Is Europe Prepared for Future Crises?

It was after 11 AM on what would otherwise have been a normal Monday morning. Tiago Villanueva, a general practitioner (GP), was preparing to go to his clinic in Lisbon, Portugal, when he realized he had no power. “I thought it was like a local power outage; so temporary and would last for a few minutes,” he said. “But I started seeing messages that this was apparently something nationwide, then actually international? And then it dawned on me that it was something very serious.”

On April 28, 2025, Portugal, Spain, and parts of France were hit by a massive power outage, leaving millions without electricity. It impacted every aspect of society, including transportation and healthcare.

By the time Villanueva arrived at the GP clinic, his colleagues were seeing patients but had resorted to working the way they did 20 years ago, writing prescriptions by hand. The phones were only working intermittently, which meant patients could not call in and use phone-based triage services. Eventually, most GPs in this and other practices were sent home. “Primary care essentially ground to a halt,” Villanueva said, with only some doctors left in place in case patients walked through the door with an emergency.

At first, there were concerns about the disruption of the cold chain: The deterioration of vaccines stored in fridges at GP surgeries with no power. But because GP practices and local hospitals in Portugal were merged last year to form local health units, this was quickly resolved in a nationwide effort. “Hospitals came to pick up the vaccines from the surrounding GP practices and store them in the hospital because they had power,” said Villaneuva, who is also president of the European Union (EU) of General Practitioners. Hospitals had back-up generators, so intensive care and other vital services remained operational.

The worst problem for primary care, however, was that many emergency responses couldn’t be coordinated from the local health units because there was no internet at GP surgeries. By Monday afternoon, the mobile phone network, which was also running on generators, had to prioritize phone calls and shut down all data services.

“All of a sudden you couldn’t receive messages at all,” Villanueva said.

Villaneuva’s is just one story among millions across the Iberian Peninsula on that fateful Monday. Reports from hospitals across Spain suggested GP clinics were cancelled, emergency patients and intensive care units were prioritized, and the infrastructure, for the most part, held up.

But there were also reports that immobile patients could not be moved between hospital floors because elevators weren’t working. In Portugal, chronic patients at home with ventilation equipment found they had no power. Villaneuva said there was panic-buying in supermarkets, and that petrol pumps and ATMs were also not working.

Bernardo Materio Gomes, a public health physician and president of the Portuguese Association of Public Health Physicians, said things could have been worse. Within 10 minutes of the outage, Gomes was in position within the Civil Protection offices, an agency whose task it is to deal with emergencies. He witnessed the response from there. “In general in healthcare, it went okay, with no major damage done,” said Gomes. “But it would have been different if the outage had gone on for 24 or 48 hours.”

Longer, and the generators supporting the health infrastructure would have begun to run out of fuel. Some hospitals started to run out of fuel even during the outage. This is where cracks in the back-up plans began to show. First, problems linking solar power connections to hospital generators could not be fixed in the middle of the crisis. Then, one of the major fuel suppliers in Portugal shut down their fuel pumps because, ironically, they required electricity to release diesel. This had a direct impact on the healthcare system. “We need to understand that the movement of people, especially health professionals, relies on fuel,” said Gomes.

Gomes said many patients needing electricity to power their ventilators found their way to hospitals. But in the future, it will be important to prepare rooms within health units like GP clinics or hospitals with generators for these patients.

Other lessons learned include the need to create a back-up communication system within healthcare to better coordinate the emergency response during future crises, more of which are expected, he said. “My main concern is to learn collectively from what went less than okay because we will have diverse threats in the environment that we’re living in,” said Gomes, who is part of a group currently reviewing Portuguese national preparedness. “But we have a lot of preparation to do in order to succeed in overcoming those challenges.”

Plans Around Europe

That more and different kinds of shocks are inevitable is a sentiment held not just in Portugal but across Europe.

“The EU as a whole is increasingly faced with unprecedented risks of different kinds that we need to prepare for,” Eva Hrnčířová, spokesperson on preparedness and health at the European Commission, told Medscape Medical News. “This concerns rising geopolitical tensions, cyberattacks, protection of critical infrastructure but also pandemics or the effects of climate change.” 

At the end of March, the European Commission even proposed a Preparedness Union Strategy, a 30-point plan to deal with future disasters at a European level. Included is preparedness training in schools, a risk warning system, EU-wide stockpiles of food, medicines, and other critical resources, and the development of guidelines to ensure populations can be self-sufficient for at least 72 hours. “It is a practical, commonsense measure that allows individuals and families to cope during the critical early phase of any crisis, such as the electrical power cuts…in the Iberian Peninsula,” said Hrnčířová. 

There has been some criticism of the strategy, not least for its potential to panic citizens, such as a proposal for individual 3-day preparedness kits.

But whatever European countries decide collectively, many are already planning for crises at the national level. Emergency planning simulation exercises are commonplace in the United Kingdom and France, for example. Some countries are instituting national and regional stockpiles, early warning systems, and developing risk assessments. In Belgium, medical students are taught war medicine. The Netherlands has divided its territory into so-called safety regions to deal with emergency responses and has created a new model emergency plan for GP care.

What the blackout in Portugal and Spain has done is to stress-test established systems and expose cracks that everybody should learn from, said Villaneuva. At the very least there should be a rethink of the role of primary care in emergency responses in Portugal. “I think you should have local leads who should be trained and prepared to be the point person for primary care when something like this happens,” he said.

Villaneuva, Gomes, and Hrnčířová disclosed no relevant financial relationships.