Last May, 68-year-old János was balancing on a stool, painting the fence of his family home near Budapest, when he took a wrong step and fell off. His right leg swelled twice to its normal size in the days following the fall. Because his symptoms persisted and there was a history of varicose veins in his family, he decided to visit a private vascular specialist, who diagnosed him with thrombosis. Deep vein thrombosis causes blood clots to form in the veins and can have life-threatening complications, so it is important to recognize and treat the problem promptly.

The doctor said he needed immediate surgery, so János got in the car with his daughter. Around 6 p.m., they arrived at the emergency room of the Szent Imre Hospital in South Buda. Upon arrival, he did not expect to sleep on his own camping bed in the hospital corridor and wait until the next day to be treated.

“There were so many people, patients were sitting and lying on the floor,” he said, recounting his experience in the emergency department at the hospital. He was called in around 11 p.m., but at that point, he had not yet been examined; a hospital worker only asked about his symptoms. Later, he was told, “there is no room in the ward, they are about to make some.”

There were no free beds, even though he really wanted to lie down to relieve the tension in his leg. He asked the doctor for permission to bring in his own chair. When he got it, his daughter brought him a camping bed from home. He was examined for the first time around 3 a.m., followed by more waiting.

In the morning, he was given a hospital bed and wheeled into another room. They told him he couldn’t get up and wouldn’t let him go to the bathroom, so he had to urinate in a plastic cup in the hallway full of patients. Shortly thereafter, however, it became clear that they couldn’t admit him to the hospital.

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The day when János was denied a place in the overcrowded emergency room of Szent Imre Hospital was not a rare occurrence at the institution. The department is regularly overloaded. Several hospital employees told Direkt36 that it is common for 20-25 inpatients to wait in the emergency room at the same time because there are not enough available beds in other departments, where they could be treated.

“Patients are lying on extra beds stacked on top of each other,” said a doctor familiar with the emergency department’s operations. According to another doctor, there are also cases where patients spend a day or two in the emergency ward because there are no beds available, so they cannot be transferred to the wards. Several specialists have recently resigned from the emergency department, and the hospital is now trying to replace them with internists.

This situation arose despite the fact that the hospital officially has 541 active inpatient beds. In reality, however, on average, 70 of them are empty, meaning that no patients are being treated there. Direkt36 also witnessed rows of closed wards in empty corridors in several departments. The number of inpatient beds has been significantly reduced in recent years, primarily due to a shortage of skilled workers. So while the emergency room is overflowing with patients, other parts of the hospital are empty.

All this is another symptom of the spontaneous degradation of Hungarian healthcare, which has accelerated dramatically in recent years: the number of functioning inpatient beds is decreasing at an accelerating pace. Wards are not only being closed – or, to use the official term, “permanently suspended” – where there are few patients, but also where there is a shortage of healthcare workers.

Direkt36’s latest investigation reveals how, while the government refuses to close hospitals for political reasons, these institutions are constantly shrinking behind the scenes.

According to our statistics based on an official database, this phenomenon is most evident in Budapest’s hospitals. The situation is bad for both patients and workers. Hospital work is hindered by a shortage of specialists, while patients often have to wait for treatment, if they receive it at all. In addition, some institutions only report these bed suspensions as a last resort, so in reality, the problem may be even more serious than official statistics indicate.

We sent detailed questions to the South Buda Centre Hospital – Szent Imre University Teaching Hospital, the Ministry of the Interior, and the National Directorate General for Hospitals, but none of them responded to Direkt36’s inquiry.

Entire corridors of wards stand empty at Szent Imre Hospital

The renovated, well-maintained buildings of Szent Imre Hospital in District XI are surrounded by a park with trees and green areas. Not far from the main building stands Building C, which houses the internal medicine departments. When we visited in early September, the first floor was almost completely deserted during visiting hours, we found the doors of sixteen patient rooms closed. On the upper floors, we also saw several locked wards.

“The first floor of Building C is almost completely empty,” confirmed a source familiar with the operations of the internal medicine department. According to the source, if there are patients in a hospital room, the door must remain open. In other words, if the door is closed, that room is not in use.

Internal medicine is officially the largest and busiest department of Szent Imre Hospital, with nearly 200 inpatient beds.

According to last year’s data, 13 percent of the hospital’s beds were unused, which is higher than the national average of 8.45 percent. Beds „permanently suspended” mean that they have not been used for patient care for more than six months. The high proportion of unused beds at Szent Imre is particularly striking given that this institution serves the entire South Buda area, one of Budapest’s most densely populated regions.

However, the situation is even worse than these statistics suggest. Several hospital employees told Direkt36 that far more beds are currently out of use than the official figures indicate. Due to a critical shortage of healthcare workers, the number of operational beds has been reduced in many departments. Staff members said it is common, for example, that the internal medicine on-call shifts can only be staffed with nurses borrowed from other departments.

“Without the mandatory overtime, all internal medicine departments would have to close,” said one nurse. The nurse works 15 days a month in 12-hour shifts, and after that, is assigned to other departments for an additional 6–8 days. “You can imagine how exhausting that is, and how little time is left for family,” the source added.

At the psychiatry department, located in Building B, more than 40 percent of beds were unused last year, while the remaining sections were overcrowded. This can be seen in official statistics, as the bed occupancy rate was 107 percent. A source familiar with the department’s operations said the reason is that the closed psychiatric ward has not been functioning for three years, and even the open ward has fewer beds. The first floor does not admit any patients; currently, only the ground floor and part of the second floor are in. This was confirmed by the on-site experiences of Direkt36.

According to the source, the lack of a closed psychiatric unit also creates serious problems for patients: if an ambulance brings in someone who should be admitted to the closed section, doctors can only examine the patient and then transfer them to another hospital. Later, when the immediate danger has passed, the patient is sent back to Szent Imre’s open ward. As a result, patients are often shuffled back and forth between institutions.

In the Department of Anesthesiology and Intensive Care — where patients in severe or even life-threatening conditions are treated — data from 2024 show that only 12 of the 17 beds were operational. According to a doctor familiar with the department’s work, in practice, only 7–8 beds could actually be used because there aren’t enough nurses. Recently, the number of functioning beds has dropped even further — the source said that currently, patients are being treated in only six beds.

Even under these conditions, each intensive care nurse is responsible for three patients, which is an extremely heavy workload in this field. (According to international recommendations, depending on patient condition, the ideal ratio is one or two patients per nurse.)

There have been multiple waves of resignations at this department in the past. In 2015, six of the eight anesthesiologists working in intensive care resigned, citing “unbearable working conditions.” They said there were not enough staff left to perform the required tasks. In 2021, amid the COVID-19 pandemic and following the introduction of new regulations regarding the employment status of health workers, 20 employees resigned from the department. According to an article by 444.hu, the reason was that “there are no tools, no staff, and no money.”

Three doctors currently working at the hospital unanimously told Direkt36 that the situation has not improved since then. In fact, the quality of care continues to deteriorate, and one described the situation as “critical.”

“The decline is visible in every aspect — professional, financial, and otherwise — especially since the COVID-19 pandemic,” confirmed another doctor who spoke to Direkt36.

All of this is partly the result of the general lack of resources in healthcare, but according to several hospital sources, it may be connected to the fact that Róbert J. Bedros, the hospital’s director with government connections, has made reducing the institution’s debt one of his top priorities.

“When we took over Szent Imre Hospital, it had roughly 970 million forints in debt, and we eliminated it within a year and a half together with the hospital staff. Since then, the hospital has operated at break-even,” Bedros said in an interview with Népszava seven years ago.

According to the Hungarian State Treasury’s data, in September 2024, the hospital’s debt stood at 1.006 billion forints — placing it in the middle range compared to other Hungarian hospitals. (At the top of the list, the Észak-Pesti Centrumkórház-Honvédkórház is burdened with more than 5.6 billion forints in debt; university clinics are not included in the data.)

Until 2023, the hospital’s director also held a government position: he served as the Prime Minister’s Commissioner, responsible for overseeing the construction of the new South Buda “super hospital,” which ultimately was never built.

Szent Imre Hospital did not respond to Direkt36’s request for comment.

One in Ten Hospital Beds in Budapest Stands Empty

Szent Imre Hospital is not the only healthcare institution where fewer and fewer beds are in use — this is a nationwide phenomenon.

An analysis of the annual data from the National Health Insurance Fund of Hungary on hospital bed capacity clearly shows that in recent years, the number of unused beds in Hungarian hospitals has steadily increased. In 2024, 8.45 percent of all hospital beds nationwide were not in operation, while in Budapest this ratio was even higher — 11.2 percent, according to Direkt36’s calculations. The number of “unused beds has been rising sharply in the past few years.

More than half of Hungary’s hospitals reported unused beds last year. A few examples: In Deák Jenő Hospital in Tapolca, all inpatient care has been discontinued. In Karolina Hospital in Mosonmagyaróvár, more than half of the beds were unavailable for patient care last year — three of its seven departments (surgery, orthopedics-traumatology, and intensive care) have shut down entirely. In Szaplonczay Manó Hospital in Marcali, 43 percent of beds were not in use. But the issue is not limited to small-town hospitals, major hospitals are also affected. Among the large Budapest institutions, for example, in Szent János Hospital, Jahn Ferenc Hospital and Péterfy Sándor Street Hospital, more than 10 percent of beds were unused.

At Péterfy Sándor Street Hospital, the situation appears particularly dramatic in the internal medicine department, which is the hospital’s largest unit. Out of a total of 568 hospital beds, more than 210 belong to internal medicine, occupying several floors and serving patients from the 5th, 6th, 7th, and 8th districts of Budapest.

Within just one year, the number of unused beds in this department rose sharply. While in 2023, 39 of the 212 beds were out of operation, by last year, it had increased to 105. Meanwhile, the bed occupancy rate rose from 72 percent to 94 percent, meaning that the remaining 100 or so operational beds were nearly always full throughout the year.

A doctor working in the department confirmed to Direkt36 that the number of used beds has indeed been reduced, although the source personally did not perceive the shrinkage to be as drastic as the official figures suggest. Staff were told that the closures were due to a shortage of nurses capable of caring for patients. However, even with fewer beds, it still happens that during night shifts, two nurses are responsible for 30 patients.

Ideally, three staff members would supervise this many patients per shift: one qualified nurse and two nurse assistants. But when only two are on duty, the nurse may have to perform basic tasks such as bathing patients, which would normally be done by assistants.

The doctors are also under severe strain, as this is one of the busiest departments in the hospital. Typically, each doctor manages over ten patients at a time, and in addition, they take an average of four on-call shifts per month. They cannot neglect their own patients even after a night shift, so it’s common that they work for additional hours. “It’s routine that we work three hours overtime after on-call duty,” said the doctor.

In the ward, four rooms have been completely closed, in other cases, beds were simply removed while the rooms remained open. Despite the reduction, overcrowding remains common. In the past, extra beds had to be placed everywhere. Since the number of beds was reduced, this happens less often, but there are still far too many patients.

“I still go to work every day with a knot in my stomach, wondering if I’ll have a place to admit the patients,” he said. Although he loves his colleagues and this profession, he admitted there isn’t a single day he doesn’t think about going home and never returning.

Péterfy Sándor Street Hospital did not respond to Direkt36’s questions.

Hospital ward closures are “the final stage”

If an inpatient hospital bed is placed in the category of “temporarily suspended,” this, in practice, means the permanent elimination of that bed, according to health policy experts interviewed by Direkt36. The statistical term merely conceals this process. In such cases, certain wards are usually closed, meaning that fewer beds are available for patients.

A source familiar with healthcare management said that there is enormous pressure on institutions to make the shortage of professionals less visible, and this method helps to cover it up to some extent, since it is not as conspicuous as the permanent closure of an entire department or hospital would be. However, according to this source, it is still the lesser evil for patients, because at least they are not admitted to a place where there is no one to care for them properly.

“The closure of entire departments is already the final stage,” confirmed Gabriella Lantos, a healthcare manager.

There can indeed be several reasons for the reduction in the number of beds. Sometimes, there truly is no longer a need for as many beds as a department currently operates with. Nowadays, there are more and more surgeries that do not require patients to stay in the hospital for days; after a few hours of observation, they can go home.

Moreover, compared to other countries, Hungary has a relatively high number of hospital beds, but they are not being used efficiently. According to Zsombor Kunetz, a healthcare analyst, this is a sign that healthcare in Hungary is overly hospital-centred, and patients are treated at the highest level of care, while primary care, specialist outpatient care, and one-day procedures are less developed.

Financial reasons may also play a role in reducing the number of beds, as most hospital departments cannot operate profitably — in other words, they do not receive sufficient funding to cover operating costs. This is particularly true for psychiatry, which ranks among the top fields in terms of unused hospital beds, and which, according to data from Vilmos Ivády of the Semmelweis University Health Services Management Training Centre, was the most loss-making speciality in 2023.

However, Direkt36’s research shows that in many places, hospitals are unable to operate enough beds due to a worsening shortage of healthcare professionals.

As revealed in Direkt36’s earlier series of articles on hospital department closures, in many hospitals — especially in rural areas — the fate of entire departments can depend on a single doctor. Yet according to health experts interviewed by Direkt36, in the capital, where the proportion of unused beds is higher than the national average, the main problem is not the shortage of doctors, but the shortage of nurses.

After all, it makes little difference if there are enough doctors when there are no nurses to care for patients after surgery or to supervise those admitted to wards.

Zoltán Balogh, president of the Hungarian Chamber of Health Professionals, said at a congress in early November that roughly 14,000 nurses are missing from adult care. He added that the situation in anesthesiology and intensive care is so serious that, due to the lack of specialist nurses, entire institutions may become nonfunctional in the future.

Péter Takács, the state secretary for health, recently estimated the number of missing nurses at 20,000 in an interview with 24.hu. “About half of them are missing in Budapest,” he added.

In international comparison, Hungary indeed fares poorly in terms of the number of nurses. According to OECD 2022 data, there are 5.7 nurses per 1,000 inhabitants in Hungary, while the EU average is 8.4.

Patients wait in line, yet hospital beds remain empty

Empty beds in closed hospital rooms become a real problem for patients when they have to wait for treatment because there are not enough functioning hospital beds available to care for them.

For this reason, we gathered hospital departments across the country where there are many patients, yet many beds are not in operation. To do this, we used the National Health Insurance Fund’s detailed national data on hospital bed occupancy. This indicator measures how efficiently a hospital uses its resources, since it shows how many of the available hospital beds are actually occupied by patients. Although the ideal rate of bed occupancy varies by department, we assumed that utilisation above 80 percent indicates that the department has many patients and limited capacity.

In 2024, we found 16 departments where, while the bed occupation rate was above 80 percent, at least 25 percent of the beds were not operating.

More than half of the 16 departments on the above list were located in large healthcare institutions in Budapest, while the other half were in county-level hospitals responsible for serving entire regions — that is, in places that should represent the highest level of care. Only one smaller rural hospital appeared on the list: the internal medicine department of the hospital in Mosonmagyaróvár.

The problem mainly affected internal medicine and psychiatric departments. According to health experts interviewed by Direkt36, the overload of these departments is due to the lack of space in social care institutions — as a result, many patients remain in hospital even when they no longer need to be there.

At the Jahn Ferenc South Pest Hospital in Budapest, more than 40 beds disappeared from the internal medicine department in a single year, while bed occupancy rose to 138 percent.

At the Cardiology Department of the Észak-Budai Szent János Hospital, last year, only every second bed was used for inpatient care, even though the bed occupancy rate was 126 percent. At the end of 2023, the hospital notified the National Centre for Public Health and Pharmacy (NCPHP, NNGYK in Hungarian) that it was forced to reduce inpatient beds in the department “due to the partial and temporary lack of minimum conditions.”

At the Department of Ophthalmology of the University of Pécs, more than half of the beds were suspended last year, while bed occupancy exceeded 200 percent.

We contacted the hospitals with our questions, but none of them responded.

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The decreasing number of available hospital beds and the overcrowding of patients are, therefore, according to the data, a nationwide phenomenon. It is not merely an abstract administrative issue — it also makes the smooth treatment of patients difficult.

János, who waited for a long time in the Szent Imre Hospital in Budapest (mentioned at the beginning of our article), ultimately did not receive treatment there.

János’s daughter eventually took him from Szent Imre Hospital to the Emergency Department of Semmelweis University, from where, after roughly one hour of waiting, he was transferred to the SE Department of Internal Medicine. He was kept there for a few days; according to János, surgery was not even mentioned, and he was only prescribed a blood thinner. This is also stated in the discharge report, which János showed to Direkt36.

Later, he returned to his private doctor, who could not understand why the surgery had not been performed. Since then, János’s leg often hurts, remains swollen, and he must wear compression stockings continuously.