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Spain repeats election as Catalan crisis boosts far right

November 08, 2019

MADRID (AP) — Spain is holding its fourth general election in as many years — and the second this year — amid voter distrust and a renewed Catalan independence bid that has bolstered the far right. The latest polls in Spanish media hint at a close finish between the blocs on the right and left, suggesting that Sunday’s vote — amid increasing fragmentation and polarization — won’t help dispel the country’s political stalemate.

Pedro Sánchez’s Socialists appeared poised to again win the most seats in Parliament but fewer even than they won in April, when the interim prime minister was unable to get the support of his left-wing rivals to keep his party in power.

Repeated elections make it even harder to win over voters, said political analyst Pablo Simón, a professor at Carlos III University. “The public opinion is angry at the electoral repeat, with record levels of discontent toward the political class and great pessimism over how the economy will perform next year,” he said.

The incumbent is up against five other men for the job as prime minister. In recent days, he has tried to lure undecided and centrist voters by saying he will focus his next term on economic issues and by toughening his stand on Catalan separatists.

He has, for example, promised to bring back prison terms for those who hold banned referendums for independence, overturning a previous Socialist position. “If we want a strong government against precariousness and blockade, a progressive government against the extreme right, and a moderate government against the extremists, here is the Socialist party,” Sánchez said Friday, wrapping up an eight-day campaign in Barcelona.

The Catalan capital has been hit by a wave of mass protests, at times violent, after nine leaders of the wealthy region’s separatist movement were sentenced to prison for an attempt to break away from Spain two years ago.

The turbulence has fueled support in the rest of Spain for Sánchez’s opposition — the conservative Popular Party and the far-right Vox, whose leader ended the campaign calling for voters to support his “patriotic alternative” to oust the Socialist leader.

Even if Sánchez succeeds in rallying support from the anti-austerity United We Can and its new splinter, More Country, a Socialist cabinet likely will need either the backing of small regional parties or for the right-wing opposition to abstain.

The eurozone’s No. 4 economy has been functioning without a stable government since mid-2018, when Sánchez ousted the graft-tainted conservatives in a parliamentary confidence vote. The center-left minority government then crumbled in less than a year after losing the parliamentary support of regionalist parties.

Sánchez’s Socialists went from 85 to 123 seats in the late April election. But he needed support from an absolute majority, or 176 of 350 lawmakers, and a falling out with United We Can leader Pablo Iglesias left him without enough votes.

The latest polls show both of those left-wing parties could lose ground. The Popular Party, meanwhile, is recovering after losing more than half of its parliamentary representation in April, falling to 66 seats. Polls show the conservatives could win more seats in this election. But leader Pablo Casado’s chances to form government are lower than Sánchez’s, given that the party’s natural ally, the center-right Citizens, isn’t expected to do well.

“We cannot divide efforts, we cannot fragment all the momentum of change that Spain has,” Casado said before some 3,000 followers gathered for the final rally at the Madrid bullring. But the party benefiting most so far from the Catalan crisis has been Vox, with its mix of Spanish nationalism and populism.

In addition to calling for deposing Catalonia of its self-government powers and outlawing regional separatist parties, Vox has stepped up its anti-immigration rhetoric. The party has released campaign videos linking migrants with criminality, and its leaders have held rallies outside centers where authorities care for unaccompanied teenage migrants.

Vox won 24 seats in April, less than what polls had predicted but still an unprecedented victory for the far right, which had been on the fringes of the political mainstream since the end of Gen. Francisco Franco’s dictatorship in 1975. This time, surveys predict Vox will win at least 40 seats in the Congress of Deputies.

The party now supports minority coalition governments of the Popular Party and Citizens in the regions of Madrid, Andalusia and Murcia, and its support was key for many other local governments, said Bonnie Field, a professor on Global Studies at Bentley University.

“If the right parties pulled out a surprise victory on Sunday, this arrangement would certainly be on the table,” Field said. Turnout is expected to be low in Sunday’s election, something that generally has benefited right-wing parties. But she noted that the Socialists succeeded in mobilizing voters in April by stirring the “fear of the radical right and the possibility of a right-wing government that depended on them.”

“We’ll have to see if that works again,” she added.

Far-right in Spain sweeps town with anti-migrant message

April 29, 2019

EL EJIDO, Spain (AP) — Surrounded by miles of greenhouses where migrant workers grow fruit and vegetables for the rest of Europe, this sleepy town on the sunbaked Mediterranean coast has become a beachhead for the arrival of the far-right in Spain, the latest country to be hit by the wave of nationalist populism sweeping the continent.

El Ejido was where the upstart far-right Vox party made its most impressive gains during Sunday’s national elections, with its promises to defend Spain’s unity and quash the separatist push in northeastern Catalonia, while also railing against the women’s movement and animal-rights activists who want to ban traditional Spanish bull-fighting.

That message helped power Vox to 10% of the vote nationwide, giving Spain’s parliament its first lawmakers from the extreme right since the 1980s. But it was in El Ejido, a town of some 85,000 residents with a large number of overseas workers key to its agriculture industry, that Vox struck its biggest victory with another of its banner causes: halting illegal immigration. In El Ejido 30 percent of the vote went to Vox, making the party the biggest victor in town.

The day after the election there were no Spanish flags hanging from the balconies of the town’s white-and-pastel-colored buildings, and no gatherings in its public squares. There was no sign of campaigning anywhere as residents of European and African descent strolled along its clean, tree-lined streets.

There was, however, an undercurrent of the populist anger that has helped catapult the far-right to election victories in Italy, Austria and Hungary. Juan José Bonilla, a lawyer and farmer who grows zucchini in the greenhouses known locally as the Sea of Plastic that blanket the surrounding Almería region, is Vox’s candidate in El Ejido for May 26 local elections to be held across Spain. On Monday, Bonilla celebrated Vox’s victory with a cake in the party’s bright-green color decorated with a photo of himself and one of the party’s national heavyweights.

While also mentioning his concern over the risk the Catalan separatists represent to Spanish national unity, Bonilla said it was Vox’s stance on immigration that drove the party’s cause in his town. “People want serious and strong steps to be taken to fight against illegal immigration,” Bonilla told The Associated Press. Traditional parties “have not known how to solve the territorial question (of Catalonia) nor immigration or the high taxes Spaniards are subject to.”

Juan Barón, a 41-year-old taxi driver who also has worked harvesting greenhouse tomatoes, said he voted for Vox because he believes migrants who work for lower wages are unfair competition. The government “helps the migrants more than people that are from here,” Barón asserted, repeating a largely unsubstantiated claim often heard from the anti-immigrant right that migrants get more public assistance than native Spaniards.

Vox won 24 seats in the 350-seat Congress of Deputies, the lower house of Spain’s parliament, making it the fifth-leading power in Spanish politics. Its gains came largely at the expense of Spain’s traditional conservatives, the Popular Party, which suffered its worst ever defeat, plummeting to 66 seats from 137 in 2016 elections.

In El Ejido, the Popular Party’s share of the vote shrank from 52% in 2016 to just 22% on Sunday. Unlike most European countries, Spain had kept a lid on the far right until Sunday. Most Spaniards wanted no reminders of the dictatorship of Gen. Francisco Franco, and the Popular Party had been able to attract a huge spectrum of voters, from the pro-business to those who embraced its patriotic rhetoric.

But corruption cases involving the Popular Party and its failure to stem the spread of secession sentiment in Catalonia have driven many voters to Vox and the center-right Citizens party. Vox leader Santiago Abascal, a former Popular Party member who took the helm of Vox in 2014, calls his ex-party “the cowardly right.”

Abascal compared his party’s showing Sunday to the “reconquering of Spain,” conjuring up the 15th-century campaign by Spanish Catholic kingdoms to end Muslim rule in the Iberian Peninsula. Two of Europe’s far-right leaders, France’s Marine Le Pen and Italian Deputy Prime Minister Matteo Salvini, congratulated Abascal for Vox’s entrance into parliament.

“My warmest congratulations to @Santi_ABASCAL and his young and vigorous party @vox_es for its smashing entry into Parliament! Nations need enthusiastic supporters!” Le Pen wrote on Twitter. Vox won its first seats in any legislative body in Spain in December’s regional elections in Andalusía, when it also won the vote in El Ejido. That breakthrough came amid a spike in illegal immigration as Spain became the leading entry point for migrants to Europe last year, with nearly 60,000 people risking their lives crossing the Mediterranean from Africa on rickety boats and rubber dinghies, often after paying human traffickers.

“Defending our frontiers is not about being on the left or the right. What we want is a defense of our frontiers and the expulsion of illegal immigrants,” Abascal told Spanish television broadcaster Telecinco on Monday. “But we don’t say this to win votes. We say it because it is what we believe.”

El Ejido has 26,206 registered foreigners, most from Morocco. Spitou Mendy, who migrated to Spain from Senegal in 2001, picks vegetables in the greenhouses surrounding El Ejido. He credits the region’s agricultural boom to the hard work of laborers like himself from North and sub-Saharan Africa who came to fill jobs unwanted by most Spaniards.

“If we work here we must also live and sleep here, and have our lives here in Spain,” Mendy said.

Wilson reported from Barcelona.

Spain’s election reshuffles party standings on the right

April 29, 2019

BARCELONA, Spain (AP) — The party that had dominated conservative politics for decades in Spain suffered an unprecedented debacle in national elections Sunday, with the eruption of an ultra-nationalist party causing a seismic shift in the nation’s political right.

The Popular Party lost more than half its support from elections just three years earlier as disenchanted voters flocked to conservative rivals outflanking it on both the left and right. Provisional results gave it 66 seats, which was its worst result since it participated in its first national elections in 1989 and was less than half the 137 it won in 2016.

“I am not one to elude responsibilities, the results are very bad,” Popular Party leader Pablo Casado told a dejected crowd at his party’s headquarters in Madrid. “I only have to say that we are going to start working right now to recover this support and to do so leading the center-right. We had sent warnings out that fragmenting the vote would not be a winning option.”

The Socialist Party of Prime Minister Pedro Sánchez replaced the Popular Party as the biggest vote winner and is poised to stay in power. But the votes that the Popular Party lost went to its closest ideological competitors.

The far-right Vox party will enter the lower house of the Parliament by winning 24 seats. It ran as the defender of Spanish traditions such as bull-fighting and railed against illegal immigration and the women’s rights movement.

The center-right Citizens party, which was participating in its third national election, also improved its share of seats to 57 seats and can aspire to soon overtake the Popular Party. Citizens persuaded some Popular Party members to leave the party and join its ranks during the campaign, including the former president of the Madrid region.

The undisputed loser of the night was Casado. The 38-year-old politician was elected party leader in July to replace former Prime Minister Mariano Rajoy, who retired from public life after he lost a no-confidence vote in Parliament following a court ruling that implicated several former Popular Party members in a corruption ring.

Casado had promised to clean up his party, but he flopped in his first major electoral test. Vox and Citizens both stole away what had been the banner cause of the Popular Party: the fight against Catalonia’s separatists.

Vox leader Santiago Abascal blasted the Popular Party for not wielding a tougher hand with the secessionists, which held an unauthorized referendum on independence in 2017 that Rajoy was unable to stop. Abascal left the Popular Party and took charge of Vox in 2014. He called his former party “the cowardly right” throughout the campaign.

After announcing a “reconquering of Spain” to a thrilled crowd in downtown Madrid late Sunday, Abascal turned up his attacks on the Popular Party. “I want to send a warning to (the Popular Party), which is already trying to blame us for their failings, for their acts of treason and their fears,” Abascal said. “You are the only ones responsible for not being able to stand up to the left.”

Spanish voters will return to the polls next month for European, municipal and regional elections.

Socialists lead Spanish election despite far-right gains

April 28, 2019

MADRID (AP) — Spain’s governing Socialists held a clear lead but will need support from smaller parties to stay in power after a national election in which a far-right party made strong gains, according to partial results released Sunday.

After having two main political parties for decades, Spain’s political landscape has fragmented into five parties. Voters have been disillusioned as the country struggled with a recession, austerity cuts, corruption scandals, the divisive Catalan independence demands and a rise in far-right Spanish nationalism.

With two-thirds of the ballots counted, the Socialists led by Prime Minister Pedro Sánchez won nearly 30% of the vote Sunday. The far-right nationalist Vox party was poised to enter the lower house of Parliament for the first time with about 10% of the vote.

The tally means the Socialists won 126 seats in the 350-seat Congress of Deputies, while the far-left United We Can party captured 35 seats. That is still 15 seats short of the 176-seat majority needed to govern.

To remain in office, Sánchez will have to form a governing alliance with smaller parties. He would likely turn to United We Can, but will have to decide whether he wants to make pacts with Catalan and other separatist parties — a move that would anger many Spaniards.

Turnout in Sunday’s vote was around 75%, up more than 8 points since the previous election in 2016, the provisional results showed. Polls a week ago showed that about one-third of Spain’s nearly 37 million voters hadn’t decided yet who to choose.

On the splintered right, three parties had competed for leadership: the once-dominant conservative Popular Party, the center-right Citizens, and the nationalist, anti-migrant Vox party. The arrival of Vox in Madrid’s national parliament marks a big shift in Spain, where the far right has not played a significant role since the country’s transition to democracy following the death of dictator Gen. Francisco Franco in 1975.

Pablo Casado, who has steered the Popular Party further to the right to stop it from losing votes to Vox, called the ballot the country’s “most decisive” in years. Vox leader Santiago Abascal, who drew the largest crowds during campaigning, told reporters in Madrid that “millions of Spaniards are going to vote with hope, they are going to do it without fear for anything or anybody.”

The surge in turnout included a huge boost in the northeastern Catalonia region, which has been embroiled in a political quagmire since its failed secession bid in 2017 put several separatist leaders in jail while they undergo trial.

Speaking Sunday after voting, Sánchez said he wanted the ballot to yield a parliamentary majority that can undertake the key social and political reforms that Spain needs. The prime minister said he wanted “a stable government that with calmness, serenity and resolution looks to the future and achieves the progress that our country needs in social justice, national harmony” and in fighting corruption.

The Popular Party and the Citizens party focused their campaigns on unseating Sánchez, hinting they could create a conservative coalition government — with the backing of Vox — like the one that recently ousted the Socialists from the southern Andalusia region.

Citizens leader Albert Rivera said a high turnout was needed Sunday to “usher in a new era” while United We Can party leader Pablo Iglesias also stressed the importance of voting. “My feeling is that in Spain there is an ample progressive majority, and when there is high participation that becomes very clear,” Iglesias said.

At the Palacio Valdes school in Madrid, voter Alicia Sánchez, a 38-year-old administrator, worried that the nationalist Vox could influence policy-making if they gain significant support on Sunday. “I’ve always come to vote, but this time it feels special. I’m worried about how Vox can influence policies on women and other issues. They are clearly homophobic. Reading their program is like something from 50 years ago,” she said.

Having voted in all elections since Spain returned to democratic rule four decades ago, Amelia Gómez, 86, and Antonio Román, 90, said they had little faith in any candidate. “All I want is for whoever wins to take care of the old people,” Gómez said, complaining that the two of them together receive less than 1,000 euros ($1,100) a month in state pensions.

Wilson reported from Barcelona.

Candidates in Spain urge voters to keep far-right at bay

April 26, 2019

MADRID (AP) — Appealing to Spain’s large pool of undecided voters, top candidates on both the right and left urged Spaniards to choose wisely and keep the far-right at bay in Sunday’s general election.

What those undecided voters do in this tight race will shape the fortunes of the two political blocs that loosely took shape during campaigning that ended Friday. With no one party expected to win over 50 percent of Sunday’s vote, the question becomes which of Spain’s top five parties will join together after the vote to create a governing alliance.

The incumbent Socialist candidate, Prime Minister Pedro Sánchez, said Friday he’s open to a coalition with the anti-austerity United We Can party, hinting for the first time at a possible center-left governing deal.

On the political right, which the conservative Popular Party used to dominate but which has splintered into three main groups, the upstart far-right Vox party is making inroads. Citizens leader Albert Rivera, meanwhile, insists that his center-right party will only join a governing coalition with the conservatives. His campaign-end speech on Friday in Valencia, which also holds a regional election, focused on lambasting the Socialists while vowing to “unite Spaniards, not separate them.”

The Popular Party’s new leader, Pablo Casado, is also determined to unseat the leftist Sánchez from power but is also battling to stop the far-right from draining votes away from his party, as pollsters are predicting.

“The only alternative to Sánchez is the Popular Party, because we are the only ones that can reach agreements and avoid a deadlock,” said Casado, warning that Spain’s economy would suffer under a center-left alliance.

Casado opened the door to some kind of post-election understanding with the anti-migrant nationalists of Vox. He said the three parties on the political right could potentially “pool” their votes, although he didn’t elaborate.

With no polling allowed in the week ahead of the vote, the only certainty is that a far-right populist party is poised to sit in Spain’s national parliament for the first time since the 1980s, and that an even more fractured political landscape is likely to emerge from Sunday’s election.

Astrid Barrio, a politics professor at the University of Valencia, said the real fight is taking place between the three right-wing parties. Vox has surged in support, mainly due to a rise in Spanish nationalism that is the direct result of separatist demands in the northeastern Catalonia region.

“The left has not responded to the right’s radicalization and separatist parties have not even dared to call for an independence referendum as a condition to eventually back Sánchez,” Barrio said, referring to the political crisis in Catalonia that has affected all of Spain.

“The idea of curbing the rise of the far-right has had a moderating effect,” she said. Three topless activists of the Femen group climbed onto a stage on Friday in central Madrid before Vox’s leader Santiago Abascal was due to speak, shouting “It’s not patriotism, it’s fascism!” as the crowds screamed back at them and police intervened to drag the activists away.

Similar counter-protests have been used by Vox to garner even more support through social media outreach, as the party tries to influence the political debate on issues such as abortion, migration, traditional values or territorial unity.

Vox has also furiously blasted the country’s fervent women’s right movement. Addressing thousands of supporters after the incident, Abascal said Sunday’s choice was “between the leftist dictatorship and the Spain that is alive,” and called on voters to fill the ballot boxes with “red and yellow ballots,” the colors of the Spanish flag.

As he spoke, Italian Interior Minister Matteo Salvini wished that Vox could bring to Spain the same changes that his anti-migrant League has brought to Italy. “The time of the Europe of bureaucrats, bankers, do-gooders and boats is over, the people are back!” Salvini wrote in a tweet in an apparent reference to rescuing humanitarian groups he accuses of encouraging migration.

Spanish law bans media and parties from conducting polls during the final days of campaigning. But the latest surveys available, published Monday, showed that a third of Spain’s nearly 37 million voters still haven’t decided who to vote for.

Warning that the rise of Vox should not be underestimated, Sánchez urged Spaniards to cast a “useful vote.” “We are facing a real risk of the right-wing and the extreme right coming together,” the prime minister said, citing how the Socialist party was unseated late last year by a right-wing pact after 36 years in power in Andalusia, Spain’s most populous region.

A close election result could bring weeks of political hard bargaining, and Sánchez said he didn’t want any government he leads to depend on the votes of small parties demanding regional independence, such as those in Catalonia, because they are “untrustworthy.”

“Spain deserves four years of stability,” he said, noting this is the country’s third parliamentary election in less than four years. Sánchez told the El País newspaper that “it isn’t a problem” if the left-wing United We Can party led by Pablo Iglesias becomes part of his Cabinet if he wins the tight race and forms the next coalition government.

Speaking to supporters in Madrid, Iglesias said that voting for his anti-austerity coalition was the only way to ensure that a Socialist government would remain truthful to left-wing policies. United We Can risks falling from the third force in the national parliament to fourth or event fifth position, behind Vox.

Barry Hatton contributed from Lisbon, Portugal.

A look at the candidates in Spain’s general election

April 25, 2019

MADRID (AP) — A new generation of young and media-savvy political leaders is vying to become Spain’s next prime minister in a general election Sunday. They are all men and less than 50. A deeply divided parliament is expected to emerge from the ballot, and whoever gets the most votes will likely need to sit down and negotiate a complicated governing alliance.

Here’s a look at the main candidates vying to take office:


Sánchez, the Socialist party leader and incumbent prime minister, is aiming to pull off yet another unexpected political turnaround.

He was forced to call an early election when his minority government failed to pass a national spending bill in February. Now, all polls forecast that the Socialists will overtake the conservative Popular Party to garner the most votes on Sunday, but it will be nowhere near a majority.

That would be another surprising victory for the 47-year-old former basketball player who temporarily lost his party leadership in 2016 in an internal spat following two crushing defeats in consecutive national elections.

But rank-and-file party members took back Sánchez as the Socialists’ general secretary in mid-2017 and a year later he engineered a stunning maneuver and became prime minister, forcing his predecessor Mariano Rajoy to face a no-confidence vote over corruption cases tainting the Popular Party.


Casado is facing his first election as head of the Popular Party, Spain’s dominant conservative political force for the past three decades. The 38-year-old lawyer, who has made most of his career in politics, took over as party chief in July vowing to clean up party corruption with a zero-tolerance approach.

Casado has been dragging the party toward more conservative ground and calling for a stronger stance on Catalan separatism. The goal is to prevent a flood of votes going to the center-right Citizens party, perceived as tougher on the Catalonia issue, and the far-right Vox.


The 39-year-old Rivera is anything but shy. A university debate champion and water polo player in his youth, Rivera made his debut in politics in 2006 at age 27 by posing nude for a campaign poster.

He has since led Citizens. It began as a tiny party in Barcelona, created to fight the local Catalan secessionist movement, and it has now spread across Spain. Presenting himself as a champion of free market, Rivera’s party has tried to carve out a space in the center of Spanish politics, enticing voters from both the Socialists and the Popular Party.

Citizens’ newcomer status is now threatened by the upstart Vox, which is also luring conservative voters.


Iglesias was tipped to lead a leftist takeover of Spain in 2015. Now, the pony-tailed former TV politics commentator is struggling to keep his far-left United We Can party from breaking apart.

United We Can has been wracked by in-fighting among its leaders and the polls show it may pay a heavy price. After returning from paternity leave to care for his premature twins he had with party No. 2 Irene Montero, the 40-year-old Iglesias is trying to rekindle the indignation of the jobless and those most hurt by austerity measures.

Sánchez may need to rely on Iglesias for support in a coalition.


Abascal is the scion of a family targeted by the now-defunct separatist group ETA in his native Basque region. He made his career as a member of the Popular Party and now hopes he and others from his Vox party will become the first far-right lawmakers to sit in parliament since 1982.

The platform of Vox, which means voice in Latin, is to defend Spain from what it says are the dangers of separatism, Muslim immigration, feminism and liberals. The 43-year-old Abascal unapologetically defends hunting, bullfighting and traditional and Catholic family values.

He has said that he wants to “reconquer” Spain, a reference to the 15th-century expulsion of Muslims and Jews from Spanish territory. The pistol-carrying politician has called for dropping strict gun controls.

Agonizing decisions being made in Spain’s virus hot spots

April 02, 2020

ZARZA DE TAJO, Spain (AP) — Raquel Fernández watched as cemetery workers lowered her grandmother’s casket into the grave and placed it on top of the coffin of her grandfather, buried just three days earlier.

Eusebio Fernández and Rosalía Mascaraque, both 86, are two of Spain’s more than 10,000 fatalities from the coronavirus pandemic. Like thousands of other elderly victims in Spain, their deaths this week illustrate one of the darkest realities of the crisis: Doctors at overburdened hospitals in need of more resources are having to make increasingly tough decisions on who gets the best care, and age appears to matter more than ever.

“Due to a lack of resources in this country, they won’t put an 86-year-old person on an assisted breathing machine. It’s simply that cruel,” said Fernández, a nurse. “My grandparents fought all their lives to be happy and build their strength so they could grow old with dignity, so of course this moment is very painful, and it is difficult for us to cope with.”

Her grandparents fell ill with a fever and cough. After staying home for several days as health authorities recommended, their son rushed them to a hospital in Torrejón, east of Madrid, on March 25. Two days later, Eusebio died of respiratory failure after testing positive for coronavirus. Rosalía died 48 hours later but her test was inconclusive. Neither was put in an intensive care unit or on a ventilator, Fernández said.

She said her grandmother had a heart condition, but that she believed her grandfather was in excellent health and should have been given more of a fighting chance. “I understand that between someone who is 30 or 40 years old and my grandfather, they will not choose my grandfather, but if this had happened in another moment, in a health care system that claims to be among the best in the world, this would not have happened,” she said.

The coronavirus causes mild or moderate symptoms for most people, but for some, especially older adults and people with existing health problems, it can cause more severe illness or death. Spain has recorded 110,238 infections, placing it just behind Italy’s 115,242 cases, which is the most in Europe. The Spanish government said Thursday the country had over 6,000 patients in intensive care.

Agonizing life and death decisions are being made in Madrid and northeast Catalonia, the main hot spots for the outbreak. Spain’s Health Minister Salvador Illa said care is being given “based on each patient’s case profile, not their age.”

But two weeks ago, workers in Madrid’s hardest hit hospitals told The Associated Press that patients over 80 were not given priority for ICU beds because of their lower chance of survival. On Wednesday, guidelines of Catalonia’s medical emergency response service distributed to hospitals and seen by the AP recommended that virus patients over 80 not be intubated. The document said staff should “offer resources to those patients who can most benefit from them as far as years of life to be saved (and) avoid hospitalizations of people with scarce chances of survival.”

Dr. Xavier Jiménez Fàbregas, medical director of Catalonia’s medical emergency system that distributed the guidelines, told AP that age is just one of many factors. He said the guidelines were accepted ethical practices being applied to this crisis, “given the elevated number of patients with respiratory failure.”

The Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care issued 15 ethical recommendations in deciding ICU admissions if beds were in short supply. They called for wartime, triage-type decisions to benefit those with a better hope of survival, not on a first-come, first-served basis.

Guidelines previously developed by New York state’s health department exclude some seriously ill people from receiving limited ventilators in major emergencies but note that making old age an automatic disqualifier would be discriminatory. The plans add, however, that given the “strong societal preference for saving children,” age could be considered in a tie-breaker when a child’s life is at stake.

Recommendations published this week by German medical associations in response to COVID-19 also say age alone shouldn’t be a deciding factor. Among the situations where they said intensive care should not be provided if availability is in short supply: if the patient needs permanent intensive care to survive.

Experts also say hospitals must calculate how long a patient might need a hospital bed or ventilator and how many more lives the machine might otherwise save. In hard-hit areas of France and Spain, patients “are hospitalized only when there is a chance to save them,” said Marc Bourquin of the French Hospital Federation.

Spanish doctors and nurses say they do not dispute that they offer the best care possible to every patient, but they said lack of ventilators and ICU beds amid increased demand have forced them to raise the bar on who gets what treatment.

Dr. Olga Mediano of Spain’s Society of Pulmonologists and Thoracic Surgeons said it is not just about saving the youngest. “You always have to decide the ceiling of care for a patient. You don’t want to put him or her through a treatment if it won’t be good for them,” Mediano told AP. “You would never intubate a patient who is 95 years old. They wouldn’t be able to take it.”

She described the current situation as unique, “with extremely limited resources and a certain number of ventilators, and intensive care units that are overwhelmed. You have to prioritize and see which patients will most benefit from certain treatments.”

She said nearly every hospital in Spain is doing so, “and we are probably being more restrictive in giving access to the ICU than before because we lack beds.” At her hospital in Guadalajara, Mediano said they are making up for the lack of ventilators by using oxygen masks, and that some patients are responding better than expected. Other hospitals also are doing this, she said.

Spain’s public health care system is known for its efficiency and universal care, but it has seen significant budget cuts in the past decade. In 2017, Spain had an average of 9.7 ICU beds per 100,000 inhabitants, compared with 33.9 for Germany in 2017, 25.8 for the U.S. in 2018 and 16.3 for France this year, according to the Organization for Economic Co-operation and Development,

One sign of hope in Spain is that it has recorded the second highest number of patients who have recovered from the virus with over 26,000. Only China, with 76,000, has more. Health officials also say Spain’s outbreak appears to be “stabilizing,” as indicated by the steady slowdown of the growth rate for new infections. This appears to be due to the stay-at-home rules Spain has employed for over two weeks as part of a national state of emergency.

Hospitals also have rushed to increase capacity, and the number of intensive care beds have tripled in Madrid and in Catalonia. But Lidia Perera, a nurse at Madrid’s Hospital de la Paz, said the situation is still critical.

“Normal wards are starting look like they are almost ICU,” Perera said. “Now the ICU is only for people who are going to be intubated.”

Wilson reported from Barcelona, Spain. Associated Press writers Nicole Winfeld in Rome and Kirsten Grieshaber in Berlin contributed.

The Associated Press receives support for health and science coverage from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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