The migration crisis in Ceuta has pushed its system to the limit, but it shows that doctors remain committed to treating every patient regardless of their origin or situation.

Crises have a unique capacity to test institutions. When normality disappears, when resources are strained and politics pervades every sphere, it becomes clear which principles are truly firm and which depend on circumstances. The serious crisis in Ceuta offers us, in this sense, a lesson worth highlighting: that of its doctors.

The scale of the situation in the Spanish city of Ceuta explains the strain placed on the healthcare system. More than 70,000 people irregularly crossed the border from Morocco at the end of July. According to official figures, between July 31 and August 31 alone, 10,725 healthcare services were provided to the migrant population, an average of 335 per day. At the emergency department of the University Hospital of Ceuta, the average increase compared to the previous year was 77 visits per day.

The numbers matter because they allow us to understand the scale of the problem. But behind them lies a much more important moral reality: thousands of people needed assistance and received it.

The doctors in Ceuta provided assistance without first asking which side of the border they came from, what documents they carried, or what their behavior had been upon entering. They treated Spanish citizens and one person who had arrived from Morocco; the wounded, the drowned, the traumatized, and the sick. They did so as doctors should: according to clinical need, regardless of nationality, religion, ideology, immigration status, or the political implications of the situation.

At times, the workload tripled the usual amount. Doctors publicly denounced the overload and warned of a basic fact that is too often forgotten: the quality of care is not an infinite variable. A system can handle an exceptional effort for a limited time, but it cannot indefinitely sustain a disproportionate demand without deteriorating response times, patient safety, and the working conditions of caregivers.

All of this is happening at a particularly complex time for the Spanish medical profession. The drafting of the new Framework Statute has sparked a significant conflict surrounding the conditions of practice, the recognition of medical specialization, and the framework for professional negotiation, with protests and tensions that remain unresolved. However, this climate of conflict has not diminished the commitment of doctors in Ceuta to providing care: their professional demands have not, for a moment, overshadowed their obligation to attend to those in need.

The political, diplomatic, police, and administrative response can and should be analyzed. It is up to others to determine responsibilities, evaluate decisions, and establish how a border should be protected. The security forces and the Armed Forces are performing indispensable functions and operate within necessarily hierarchical structures. Their actions were in response to orders, regulations, and policies issued by legitimate authorities. However, the medical act has a different nature. It is also subject to the law, but it retains its own moral dimension: when a patient presents, the professional obligation toward them cannot depend on their political or administrative status, nor on orders received from a superior.

The doctor-patient relationship is, by its very nature, a fiduciary one. The term may sound academic, but it expresses something very concrete. The sick person is in a vulnerable position and entrusts another human being with knowledge, intimate information, decisions, and sometimes even their life. The doctor accepts this trust and, in doing so, assumes an obligation of loyalty. Their primary responsibility is not to an ideology, an administration, a political party, or a particular worldview. It is to the sick person in front of them.

The Code of Medical Ethics of the Spanish Medical Association, which is mandatory for all Spanish physicians, is not a mere collection of good intentions. It expresses commitments inherent to the profession: service to humanity, respect for human dignity, non-discriminatory care, and the defense of quality healthcare. The Code of Ethics contains one of the profession’s most demanding statements: a physician’s primary loyalty is to their patient. Its true value is not demonstrated when everything is running smoothly, but rather when adhering to it proves difficult.

Providing care to a migrant does not equate to endorsing a particular immigration policy. Nor does claiming control of a border authorize discrimination against those in need of medical assistance. This is especially important to emphasize in times of polarization. These are distinct issues that a mature society should be able to separate.

The doctors in Ceuta have done it. They have continued providing care as the pressure on healthcare services increased, and at the same time, they have expressed the understandable concern about the sustainability of that care. There is no contradiction between these two attitudes. There is both a profession and a medical identity.

Therefore, Ceuta is not merely a border, political, or institutional crisis. It is also a stark reminder of something fundamental. Where other institutions have been caught in a web of orders, borders, and political maneuvering, medicine remains at its core: a patient, a need, and a duty. That is the fiduciary relationship. And that, ultimately, is why Spanish citizens continue to trust their doctors.

Jose Maria Dominguez . President of the Ethics and Professional Conduct Committee of the Spanish Medical Association. Member of the Bioethics Observatory. Institute of Life Sciences. Catholic University of Valencia