As with so many things, the trouble for Iceland’s hospitals began after the 2008 financial collapse. Funding for Landspítali, when adjusted for inflation, dropped by nearly half between 2007 and 2009; while it has since begun to increase again, it has not yet reached its pre-crisis levels.

The budget cuts had an immediate effect on nurses’ wages. Although they had risen by 8.6 percent between 2005 and 2008 according to the OECD, they only went up by 0.2 percent between 2008 and 2011 — an effective cut when inflation is factored in. Workers in many other industries experienced the same cuts, which is why in recent months Iceland has been deluged by one wave after another of labor strikes from workers demanding sharp pay increases.

Doctors affiliated with the Icelandic Medical Association led the charge in late 2014; by striking, they successfully pressured the government into awarding them pay increases of 20 percent or more.

In part because Iceland is such a small country — the total population is about 320,000, or half the size of Boston — doctors typically go abroad to complete their residency. The difference now is fewer of those doctors are coming back. A 2013 poll of students at University of Iceland’s medical school — including those studying to be doctors, nurses, and radiologists — found that roughly half were thinking of seeking work abroad.

Meanwhile, the population of doctors remaining in the country is aging; a survey from 2014 found the average age of a medical specialist had reached 55. When those doctors retire, it is unclear whether there will be enough younger professionals in Iceland to replace them.

Icelandic Medical Association president Thorbjörn Jónsson told Al Jazeera over email that his union hoped a wage increase would prevent more attrition in the ranks. “The number of doctors had declined by about 10 percent in Iceland in recent years, and such a situation would be intolerable in the long run,” he said. “Higher wages should ensure better staffing and quality in the health care system.”

Hospitals abroad, sensing the discontent among Icelandic health care workers, have worked at luring them away.

Last year, Norwegian recruiters somehow obtained the phone numbers of nurses working at Landspítali and began sending text messages inviting them to apply for better-paying nursing jobs in Norway. According to Stefansdottir, some Landspítali nurses received texts from the Norwegians on a daily basis.

Iceland lags behind its Scandinavian neighbors when it comes to wages across most industries, and health care is no exception. As of 2014, the average Icelandic worker in the “human health and social work activities” sector earns a little under $32,000 per year according to data from the government agency Statistics Iceland. In contrast, the average Norwegian worker working in what Statistics Norway calls “health enterprises” collects upwards of $60,500 annually. The average registered nurse in the United States makes an annual salary of more than $65,000 according to the U.S. Bureau of Labor Statistics.

Not every nurse is willing to abandon Iceland. Stefansdottir, who lived in the United States for seven years before returning to Reykjavik, said she and many of her colleagues feel personally invested in the success of their nation’s health infrastructure. “I think most people who work for Landspítali, they want to build it up,” she said. “We have a lot of younger people that have been studying abroad but are coming home.”

If the state of the Icelandic health care system continues to decay, several nurses expressed fears that it would eventually adopt some attributes of the American system and become more privatized. But Sveinn Magnússon, director general of Iceland’s Ministry of Welfare, told Al Jazeera, by email, “We have not seen any indicators pointing towards deterioration.”

Nurses such as Stefandottir disagree. “It’s sad,” she said. “We’re not that many. We should be able to take care of our population.”