The disease emphasizes the racism and ableism of the public health sector in Germany. People with disabilities and chronic illnesses must be prioritized over profits.
This essay is part of the Color of Long COVID series, supported by the Disability Visibility Project.
One day in February 2022, I wake up in bed at my childhood home. I am in pain and overwhelmed by a degree of fatigue I could have never imagined — the kind I now know comes from Long COVID.
Sometimes I think I am simply dying slowly; otherwise, there seems to be no explanation. I can barely stand up. Lying in bed, I am exposed to the guilt and the shame of feeling useless. Becoming this sick made something brutally clear to me: this health system can’t hold bodies that fail, slow down, or collapse.
Before Long COVID, I worked as a nurse at a hospital in Berlin. My colleagues would sometimes throw at me in a biting, joking way that I supposedly suffered from “südländisches syndrom.” The term, which roughly translates to “Mediterranean syndrome,” is a racist, stigmatized reference that circulates in medicine and the public health sector in Germany. It is not an actual medical syndrome.
The term, along with related labels such as “morbus mediterraneus,” emerged in German medical culture in the late 20th century as a racist stereotype clinicians used to dismiss the symptoms of patients racialized as “from the South.” As a person of Iranian background, I was a target of this racist thinking.
The term is a discriminatory construct that leads to misdiagnosis and minimization of real symptoms, and contributes to structural racism in the healthcare system in Germany. I heard my colleagues use it or related terms many times, including about me. In the anthology Unlearn Patriarchy 2, Mandy Mangler and Gonza Ngoumou also describe their experiences with this racist phenomenon in the German healthcare system: “The term Morbus mediterraneus was even invented to give the construct a pseudoscientific veneer.”
I had also faced racism from patients when I was a nurse, like the man who rejected every intervention from me and said, “You are surely grateful that you have the opportunity to be here in Germany. But if you want to stay, you need to try a little harder.” Meanwhile, he took his medication instantly from my blonde colleagues.
Sometimes I remember how I used to race up and down the ward’s halls. Today, it feels as if a hyena tore me apart, devoured the best pieces, and spat out the inedible leftovers. Now the leftovers are lying here in bed. Full of despair, shame, and fear. I had known how the system looked at people who faltered. I simply believed I could outrun its gaze — until Long COVID made it impossible.
I had known how the system looked at people who faltered. I simply believed I could outrun its gaze — until Long COVID made it impossible.
Not unlike in the U.S., German work culture is shaped by performance pressure, a lack of class consciousness, and a collective fear of failure and of poverty. Instead of punching up, people punch down toward those who society considers weaker. They become a projection of this fear of failure.
Among the groups considered weaker are people with Long COVID. Long COVID challenges several societal dogmas: its scale puts into sharp relief that illness is not an individual failure and therefore not an individual problem. The disease also exposes that a person’s worth does not come from productivity and that it is a fundamental error to run health systems like profitable companies. It is not surprising that research into the illness is underfunded and slowed down.
Even Germany’s new National Decade Against Post-Infectious Diseases initiative remains trapped in an old logic: it funds biomedical responses while ignoring the social conditions that shape who gets sick, who gets believed, and who gets left behind. It also offers no immediate relief, and no recognition of how class, race, and gender inequalities limit access to care.
I liked being a nurse. I enjoyed supporting people who were in medical crises and needed both practical care and emotional support. The work suited me. But I was never given the time I needed for each patient to actually be satisfied with my own work.
Everyone at the hospital where I worked faced enormous pressure. Newcomers or less-favored colleagues often faced verbal outbursts or bullying. My colleagues were also dissatisfied with me when I hadn’t finished all of my tasks by the end of the shift.
So I worked fast, took few to no breaks, and tried to find some impossible compromise between my own standards and the expectations of my colleagues and superiors. I had already learned as a teenager how to behave in order to be categorized as a “good foreigner.” I didn’t prioritize my own needs and boundaries, and the system I worked for had no interest in them, either. This went on for years. Back then, I believed that if I only tried hard enough, things would somehow turn out okay.
I had already learned as a teenager how to behave in order to be categorized as a “good foreigner.” I didn’t prioritize my own needs and boundaries, and the system I worked for had no interest in them, either.
“Work hard, study hard and you will have a good life,” I used to tell myself before I developed Long COVID. The neoliberal performance promise was burned into me, as it was for most everyone living in high-income and efficiency-oriented societies. So I trained as a nurse, worked shifts after I completed my training, and studied medical education alongside it. Later, I went on to complete a Master of Science in public health.
There wasn’t much room for hobbies, but I had romantic and platonic relationships. For me, like many others in Berlin, parties and clubbing were at the center of many friendships. That’s what made up my identity.
When I got Long COVID, that entire structure imploded.
At first, I didn’t understand what was happening to my body. In my head I kept snapping at myself: “You’re only in your early thirties. You can’t suddenly be too exhausted to meet obligations or maintain friendships.” So I dragged my body to work. And I dragged it to parties. With devastating consequences.
Months later, I had to lie in bed for weeks and depend on my mother to take care of me. My friends — they’d forget me soon. I was sure of it.
Shifting from the “performance promise” towards a society rooted in care
Over the following years, I encountered many physicians and therapists, who had no answers for my condition. And yet they, and some people outside the health system as well, never missed an opportunity to remind me of my shattered dreams: “It’s such a shame. You’re so well educated.”
The performance promise didn’t come true in my case. But I’m the one blamed for it, instead of the system.
I wish that instead of upholding and spreading myths like the “südländisches syndrom,” there was more research on why people of color have higher rates of Long COVID. Why healthcare workers are disproportionately affected. Why women and LGBTQ+ people are affected more often. And why all of these groups also face more medical gaslighting than straight, white, cishetero men.
At a certain point, I stopped waiting for that one medication that would magically make all my symptoms disappear. Instead, I began to believe that I could have a good life even with this illness.
Wouldn’t it be beautiful if this belief could grow in a society rooted in solidarity and care? If all of us who are pushed to the margins of the efficiency culture could start believing in a good life — not despite, but with our vulnerability? If the responsible social and health institutions made us feel like they want us to be well, even when we are not able to perform? If hospitals were places that people with Long COVID could turn to with hope instead of fear. It is hard for me to imagine that hospitals could ever transform in this way so long as they remain profit-driven and embedded in a capitalist system.
To have a good life with Long COVID, I would need to live in a world in which I am not put under such emotional and financial pressure that I wake up in the morning already paralyzed with fear that service providers and caseworkers in various institutions won’t believe me again, and will cut or deny my benefits.
I want a care-centered society in which everyone takes part in care work, everyone understands that they will one day depend on it. But also because everyone is aware that resources are unequally distributed and that compassion matters. Political theorists have long argued that care must be understood as a collective responsibility rather than an individual burden. The vision of care as collective, independently organized work rooted in community and guided by disability justice has already been described and dreamed of.
Institutions should be measured by how well they treat the people who are most burdened, not by their profits. It is the German health system that must change at a fundamental level, not the people whose needs it is meant to serve.
Institutions should be measured by how well they treat the people who are most burdened, not by their profits. It is the German health system that must change at a fundamental level, not the people whose needs it is meant to serve.
Daphne Sara Safaei is a Berlin-based writer and former nurse whose work explores chronic illness, racism, patriarchy and care-centered alternatives to neoliberal systems.
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