At least 5,000 Russians marched through Moscow on Sunday to protest against plans to lay off thousands of doctors and close hospitals in the capital amid a flagging economy.
Doctors, patients and other protesters braved the freezing cold to voice their opposition to an ongoing Moscow healthcare reform that could remove up to 10,000 doctors from their jobs and close 28 hospital and clinics by early next year.
The demonstration followed a previous doctors' rally early this month, which was the first social protest in Russia in a decade. The pressure on the country's budget has intensified as the economy is taking a hit from low oil prices, a drop in the value of the national currency and from Western sanctions over its role in the deadly conflict in eastern Ukraine.
Many of the protesters were dressed in white coats over their winter jackets. Some carried banners with the names of the hospitals that are being closed.
"Save money on war, but not on doctors," one banner read.
Authorities defend the reform as a much-needed step to modernise a decrepit Soviet-era health care system and close down hospitals that are deemed inefficient. They also say it as a step toward implementing President Vladimir Putin's election pledge to increase doctors' salaries to twice that of the average employee by 2018.
Protesters lamented not only the cuts but also the secrecy that has surrounded the reform, the details of which only became public following a leak to the press in October.
"We're here to show our solidary," said Tatyana Korshunova, 69, who works at a research centre. "Nobody explained anything to us, there was no discussion (of the reform)."
A Moscow psychiatrist said pretty much everyone in the medical community agrees that reform is needed, "but it's not the issue of what we need the reform for, but it's about how it is being done - this is a disgrace".
Moscow authorities said they would offer training programmes for those who are being laid off, but doctors have criticised the effort saying it means they are being offered jobs that they are not qualified for.
The Moscow health department this week held round table discussions with medical professionals, while Moscow Mayor Sergei Sobyanin offered the doctors a one-off severance payment of up to 500,000 rubles (£6,365) each.
The move came just days before the Sunday rally and was considered by some as an attempt to muffle the protest.
Valentin Abdulkhayev, a 37-year-old doctor at a tuberculosis clinic, said the offer of the severance pay is "merely about obeying the law. It's what they were supposed to do."
A petition adopted at the end of Sunday's rally called for the resignation of Mayor Sobyanin and top Moscow health officials.