Political wrangling over the construction of a new hospital in Tallinn has dragged on for years. However, in 2024, the city launched a tender for the hospital's design and a corresponding contract was signed last September. The project was led by Isamaa Deputy Mayor Karl Sander Kase. After the municipal elections in October, Isamaa remained in power, now sharing a coalition with the Center Party, but the focus has shifted from building the new hospital to seeking ways to terminate the project.

"Before the 2025 local elections, the former mayor committed to a €30 million design project without actually having the funds to back it. The real question is whether the city should shoulder responsibilities that, by law, fall to the state," said Tallinn Deputy Mayor Riina Solman (Isamaa).

According to Solman, the design phase of the new Tallinn Hospital has been frozen and cannot move forward until the capital and the national government reach a funding agreement at the Riigikogu level. She noted that current Social Affairs Minister Karmen Joller, a member of the Reform Party, holds a position on the hospital that is entirely at odds with that of her ministry's officials.

Under the current plan, the hospital's design is expected to be completed by the end of 2028, which would align with a new opportunity to apply for European Union funding. Solman said the city has commissioned a legal analysis.

"We need to determine whether there's even a shred of hope of receiving EU funding. Ordering a design implies that you intend to build. You can't ask the EU for money without a project. That's also a fact," Solman said.

Former Mayor Jevgeni Ossinovski (SDE) said extensive groundwork was done together with the Ministry of Social Affairs to address legal and financial issues and to plan the new hospital in an optimal way.

"In reality, we continued and advanced to the next phase of a project that was actually launched ten years ago and most recently led by former mayor Mihhail Kõlvart (Center). The fact that both Kõlvart and Isamaa have now changed their stance on this is rather astonishing," said Ossinovski. In his view, Solman's talk of freezing the project effectively means the hospital will never be built.

While Isamaa has criticized Ossinovski for saddling the city with tens of millions in obligations without financial coverage, the former mayor maintains that the project, which was to be completed by 2028, was thoroughly calculated.

"That timeline was no coincidence — it was deliberately chosen so that by then we'd have a new national government and a new EU funding period, which would allow us to implement the financial model we negotiated with the state," Ossinovski said.

He added that it would be possible to secure €100 million in EU support for a crisis hospital, another €100 million from CO2 credit funds and the rest would need to come through shareholder loans.

"The idea was that both the state and the city would provide AS Tallinna Haigla with loans to construct the hospital and then the company would repay the money over ten years from its operations," Ossinovski explained.

If the new hospital is not built, the existing hospitals — left largely unrenovated in anticipation of the medical campus — will have to be modernized. The estimated cost of building the new hospital is €850 million, while renovating the current facilities would cost €650 million. That burden would fall entirely on Tallinn taxpayers, as no EU or CO2 funding could be used.

The East Tallinn Central Hospital (ITK) is practically a cross-section of Estonian history, with some buildings dating back to the early years of the republic and others built by German prisoners of war after World War II. Even if fully renovated, the facilities cannot be made to fully meet modern standards due to technical constraints.

Tallinna Haigla CEO Arkadi Popov said it is extremely difficult to modernize old hospitals to current standards. He cited the surgical wing as an example, noting its strict requirements for ventilation, lighting and electricity.

"To renovate an operating room, we'd have to halt surgical activities or drastically reduce them because it's practically impossible to renovate a functioning surgical block," said Popov.

If the new hospital campus is not built, new buildings will be needed for ITK and West Tallinn Central Hospital, as well as for the Tallinn Children's Hospital. While the current city government believes the existing hospitals can last another 20 years, Popov is less optimistic.

"Structurally, the buildings may stand, but from the perspective of a patient seeking treatment in proper conditions and the medical staff working in these hospitals, I don't think that's an adequate solution," said Popov.

According to healthcare expert Toomas Palu, hospitals are generally built with a 50-year outlook and it's not just Tallinn's facilities that are outdated. The state-owned North Estonia Medical Center (PERH), largely constructed in 1980, faces the same fate.

Palu said the drawn-out, obstacle-ridden process of building a single local hospital is not unique to Estonia.

"Healthcare is inherently political everywhere because of the many stakeholders involved. What makes it especially difficult in Estonia is that one area may be served by institutions with split governance and ownership. We see just how hard it is to reach agreements between different owners," Palu said, adding that constructive discussions could help bring about a shared solution.

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