupt the functioning of departments, but the general shortage of healthcare professionals also causes problems for them.

For example, in June 2021, the Szent János Hospital in Buda informed the NCPHP that it wanted to terminate MRI diagnostics due to a shortage of specialists. Due to various bureaucratic obstacles, it took two months after the announcement to issue a decision that allowed the hospital to suspend this service. Patients were transferred to Szent Margit Hospital. However, after one-month, Szent János sent another letter to the authorities stating that despite continuous job advertisements, they still could not find staff, meaning they were still unable to perform MRI scans. The hospital did not respond to our questions.

The fate of a hospital deparment can depend on a single doctor

According to our analysis, most closures happened due to renovation, painting, elevator installation, CT repairs, and air conditioning repairs. These problems were usually resolved quickly, but even in such cases, prolonged repair work caused weeks of disruption to care.

For example, in the summer of 2021, the Dél-pesti Central Hospital requested a six-day suspension of the traumatology due to renovation work, and then had to close it again two months later because “urgent warranty repairs became necessary.”

There have also been cases where wards have been closed due to epidemics or pests. It was the case, for example, when 12 patients in the internal medicine department of Szent Margit Hospital contracted diarrhea or when bedbugs appeared in the emergency department of the South-Buda Szent Imre Central Hospital.

According to our database, one-third of hospital ward closures and suspensions of care are due to a lack of staff or because patient safety is compromised due to overcrowding or a lack of equipment. This affects both small rural institutions and large hospitals.

Based on this, the Hetényi Géza Hospital in Szolnok is struggling the most with the shortage of doctors and nurses. Over the past five years, the hospital has requested the closure of its departments at least 75 times due to a lack of medical professionals.

At the Flór Ferenc Hospital in Kistarcsa, which is also at the top of the list, otolaryngology was particularly affected:

“due to the critical human resource situation,” for example, they requested the temporary closure of the department at the end of June 2022.

In theirletter written in August, they wrote that despite all their efforts, they were unable to maintain operations because the employee already working there did not want to stay, and they were unable to reach an agreement with an external doctor. For this reason, they requested the expansion of the closure. By November, they were only able to employ one head physician and one specialist, so NCPHP extended the closure of the ward until the end of the year. Based on the available documents, it is unclear whether the otolaryngologydepartment in Kistarcsa has been functioning properly since then, and the hospital did not respond to Direkt36’s inquiry.

Several documents illustrate that many departments are unable to cope with the retirement, illness or leave of a single doctor. Here are just a few examples:

• In the fall of 2022, the Uzsoki Utcai Hospital in Budapest informed the NCPHP that it could not provide pulmonology services or care for homeless people with tuberculosis because only two pulmonologists remained in the entire hospital due to retirement and resignations.
• In July 2021, patients requiring pulmonary and thoracic surgery were treated at the Debrecen Clinic, 140 kilometers away, for two weeks instead of at the Szolnok Hospital because one of the two specialists had suffered a sports injury.
• During the COVID pandemic, the only gastroenterologist at the hospital in Esztergom caught the virus, and the substitute specialist was over 65 years old, so the hospital was temporarily unable to treat patients arriving at the department.
• In December 2020, the Flór Ferenc Hospital in Pest County announced that its dermatology department, which had been struggling with a shortage of human resources for years, would be forced to close. Their letter revealed that they only had one resident doctor working there, “who is permanently doing professional practice at another institution,” and one full-time doctor who “does not wish to continue working in the inpatient department from January 1.”

Compared to renovations and repairs, solving the shortage of specialists is generally much more difficult. At Somogy County Hospital, for example, the pulmonary and thoracic surgery department was only able to reopen after almost five years.

The chief physician at Nyírő Gyula Hospital announced back in 2015 that “due to a lack of personnel, their gastroenterology department would be temporarily closed.”

The closure was extended five years later until June 2021. We contacted the hospitals regarding the document, but they did not respond.

Stroke care and CT diagnostics are frequently suspended, and maternity wards also experience numerous disruptions

We compiled a ranking of the most frequently disrupted services by looking at which types of departments experience the most closures. It turned out that the area most affected is precisely the one where it is critical for patients to get to the hospital in time. It is stroke care, for which hospitals have reported at least 167 times in five years that they are unable to admit patients. Of these, 83 closures have occurred in the last year and a half.

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Stroke—when the brain does not receive enough blood, causing damage to brain tissue—requires immediate treatment, which is why there is a nationwide network of stroke centers. However, if a stroke center closes, stroke patients must be transported further away, for example to a neighboring county. Treatment must be started within 4.5 hours to prevent the patient from suffering permanent damage or permanent paralysis.

This figure shows that, apart from stroke care, CT diagnostics and the neurology department are the most frequently disrupted:

If we narrow the analysis to cases where closures were due to a lack of specialists or essential conditions for safe patient care — such as available beds or equipment — paediatric care and maternity wards stand out:

The leading position of paediatrics and chlid healthcare, shown at the top of the figure, is partly explained by the fact that it is a large category that includes several medical specialties dealing with children: for example, paediatric ophthalmology, paediatric psychology, paediatric otorhinolaryngology and so on.

The shortage of staff in obstetrics may be linked to the ban on gratuity payments introduced four years ago. According to Balázs Rékassy, a doctor, health manager and health policy expert, the shortage of specialists is mainly felt in departments that were “ gratuity payment was common, such as obstetrics and surgeries that can be planned. Doctors were not able to earn as much as before because of the abolition of the gratuity fee, so they preferred to go (wholly or at least partly) to private institutions.

In addition, Rékassy says that a highly qualified team of doctors in neurology and stroke care has to be on call at all times, and it is very difficult to achieve this 24 hours a day. He said this is also because the skills of well-trained, young doctors are not paid enough in the Hungarian system, which contributes to the shortage of staff. The field is less attractive to nurses because it often involves physically demanding tasks, such as moving paralyzed patients.

When an ambulance drives hundreds of kilometres

We used the database to calculate how many kilometres patients or their ambulances had to travel after a ward closure to reach the replacement hospital designated by the NCPHP.
We examined hospital departments that admit patients requiring especially rapid access to care. We found several outliers.

Last November, for example, all four beds in the burned injuries unit in Debrecen were full, so if there were other patients in the region, they had to be transported more than 200 kilometres to Budapest. “Burn victims are in terrible pain, so if their condition is serious, it is only worth transporting them so far under anaesthesia,” explained Tibor Lengyel, president of the Hungarian Ambulance Workers’ Federation. The Clinical Centre of the University of Debrecen told Direkt36 that the capacity of the department was restored within a day and that they had no information if patients had to be transported to Budapest because of the closure.

According to Lengyel, the transport and the long journey are stressful for all patients, regardless of their state of health, because they feel weak and afraid. “Such process is also a huge burden and additional cost for relatives, who have to travel hours instead of the usual nearby hospital to visit their sick relatives or to bring them food and fresh clothes,” he added. For paramedics and hospitals receiving patients it is a lot of extra energy and resources to take care of these patients. Lengyel said it is common for paramedics to spend up to 4 hours with patients because no hospital wants to receive them, citing workload.

According to our analysis, there have also been examples of transferring the care of pregnant women at risk of preterm birth and high-risk pregnancy and neonatal intensive care from Pécs to Kecskemét, Zalaegerszeg and Szeged. These cities are all more than 2 hours away by car. And from the University Hospital of Pécs, from November 2019 to February 2020, intensive care for high-risk newborns has been moved indefinitely from the University Hospital to hospitals more than 160-190 kilometres away due to “sudden temporary disruption”. This has been repeated twice since then because the ward was full, with the nearest designated hospital being the clinic in Székesfehérvár, 160 kilometres away.

According to Lengyel, women who are at risk of preterm birth or high-risk pregnancy are usually admitted to the hospital earlier, as the chances of complications during pregnancy, during delivery and even after birth are increased. However, if the ambulance has to carry the mother for hundreds of kilometres, “the health of the woman and her baby is particularly at risk”, as the ambulance has limited space and equipment availability in the moving vehicle . “An ambulance cannot be as well equipped as an entire maternity ward, backed up by an intensive care unit,” he said.

We contacted all of the above-mentioned hospitals, but they did not respond to Direkt36’s enquiries.

The hospital in Szolnok has been struggling with staff shortages for years

According to our analysis, Hetényi Géza Hospital in Szolnok, which has closed its departments more frequently than any other hospital in Hungary, has long struggled with a shortage of doctors and nurses. The negative effects of this were evident when Tamás Olej’s father needed neurological care, but there was no specialist available at the hospital.

The 67-year-old father suddenly fell ill on Saturday during last year’s long Whitsun weekend. He had nausia, his vision deteriorated, and his speech became slurred. Since the man had previously had a stroke, from which he had fully recovered, the family knew that they had to call an ambulance immediately, as they recognized that the symptoms could indicate another stroke. The ambulance arrived quickly, and an hour later, at 5 p.m., the man was admitted to the emergency department of the Hetényi Géza Hospital in Szolnok.

However, they did not make it to the neurology department, where such cases are usually treated, because there was no specialist on duty at the time. The doctor on duty therefore sought advice from a neurologist by telephone, and Olej’s father was sent for a CT scan. The outpatient form, which Olej showed to Direkt36, lists the diagnosis as a transient ischemic attack, which means a temporary disruption of blood supply to the brain. It has the same symptoms as a stroke, but these symptoms disappear after a few minutes or hours.

“Based on the neurologist’s opinion, hospitalization is not necessary,” they concluded after the CT scan and sent him home.

As the family did not consider the care provided at the hospital to be adequate, they took the man to a private hospital three days later, where, due to the time that had elapsed, it was no longer possible to determine exactly what had happened. Olej’s father has been struggling with balance problems, fatigue, and peripheral vision loss ever since, and the symptoms have not been alleviated by medical treatment. To this day, the family does not understand why, if there was no appropriate specialist at the institution, he was not sent to another one where he could have been examined more thoroughly. “It’s pointless to call it a stroke center if there is practically no care,” said Tamás Olej.

According to sources familiar with the institution, Hetényi is a modern, clean, and well-equipped hospital. “The hospital itself is not bad, it has some very modern wards, but it is understaffed, and the hospital’s debts make it difficult to purchase equipment and medicines,” said a doctor who has been working at the Szolnok healthcare institution for years. The doctor added that there are wards where medical care can only be provided by hiring external staff. A nurse told Direkt36 that in her ward, everyone can only take vacation if they submit their entire annual vacation plan in February.

According to Direkt36’s analysis, the Hetényi Géza Hospital reported the most department closures in the entire country—at least 78 times—75 of which were due to a shortage of medical workers. Since the beginning of 2024 alone, some departments have been temporarily closed 27 times due to a shortage of medical staff. The designation decisions reveal that care was disrupted in the departments of face, jaw and oral surgery, stroke, neurology, obstetrics and neonatal intensive care.

From June to December 2022 there was not a single month when they were able to cover the delivery room on call due to a “temporary lack of personnel.” In the stroke and neurology on-call department, when one of the doctors retired, they were barely able to cover the summer vacations.

“There were two chief physicians who retired, and there was no one to replace them,” one of the hospital’s doctors told Direkt36 about the state of the neurology department. According to him, this meant that last summer, the neurology department was only open every other day. “The urology inpatient ward has been closed for a year and a half because two doctors resigned, one young doctor moved to Germany, and the others retired,” the doctor continued.

The temporary closures of the hospital’s departments have been reported several times in the Hungarian press, but the management has never publicly acknowledged them as a persistent problem. When RTL Híradó reported last year that several units had been suspended at the Hetényi Géza Hospital, Miklós Piroska, the former head of the county assembly who became the hospital’s director general, wrote in a statement that “contrary to one-sided, distorted and misleading rumors,” care was being provided at the institution.

However, documents published by the hospital show how serious the human resources shortage is. Currently, the hospital is looking for employees for numerous positions in nearly 20 departments on its website. Based on the job advertisements, there is a shortage of doctors and specialists in particular at the institution. The hospital’s latest annual report published on its website for 2019 states that “the shortage of specialists continues to cause serious problems in professional care.”

Meanwhile, the institution is one of the most indebted hospitals in the country, with debts of 1.1 billion forints last June.

We contacted the hospital in Szolnok with our questions, but they did not respond to our inquiry.

„At the limits of their capacity or beyond”

Our analysis also looked at where hospital department closures had the biggest impact on patient care. To do this, we took into account patient turnover and the length of closures. For our calculations, we used a database compiled and maintained by biostatistician Tamás Ferenci, (see the end of our article for details on the exact calculation method), based on official statistics. Based on this, the ranking of hospitals is as follows.

The visualisation not only reveals that Szent János Hospital in Budapest ranks first, but also highlights the problems of large hospitals in the capital. The biggest disruptions occur in Budapest, due to the transfer of care from one hospital to another.

Although the number of documents forming the basis of our database has varied from year to year, several experts with a good knowledge of the healthcare system agreed that the situation in healthcare has deteriorated significantly over the last 10 years, and there has been a noticeable increase in the number of ward closures. According to Tibor Lengyel, president of the Hungarian Ambulance Workers’ Federation, the number of closures has increased recently, and paramedics are often informed that a particular department in a given institution is no longer operating.

Furthermore, the documents published on the NCPHP website are only the tip of the iceberg, in reality, many more hospital wards are struggling with serious problems. According to Balázs Rékassy, a doctor and healthcare manager, in cases where fewer beds are operating than they should due to a shortage of staff, wards are not usually closed until all other options have been exhausted.

“In reality, it often happens that a ward operates with far fewer beds, fewer nurses, and a difficult-to-staff on-call team”, he said.

This situation is illustrated by a 2023 Supreme Court ruling in a labour lawsuit brought by a doctor working at a large county hospital.

The doctor, who sued the hospital for unjustified withholding of remuneration, had been working at the institution since the 1980s and had been head of the paediatric department since 2020. The doctor ran the department as the sole specialist, later with the help of one, then two residents. In addition, an endocrinologist (a specialist in the treatment of hormone disorders) tried to assist three days a week.

“Due to the constant shortage of doctors, the plaintiff worked extraordinary hours almost from the beginning. From April 2021 they worked almost continuously, as they had to return to work immediately after shifts without rest, due to the lack of other specialists,” the judgment states. The doctor had to take on 31 on-call shifts in seven months, and after these shifts, had to return to work the next morning.

“The plaintiff performed the additional tasks with increasing difficulty, at the limits of their capacity or beyond. They trusted for a long time that the staffing problems would be resolved over time, but this did not happen in a reassuring manner,” the ruling states. As the hospital was still unable to find others to help with the work, the doctor handed in his resignation in November 2021.

According to Tibor Lengyel, head of the Hungarian Ambulance Workers’ Federation, the current system is only sufficient for short-term survival.

“The healthcare system is not kept alive by office workers, but by the workers, nurses, doctors, and paramedics who make it work somehow. They work out of dedication. The state is taking advantage of this,” he summarized.

In the following articles, we will illustrate how the system endangers patients with the help of personal stories and why the government is not addressing the problem.

Editor of the series: Zsuzsanna Wirth.

Illustration: Virág Török / Telex

Ferenc Bakró-Nagy / Telex contributed to the creation of the data visualizations.

How Was the Database Created?

Decisions regarding hospital department closures and reopenings, along with related annexes, have been published on the website of NCPHP since 2020. When we began data analysis at the end of March, more than 1,400 such documents were available. It was clear that downloading and manually organizing the contents of these lengthy and complex decisions one by one into a database would take months. Therefore, we sought the assistance of an artificial intelligence programmer. We also decided to use artificial intelligence because the multi-page legal texts of the decisions could not have been effectively parsed for relevant information through programming alone. In the documents, multiple expressions were often used to describe the same phenomenon, hospital names changed over the years, and dates were sometimes written in numerals, sometimes in words. These factors necessitated a program capable not only of reading but also interpreting the text.

We used Python (a high-level programming language) to download the documents. Afterwards, we encountered the next challenge: NCPHP had uploaded many documents in scanned format, making text search and copy impossible. To solve this, we used optical character recognition (OCR) software, which can recognize text in images and convert it into editable and searchable formats. We then filtered out documents irrelevant to our analysis, such as decisions concerning outpatient care.

Next came building the database, for which we used artificial intelligence programs from OpenAI and Google Gemini. We instructed the program to extract from the documents which hospitals requested ward closures or suspension of services, the reasons given, and the duration requested. We also asked it to calculate the distances between the affected institutions.

After completing this, five members of the Direkt36 editorial team individually reviewed the resulting database of 1,250 rows and corrected any errors. This allowed us to easily calculate, using Excel pivot tables and Python programming, which hospitals requested ward closures most frequently, which wards were most affected, and the most common reasons behind the closures.

We created our database from documents issued since 2020; however, some from before 2024 may be missing. Despite our request to NCPHP to share any decisions not yet published on their website, they only partially complied, providing comprehensive data from 2024 onward. As a result, some decisions from previous years—exact numbers unclear—may be absent. According to several sources familiar with ward closures, hospitals have reported operational difficulties to NCPHP more diligently in recent years, so this can also influence the statistics. It is positive insofar as the recent data reliably reflect reality, but it limits year-to-year comparisons.

Since precise data are only available from 2024, we calculated for this year how much patient care was proportionally disrupted by closures, measured by the so-called patient days affected. An inpatient day refers to a day a patient spends in a hospital. This is a commonly used hospital activity metric, for which the National Health Insurance Fund (NEAK) publishes detailed annual statistics broken down by institution and specialty (e.g., obstetrics, ophthalmology). From these data, it is possible to calculate how many inpatient days a hospital would have completed without disruptions and what percentage of these was affected by closures. It can be calculated by hospitals, specialties, or even for the entire Hungarian healthcare system.

However, this process had more challenges. Documents specifying exact closure durations were easy to handle, as we counted the number of days affected. However, some decisions were indefinite, valid “until revoked.” In such cases, we searched for revocation files indicating ward reopenings. If there was no revocation, we assigned the reopening date as the end of the year since we only compared data within that year. Using this method, we found that ward closures disrupted 0.6% of all hospital inpatient traffic in 2024.

Out of 126 hospitals, 96 experienced no such disruption, and only 7 had disruption rates above 1%. It is difficult to assess whether this is high or low, as no international comparative data are available, and comparison with earlier domestic data is problematic. Future data will be comparable to this baseline, but more importantly, this method allows us to compare hospitals with one another. For example, it emerged that ward closures most significantly disrupted inpatient care in large hospitals in Budapest.