Between 11 June and 19 July, 48 of the world’s best national football teams will play 104 games in 16 host cities in the US, Canada, and Mexico, competing for football world supremacy in FIFA’s quadrennial World Cup tournament. Thirteen of those games will be played in Toronto and Vancouver, each city anticipating a financial and tourism boom from the 300,000 well-heeled patrons and fans expected to share in the dynamism (and commerce) of the world’s most popular competitive sport.

But along with the economic bounty for Canada’s most commercially vibrant cities, and the superhuman reach for perfection by athletes, comes a chilling warning that Canadian hospital emergency rooms, already operating at overdrive, are overloaded, and have no room to expand without jeopardising existing quality of care for its own citizens. 

Capacity concerns 

In a lead article in the Canadian Medical Association Journal (CMAJ), written by Dr Catherine Varner, an emergency room physician in downtown Toronto where ERs routinely run at over 100% capacity and assignment of beds may take days rather than hours, she said: “Healthcare providers in Canada are accustomed to flexing and triaging acute care and public health resources. Being in a constant stage of surge capacity is actually the norm. However, even when anticipated surges occur, bedside experiences and provincial quality metrics suggest that systems cannot absorb more load when they are already operating at or above capacity without compromising the quality and safety of patient care.” Dr Varner also noted that co-locating FIFA with the Toronto Pride Festival (the second largest in the world) in one city at the same time only accentuates the problem of access.

Canadians pay heavily for their healthcare – primarily through dedicated fees or everyday sales taxes on everything they buy or rent

Attending to emergencies such as a catastrophic injury to one or more star players or high-profile attendees, dust-ups between competing fan gangs – a recurring sideline issue at these affairs, or – heaven forbid – the collapse of some of the 17,000 temporary bleacher seats added to Toronto’s home stadium to accommodate international visitors, could easily overcome any city’s emergency room capacity. And most of Canada’s major emergency rooms routinely run at or over 100%, with elapsed time between initial assessment and subsequent treatment by the ER physician running at four to five hours in many cases – far more during peak bad weather seasons. And then there’s the adjacent problem of ‘boarding’: keeping a patient lying on a gurney, perhaps in a hallway waiting for admission to a hospital bed – a journey that can stretch into days.

Worries about patient care

In her article, Dr Varner noted that “in the peak of influenza season over the past two years, Ontario has had record-setting emergency department lengths of stay for admitted patients with an average of nearly 24 hours in January 2025”.

She concluded that “increasing staff, even for the duration of these events (e.g. FIFA), is likely not feasible since Canadian hospitals and public health systems already face human resource challenges and budget shortfalls in these years following the Covid-19 pandemic”.

Interviewed by the media after the release of her CMAJ report, Dr Varner noted that during the Major League Baseball World Series in Toronto last November (2025), she saw a surge in trauma, alcohol and substance use-related visits, but, with only one available intensive care unit (ICU) bed available at her hospital – Toronto General – there was only so much that could be done. As it is, four of the seven games were played in Toronto. 

Earlier in 2025, when FIFA outlined a list of requirements for accessing specialist medical services for FIFA staff and players – emphasising the need for instant, no-delay, access for emergency care in time-critical situations – CBC Vancouver interviewed Dr Kerry Bowman, bioethicist lecturer, and Assistant Professor in Family and Community Medicine at the University of Toronto, who concurred that FIFA’s request was quite reasonable, as perhaps some other arrangements could have been devised, but the response from Canada he found “much more worrisome”. Dr Bowman said that treatment options in an emergency room should be made on the basis of medical necessity, “but if that necessity is the fact that they are a high-profile sports star or a VIP associated with FIFA, that’s a real problem… it’s a huge compromise to justice within our system… you cannot knock any Canadian person out of alignment (for care)… it’s very problematic ethically… and it sets a terrible example for people training in healthcare.”

But along with the economic bounty for Canada’s most commercially vibrant cities, and the superhuman reach for perfection by athletes, comes a chilling warning

How did it come to this?

The Canada Health Act, promulgated in 1984, required that all 10 provinces and three territories set up and administer plans honouring the right of citizen-residents to access all medically necessary medical services without regard for their ability to pay, and no extra billing for certain specialist services, as there had been under the original Medical Care Act of 1966. That extra billing was for services out of the ordinary, perhaps by specialists with unique skills. This deletion created long and nasty fee schedule negotiations between physicians and health ministries and left little incentive for advancing private treatment.

The model of private hospitals working in tandem with state-administered systems, as is common in, say, the UK or many European nations, is not the Canadian way, even though it doesn’t accommodate the needs of Major League Baseball, FIFA, the Olympics, or Pride Festivals. Yet Canadians pay heavily for their healthcare – primarily through dedicated fees or everyday sales taxes on everything they buy or rent, from beer at the ballpark to parking spaces. It is true they are not presented with a physician’s bill or a multi-page hospital charge sheet when it’s time to go home, and that’s where the myth of Canada’s ‘free’ healthcare originates. 

But for many, that’s where the spending begins, especially for the 
1.4 million Canadians on waiting lists for specialist services, some of them longer than a year, for procedures as common as neurological or orthopaedic surgeries. 

To be precise, Canada does have a private healthcare sector – that’s the out-of-pocket part of the budget that goes to private health insurance not covered by provincial plans: drugs, eyewear, dental care, cosmetic/weight control, optional services – all accounting for the 30% of health costs not covered by basic health plans.

But for any serious/potentially catastrophic event, it has to be ‘line up and wait’ – though it’s hard to visualise Ronaldo or Messi arriving by ambulance at a hospital in Vancouver or Toronto (followed by throngs of international journalists) and being told, ‘Hang on, the doctor will be with you in four or five hours… more if things get really busy. Please take your place in line.’