The nurses of Ceuta request the state of alarm due to the healthcare collapse: up to 1,600 interventions

The declaration of the state of alarm is, constitutionally, a decision of the Government, but with a very clear parliamentary framework and control. That it affects only part of the territory (for example, the autonomous city of Ceuta) does not change the basic procedural scheme, although it is specified in the content of the decree (territorial scope and measures).

1. Who declares the state of alarm and how

According to Article 116 of the Constitution and Organic Law 4/1981, the Government is the one who declares the state of alarm by means of a royal decree agreed upon in the Council of Ministers. This decree:

• Must specify the territorial scope (in your example, Ceuta and, if applicable, its territorial sea or connected spaces).
• Must set the initial duration (maximum 15 calendar days).
• Must specify the measures to be adopted (restrictions on movement, requisitions, service interventions, etc., within what is permitted by LO 4/1981).

This declaration does not require prior authorization from the Congress: it comes into effect from its publication in the BOE (or the moment set by the decree itself), although parliamentary control is immediately activated.

2. First parliamentary procedure: communication to the Congress

The Constitution requires the Government to give immediate account to the Congress of Deputies of the declaration. In practice, this is articulated on two levels:

• Formal communication of the declaration, which is recorded and included in the agenda of the Plenary.
• Possible appearance of the Prime Minister or the competent minister to explain the reasons, territorial scope (Ceuta, in this case), and measures.

If the Congress is not in session, it must be convened immediately to be informed of the declaration. This is already a relevant parliamentary act, although nothing is voted on yet if the duration does not exceed the initial 15 days.

3. Extension of the state of alarm: parliamentary authorization

The key point of the strict parliamentary procedures comes with the extension:

• The Government, if it considers it necessary to extend the state of alarm in Ceuta beyond the initial 15 days, must request authorization from the Congress for the extension.
• It submits a motivated request, specifying:
  • Territorial scope (it can remain limited to Ceuta or be modified).
  • Duration of the proposed extension.
  • Measures intended to be maintained, modified, or added.
• The Board of the Congress qualifies the request and includes it in the agenda of a Plenary session.

In the Plenary, a debate is held in which:

• The Government intervenes to defend the extension.
• Parliamentary groups intervene, setting positions and, if applicable, proposing conditions or modifications (for example, further limiting the territorial scope, specifying particular measures, or reducing the duration).

Subsequently, a vote is held. The extension is approved by simple majority (more votes in favor than against), unless the Rules of Procedure establish any additional procedural nuance. The Congress can:

• Approve the extension as proposed by the Government.
• Approve it with conditions (modifying the term, territorial scope, or applicable measures).
• Reject it, which means the end of the state of alarm upon expiration of the current term.

4. Parliamentary control during validity

While the state of alarm is in effect in Ceuta, the Congress exercises ordinary and intensified parliamentary control over the Government. It can use:

• Oral and written questions to the Government, in Plenary or in committee, about the application of measures in the autonomous city.
• Interpellations and motions, to debate and vote on political positions regarding the suitability of the state of alarm or specific restrictions.
• Periodic appearances of the Prime Minister or involved ministers, to report on the evolution of the situation.
• In extreme cases, a motion of censure if the majority of the Chamber considers the Executive's actions unacceptable.

5. Revocation or termination

The lifting of the state of alarm occurs:

• Automatically when the term expires set in the decree or in the extension authorized by the Congress.
• Before that term, if the Government approves a new royal decree that nullifies the state of alarm in Ceuta (government decision).

The Congress does not directly issue a legal act that revokes the state of alarm, but it can:

• Refuse to extend it, which forces its termination upon expiration of the term.
• Approve motions or resolutions urging the Government to lift or modify it.
• Exercise intense political control that has consequences for the Government's stability.

In summary, to declare the state of alarm in an autonomous city like Ceuta, the initial decision is the Government's, but the continuity, scope, and conditions of the regime depend on the parliamentary procedures in the Congress: immediate communication, debate, authorization of extensions, and constant political control.

The competencies and functions of the Minister of Health are generally determined by Law 50/1997, of November 27, on the Government, and specifically by the royal decrees of basic organic structure of the ministerial departments and the Ministry of Health itself (among others, Royal Decree 1047/2018, of August 24, which develops the basic organic structure of the Ministry of Health, Consumer Affairs and Social Welfare, and subsequent regulations that modify and update it).

1. General framework: functions of any minister

Law 50/1997, on the Government (text in the BOE), establishes the basic statute of members of the Government, including ministers. Based on this law, it can be summarized that the Minister of Health is responsible, as a member of the Government and head of a ministerial department, for:

• Directing the Ministry's activity, setting the general lines of action within the political guidelines established by the Prime Minister and the Council of Ministers.
• Exercising regulatory authority within her competencies, through the proposal and signing of ministerial orders and other general provisions, always within the framework of laws and royal decrees approved by the Council of Ministers.
• Presenting to the Council of Ministers proposals related to her scope (draft laws, royal decrees, agreements, health plans and strategies) for discussion and, if applicable, collegiate approval.
• Managing human, material, and budgetary resources of the department, in accordance with budget laws and the organization established by royal decrees of organic structure.
• Representing the Ministry before other public administrations, institutions, and national and international organizations, both politically and technically-administratively.
• Appointing and dismissing certain senior officials of her department (secretaries general, directors general, etc.), under the terms and limits set by the Government and General State Administration organization rules.
• Politically responding before the Congress of Deputies for the performance of her department, appearing when required and answering questions, interpellations, and information requests.

Law 50/1997 also regulates aspects such as the appointment and dismissal of ministers by the King, at the proposal of the Prime Minister; the regime of incompatibilities (prohibition of professional or commercial activities, among others); and the rules of substitution when absence or vacancy occurs, all equally applicable to the Minister of Health.

2. Specific framework: competencies in health matters

The sectoral competencies of the Minister of Health are specified in the royal decrees that establish and develop the basic organic structure of ministerial departments and the Ministry of Health. In the last decade, this regulation has been adapted through successive royal decrees, including Royal Decree 1047/2018, of August 24 (BOE-A-2018-11841), which develops the structure of the then “Ministry of Health, Consumer Affairs and Social Welfare,” and subsequent regulations that modify and reorder it.

Within this organic framework, the Minister's functions can be summarized as being responsible for the direction of the Government's policy in health matters and, in particular, leading the main lines of action in areas such as:

• General health policy at the state level, including the basic organization of the health system and coordination of the actions of the General State Administration.
• Public health and prevention, at the state level and in coordination with other departments and institutions.
• Relations with autonomous communities in health matters, through cooperation bodies provided for in the regulations (interterritorial councils or other collegiate bodies regulated in the organic structure royal decrees).
• Planning and cohesion of the National Health System, setting common criteria and state reference frameworks, within the constitutional distribution of competencies.
• Direction and supervision of the Ministry's senior and management bodies (secretariats of state, general secretariats, directorates general, and dependent agencies), which assume, by delegation or decentralization, the ordinary management of various health policies.
• Promotion and coordination of Spain's participation in international health organizations, in collaboration with the Ministry of Foreign Affairs when appropriate.

3. Relation with other regulations and organizational adaptation

The regulations on the basic organic structure of ministerial departments — including royal decrees issued under Royal Decree 139/2020, of January 28, establishing the basic organic structure of ministerial departments, and its numerous modifications — periodically reorganize which directorates general and specific bodies depend on the Minister of Health and how competencies are internally distributed.

Consequently, although the core functions of the Minister of Health are stably set by Law 50/1997 (political direction, regulatory authority within her scope, department management, and responsibility before the Cortes), the details of her material competencies in health are adjusted through organic structure royal decrees that may change with each Government reorganization.

Mónica García Gómez (Madrid, 1974) is an anesthesiologist and politician, a reference of the Madrid left, whose career combines clinical practice in public health with activism in defense of the national health system and, later, institutional action in the Assembly of Madrid leading the Más Madrid space. This entire trajectory culminates in her appointment as Minister of Health in November 2023.

Education and medical career

According to her institutional biography, García graduated in Medicine from the Complutense University of Madrid. After completing her training, she worked as an anesthesiologist at the 12 de Octubre Hospital, one of the major reference centers of Madrid's public health system. That direct clinical experience, in a hospital with a high care load and complexity, is the starting point of a profile that has always identified herself as a “public hospital doctor” even after her jump to politics.

During this stage, she combines anesthesiology with a growing sensitivity towards the working conditions of professionals and the organization of the health system. The biography recorded in the public officials database emphasizes that her professional identity is that of an anesthesiologist, something she herself has later claimed as the anchor of her discourse on health.

Health and associative activism

Before entering institutions, García became visible in the field of health activism. The official biography highlights her active participation in defending public health through the Association of Specialist Physicians of Madrid (AFEM). From that space, she engaged in mobilizations against outsourcing and privatization processes of health services in the Community of Madrid.

This activism places her within the so-called “white tide,” the cycle of protests by professionals and citizens defending public health. Her role combines the technical voice — as a specialist who knows the internal functioning of hospitals — with a growing public projection, which would be decisive for her later jump to institutional politics.

Beginnings in institutional politics: Assembly of Madrid

From that mobilization trajectory, Mónica García became a deputy in the Assembly of Madrid. The stakeholders' file indicates that she first served as a regional deputy for Podemos and later joined the Más Madrid group, eventually presiding over the parliamentary group.

In the Vallecas Chamber, she specialized in health debates and in controlling the regional government of the Popular Party. Her biography notes that her discourse revolves around defending public health, criticizing privatization processes, and denouncing the working conditions of health professionals. That parliamentary work, combined with her medical activism background, helped consolidate her image as a spokesperson for “Madrid's public health” against the PP governments.

Consolidation in Más Madrid and opposition leadership

With the consolidation of Más Madrid as a political project distinct from the initial Podemos space, García aligned with the sector led by Íñigo Errejón. The official biography highlights her closeness to Errejón and explicitly mentions that she joined his candidacy in 2019, within the reconfiguration of the Madrid left.

From there, her political weight grew. Subsequent parliamentary press articles recall that she headed the Más Madrid list in the 2021 regional elections, in which the formation became the second force in the Assembly. Later, she would again lead the candidacy in 2023. That double electoral leadership consolidates her figure as a reference of the main alternative space to the Popular Party in the Community of Madrid.

At the same time, she assumed organizational responsibilities within the party. The public officials database records that she holds the presidency of Más Madrid, and other journalistic sources describe her as the regional leader of the organization and co-spokesperson, reflecting leadership both institutionally and internally.

From regional leadership to the Ministry of Health

After several years as a regional deputy, health spokesperson, and lead candidate in Madrid elections, Mónica García made the leap to national politics. The stakeholders' file notes that, in November 2023, she was appointed Minister of Health of the Government of Spain, a portfolio she assumed leaving her seat in the Assembly of Madrid.

By then, her professional and political trajectory was marked by three main traits that explain her profile at the time of appointment: prolonged clinical experience in public health as an anesthesiologist; sustained activism in defense of the health system through AFEM and public health mobilizations; and a parliamentary career in the Assembly of Madrid in which she went from opposition deputy to leader of Más Madrid and main left-wing opposition reference to the Madrid PP. That combination of hospital doctor, activist, and regional leader is what led her to become head of the Ministry of Health at the end of 2023.