an eventThe 2020 shutdown

The year cross-border care stopped. On 11 March 2020 the Director-General of the World Health Organization told a media briefing in Geneva: "We have therefore made the assessment that COVID-19 can be characterized as a pandemic." Borders closed, airlines grounded, and hospitals cancelled the planned operations that are this directory's entire subject.

Travel first. UN Tourism's assessment of the year, published on 28 January 2021, recorded "1 billion fewer international arrivals in 2020 than in the previous year", international arrivals dropping by 74%, an estimated loss of USD 1.3 trillion in export revenues, and between 100 and 120 million direct tourism jobs at risk. By region: Asia and the Pacific down 84%, the Middle East and Africa 75% each, Europe 70%, the Americas 69%.

Then the operating lists. The CovidSurg Collaborative's modelling, published in BJS in 2020, projected that "28 404 603 operations would be cancelled or postponed during the peak 12 weeks" of disruption — 2,367,050 a week, a global cancellation rate of 72.3%, taking in 81.7% of operations for benign conditions, 37.7% of cancer operations and 25.4% of elective caesarean sections. It is a projection from a survey of surgeons fed through a model, not a tally of cancelled operations, and it should never be quoted as a count.

A destination gives the shape on the ground. Türkiye's official health-tourism series — published by USHAŞ from Turkish Statistical Institute figures, which come from a survey of departing visitors' stated purpose rather than from any hospital's records — counts 756,926 in 2019 and 435,691 in 2020, a fall of about 42%, then 729,592 in 2021 and 1,381,807 in 2022, nearly double the last year before the closure.

Inference — the year did two lasting things to this subject's evidence. It put a hole in every series that a chart now has to draw across, and for many countries in the World Bank's arrivals table 2020 remains the most recent year with a value, so a map of the latest available data is a map of the shutdown. And it taught the trade that a patient who cannot fly is a patient who waits: the queues the pandemic built are part of why the demand came back larger than it left.