Doctors working at state hospitals started a two-day strike on Tuesday morning as a dispute over performance-based bonuses paid by the state health services (Okypy) rolls on.

Okypy said they have “taken measures” to ensure patients continue to be treated and that “people’s lives are not endangered”.

Doctors’ union Pasyki chairman Sotiris Koumas said that while the strike is going on, doctors will “only work for those who are hospitalised” and that accident and emergency units will “operate in a specific way”.

Koumas said Pasyki and Pasydy would be meeting after the end of the strike to evaluate results and announce further measures.

“When you start with a 48-hour strike, all measures are possible,” Koumas said and blamed the employers – health minister and Okypy – for “forcing” them into a strike.

Pasydy doctors’ representative Moisis Lambrou said this was “a sad day, because those who should have got the message, didn’t.”

He added that everyone who participated in the negotiations tried to blame the doctors.

In a press release, Pasydy said it was necessary to find a solution immediately and that the strike could have been avoided.

Those who had appointments with specialist doctors, all-day hospitalisations for treatment, endoscopies, or other similar procedures scheduled on the days of the strikes, will have their treatment postponed.

Additionally, they said, all scheduled operations have been postponed, and only emergencies regarding patients in critical conditions will be handled. As such, anyone attending an accident and emergency unit with a non-critical emergency will be taken to a nearby private hospital by ambulance.

Intensive care units are operating with minimal staffing, while chemotherapy sessions which can be rescheduled will be rescheduled.

The Cyprus News Agency reported that at Famagusta general hospital and Larnaca general hospital, a number of doctors decided not to strike, meaning that a number of clinics in the two hospitals remain open.

Government spokesman Konstantinos Letymbiotis on Tuesday called for “responsible attitudes on all sides”, and said, “what is affected by this strike is the patients themselves, but also hospitals’ prestige.”

He said the government has “set as a top priority [public hospitals’] upgrade and further modernisation”, and said it is the government’s aim for “the health sector to resemble that of a modern European state.

“In a modern European state, there cannot be no access to healthcare for even hour, nor can we put a price on human life,” he said, adding that “strikes in this sector should be avoided as much as possible”.

He also made reference to people who had had their appointments, operations, or chemotherapy sessions rescheduled due to the strike, saying, “we must weigh this up.”

Later in the day, Health Minister Michael Damianos also implored doctors to end their strike, saying, “there is a solution” and that “dialogue and cooperation must take place”.

“We certainly ask the doctors to return to work because I am sure that there can be a solution to this problem,” he said.

He was asked how worried his ministry was about the possibility of the doctors potentially indefinitely extending their strike, and said, “it is always a bad scenario for a strike to take place.

“As I said before, we invite them to the negotiating table, to find a solution with Okypy. In essence, that is my proposal. Our doors are open because this issue must end. We must not continue to make patients suffer,” he added.

President Nikos Christodoulides had intervened in the matter on Monday night, saying the state “will not bow to pressure that does not have [the] public interest at its epicentre”, and that “a crisis would be in no one’s interest”.

Doctors insist they are owed €4.5 million in financial incentives for 2023. Okypy had offered them €4.1m in July, before an independent analysis found that they were owed just €2.5m, infuriating the doctors.

They insist that they are ready to speak at any time to resolve the issue, particularly with a view to setting the parameters for pay going forward. However, they are also keen to reopen the matter of pay for the year 2023 – a matter Okypy insists is closed.

Okypy said any solution to the dispute “must be holistic, and said an agreement should cover financial incentives between 2023 and 2027

Doctors had also come under fire from the Federation of Cyprus patients’ associations (Osak) last week, with the federation describing it as “inconceivable and unacceptable” for trade unions to use patients’ health and safety as a tool to force their employers to accept their demands.

Despite the criticism, they insist they are owed much more than what has been offered, with Koumas saying in August that “our position is that the procedure was not followed as agreed, while the part of the analysis which has been leaked is just a part. It is not the entire study, the conclusions, and the recommendation made by the financial analyst.”

Meanwhile, Okypy spokesman Charalambos Charilaou was keen to point out that the given figure of €2.5m is “much smaller” than what doctors had originally claimed earlier in the year – a figure he said had amounted to more than €5m.

He was also keen to conclude proceedings and swiftly reach an agreement with Pasyki based on the analysis.

“There was a commitment from both sides that any outcome [from the analysis] would be acceptable. We on our side will keep our word and distribute the €2.5m to the doctors. We have invited the doctors’ unions to come today for that money to be distributed, but from what we have heard … they will not come, which is a shame,” he said.