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Robert L. Quigley, MD, D.Phil. Headshot

With Confederations Cup in the Rear-View, Brazil Looks to the World Cup

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After the 2013 Confederations Cup final, many fans hadn't even left Rio's Estádio do Maracanã before they began making plans for next year. Brazil had just put a 3-0 drubbing on rival powerhouse Spain, and many spectators were already looking ahead to the 2014 World Cup -- which takes place in many of the same locations and venues.

As international soccer/football fans know, the 2013 Confederations Cup had been anticipated as a full dress rehearsal for next year's World Cup. But was it? And what lessons were learned this past June? Perhaps more importantly, what did Brazil's international visitors take away from the Confederations Cup that will help others have an easier time next summer?

In assessing Brazil's preparedness, the first point to note is one that actually surprised many observers: In fact, the Confederations Cup simply didn't draw as many international visitors as expected. And to an extent, this low turnout among global travelers has clouded our ability to predict what will happen during the World Cup -- when crowds will be huge.

As most attendees for this year's Confederations Cup matches were Brazilian, many of the major fears -- of traffic gridlock, long lines, and more -- were held somewhat in check. That is, they weren't as bad as they could have been. Most fans knew where they were going, they spoke the language, and they could navigate tricky situations with dexterity.

But there were still plenty of challenges. Let's examine each of the major areas of concern.


"Confederations Cup host cities had been looking for short-term solutions," Jan Walter reported afterward for Deutsche Welle, "such as special bus lanes to the stadiums or closing schools and government offices on match days in order to reduce the traffic and the impact on tourists." But, he continued, "it didn't really work."

Walter quoted one club's marketing director as saying "it took some people four to five hours to get to the stadium." And while he didn't mention a specific city, Recife, for example, did experience horrendous traffic due to poor road infrastructure. In that location, Uruguay's coach complained that his team was forced to spend three hours in transit for a training session.

In other, larger, cities, however -- like Rio and Sao Paolo -- problems were fewer, as many fans, accustomed to the flow of traffic, left early and arrived on time.

In any event, the good news is that fixing and widening roads is quantifiable (unlike, say, crime or unpredictable protests). The government of Brazil is well aware of this particular issue and they're promising that major traffic issues will be solved in time for the arrival of 600,000 fans for next year's World Cup.

Stadium infrastructure

Brazil's Minister of Sports, Aldo Rebelo, was of the view that the fan experience inside the venues was smooth. "We had around 50,000 spectators per game," he said, "and nobody had problems."

His take may have been a bit optimistic, however, as there were certainly stadium infrastructure issues during the Confederations Cup. Complaints consisted primarily of a lack of food stands, inaccessible internet, and long restroom and water fountain lines inside aging stadiums and those under renovation (something I witnessed myself). At International SOS, we actually assisted with a number dehydration cases during the matches.

The cause of these problems, however, was quite understandable when considering how old the venues were: four of the six stadiums used during the Confederations Cup were built between 1948 and 1974.

But the scene will be different during the World Cup -- and presumably better. In fact, of the 12 stadiums slated for use during the 2014 World Cup, seven will be brand new -- built specifically for the event. The other five are in the process of being substantially renovated. (For example, at Fortaleza's Estadio Castelao, improvements will include four new, exclusive bus lanes, an LRV (light rail vehicle) line and two metro stations -- all of which will make it easier for fans to reach the stadium.)

While not all of this construction was complete in time for the Confederations Cup, the fan experience is expected to be far superior for the World Cup -- as the improvements are currently on schedule.


While traffic in Brazil was generally manageable during the Confederations Cup, problems were exacerbated once street protests began in earnest. In fact, the Confederations Cup endured "unprecedented social unrest, with more than 1.5 million Brazilians taking to the streets" during the tournament. Unfortunately, some of the protests were "marred by sporadic violence and vandalism."

But even faced by throngs of protesters, the police, in my view, did a spectacular job -- acting appropriately and professionally -- in quickly dispersing the crowds once they became unruly. They certainly were effective at keeping things functioning.

Now, this isn't to say there weren't particular complaints about police conduct -- or that some of the protests weren't without merit. Writing for Deutsche Welle, Walter cites one instance of police firing tear gas without provocation. He writes that, "many felt police tactics were heavy-handed and not conducive to de-escalation."

He may be right in that case, but there are always examples heavy-handedness during large, unpredictable demonstrations. From my vantage point, I saw a police force that came out in numbers -- and one that came well-prepared to enforce the law.

The big question, however, is what the security situation will be like during the World Cup next year. Predicting the scope and impact of further protests (and crime) on thousands of tourists, many of them uninformed, is certainly a challenge at present -- but we know it could be significantly disruptive.

All that said, Brazil's security professionals learned a great deal during the Confederations Cup and I see no reason to believe their effectiveness and professionalism won't be replicated for the larger crowds during the World Cup -- whatever they may bring.

Emergency health care

As I wrote before the matches, it's important to understand that health care quality varies considerably across Brazil -- and each region has its own challenges. For example, health care in Rio de Janeiro is world-class and many staff members speak English or other languages. In northeast Brazil, however, travelers will find less infrastructure, fewer English speakers, and less health care technology.

Having noted that, Brazil's health care infrastructure appeared to hold up quite well during the Confederations Cup. Major complaints were few and far between. At International SOS, we received fewer than 2,000 calls for assistance from spectators in Brazil, and the Brazilian health care system was able to accommodate each one. We had little difficulty getting folks into the appropriate facility -- whether it was a private hospital or a public one.

Obviously, for the World Cup, more fans will mean more problems. But as a dress rehearsal, there were no significant warning signs during the Confederations Cup -- other than the protests -- that should be cause for concern.

In sum, Brazil isn't the first emerging country to deal with major infrastructure challenges before a global event. Greece during the 2004 Summer Olympics and China during the 2008 Summer Games were arguably further behind than Brazil is at this point -- and many observers predicted failure in those locations. But both nations, by all accounts, succeeded in hosting hundreds of thousands of visitors.

I expect the same for Brazil. Overall, the Confederations Cup was a positive experience -- and the outstanding issues should be ironed out well in advance of the 2014 World Cup. Brazil is a wonderful country, and as long as the government internalizes the improvements that need to be made, next year's World Cup should be successful.

Rest assured, we'll be monitoring the situation as it develops.

Robert L. Quigley, MD, D.Phil., is the Regional Medical Director, Americas Region, for International SOS, an international healthcare, medical assistance, and security services company.