You’re running a hospital group in an emerging market and your medtech bill suddenly doubles, so does your rent and your debt. That is the reality for many Russian hospital groups after the currency halved against the dollar. Western medtech is vital and dollar-denominated debt and rents are common.

But not just Russia. Brazil has also seen the real halve against the dollar and the Turkish lira has dropped 50%.

Couple this with recession and the impact on many hospital groups is devastating. Mark Kurtser, who runs MDMG, a big Russian obs, gynae and paediatric chains told us that 2016 would be “catastrophic “ for many Russian groups (but not for MDMG where debt is low and ruble denominated).

But it would be easy to exaggerate the likely impact. Russian expert Emmett Moriarty says many emerging market healthcare service groups have no debt at all and some will have hedged.

But some groups will fail, particularly if we see a real recession – one that hits consumer demand.

On balance, the next 18 months are an opportunity for the best, and most well-run operators to consolidate. They could even be a rare opportunity for mature market operators such as Ramsay, Life, Netcare and Mediclinic to gain entry to these markets.