doctors between lack of means and repression

In this medical center in Cairo, people who have contracted Covid-19 can come and get their treatment, free of charge provided by the Ministry of Health. Egypt, June 3, 2020.
In this medical center in Cairo, people who have contracted Covid-19 can come and get their treatment, free of charge provided by the Ministry of Health. Egypt, June 3, 2020. MOHAMED ABD EL GHANY / REUTERS

In the hospital devoted to the treatment of victims of the Covid-19 in a popular suburb of Cairo where he works, Ahmed (the name has been changed) describes a “Horrible situation” for medical personnel. “Doctors lack protective gear, there are no screening tests for us. If you are infected, you have no quarantine, you are sent home. We don’t receive any bonus for the work we do and we are seen as a danger by the rest of society “, enumerated, Tuesday, June 2, by telephone, this doctor, annoyed in addition to see Egypt donating masks to other countries, like the United States.

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Egyptian doctors have been ranted against the health system’s unpreparedness for the Covid-19 epidemic and the risks they run at the hospital have increased on social media since May. They took an alarmist tone when the curve of contaminations and deaths, far from flattening, got racing at the end of the month. With 1,126 deaths and nearly 30,000 cases of contamination as of June 5, according to official figures, the country of 100 million inhabitants is still relatively spared, but it now records more than a thousand infections and dozens of deaths every day. Doctors have paid a heavy price, with at least 32 dead, according to the doctors’ union, and several hundred infected.

Collective resignation

From the beginning of May, the union alerted to the risk of saturation of hospitals, demanding strict confinement of the population and an improvement in the working conditions of nursing staff. Faced with increasing criticism, the regime of President Abdel Fattah Al-Sissi has hardened the tone. The media under the orders of power no longer hesitate to disparage those whom they still hired a few weeks ago, as “The Egyptian White Army”. And, while more than 500 people have already been arrested for criticizing the government’s handling of the epidemic, according to the Arab Human Rights Information Network, doctors are in turn the target of the repression.

“National security threatens to arrest us if we speak in the media or on social networks, or if we resign”, protested Ahmed on Tuesday, citing the case of two colleagues arrested for speaking out on their Facebook page. The young doctor was also arrested on Thursday. “It is very difficult to say how many doctors have been arrested”, says lawyer Mohamed Issa, who has heard of at least a dozen cases. All are being prosecuted for spreading false information and belonging to a terrorist group, an accusation referring to the Brotherhood of the Muslim Brotherhood which is commonly used in political trials.

Arm wrestling between the State and the medical staff tense after the death, on May 25, of Walid Yahia, a 32 years old doctor, of the consequences of the virus without being able to obtain a bed in a quarantine hospital . Dozens of colleagues at Mounira General Hospital in Cairo posted a collective resignation letter on Facebook. Raising the tone, the doctors’ union blamed the ” responsibility “ the rise in cases of contamination and death among doctors at the Ministry of Health, threatening him with legal action for what he considered a “Negligent homicide” across the profession. He warned of a “Possible total collapse of the health system that could lead to a health disaster (…) if the ministry persists in its passivity and negligence ”.

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Faced with pressure from the union and threats of resignation from caregivers, the health ministry oscillates between dialogue and firmness. The talks he started in late May have resulted in some concessions. Advances have been obtained on protective equipment, indicates to World Ehab El-Taher, the general secretary of the union. “But then we had to convince hospital directors, who kept their stocks for fear of facing shortages, to distribute them to the nursing staff”, he adds. However, the union has not yet obtained screening tests for caregivers. “The hospital directors reserve the tests for themselves, while the caregivers are confronted with the disease on a daily basis. It’s very dangerous: they can infect patients. “ continues Mr. El-Taher.

Disciplinary measures

The ministry has promised to reserve caregivers a quarantine unit in each hospital. “We have to requisition hospital rooms for them, which reduces the number of rooms available for patients”, testifies Doctor Manar El-Kholy of the Qasr Al-Aïni hospital, in Cairo. The doctors’ union also deplores the lack of practitioners and training in the treatment of Covid-19. Due to the shortage of doctors in Egypt (1 per 1,000 inhabitants), “Elderly, pregnant and young mothers have been called upon to work in quarantine clinics, which is dangerous for them”, laments Ehab El-Taher.

Prime Minister Mostafa Madbouli on Monday ordered the hospital administration to take disciplinary action against any absent practitioner and to prevent caregivers from going on vacation for the next two months.

The peak of the pandemic still seems far from being reached. 1er June, the Minister of Scientific Research, Khaled Abdel-Ghaffar, who admits that the number of contaminations is surely higher than that of the tests carried out, has not ruled out that Egypt “Reaches 100,000 or even a million cases”.

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The health system, weakened by decades of underfunding – in 2019-2020, only 1.2% of GDP, or 4.3 billion euros, was allocated to it – is near the breaking point. “The situation is still under control, but the coming weeks will be the real test for the health system”, analyzes Ayman Sabae, a researcher in health law at the Egyptian Initiative for Personal Rights (EIPR).

On social networks, videos and testimonies of patients refused by hospitals are increasing. “The hospitals are full because many people with moderate symptoms, who could have quarantined themselves at home, are rushing there. There is poor communication from the Ministry of Health on what to do. As a result, there is sometimes no more room for those who really need to be hospitalized. But the intensive care and resuscitation rooms are empty ”, said a hospital executive in Cairo, who wished to remain anonymous. “Some patients were also refused because they went to a hospital other than the one designated for them by sector”, explains Ayman Sabae, of the EPRA.

The health ministry has announced that it will increase the number of hospitals in charge of Covid-19 to 376. “Some are not yet functional or even built”, objected Mr. Sabae. The government does not seem ready yet to give up on its ambition to deconfine the country in mid-June. After receiving an emergency loan of 2.8 billion dollars (2.48 billion euros) from the International Monetary Fund in May, Egypt wants to revive its economy, and in particular tourism, which represents 12% of its GDP. With the displayed objective of “Coexist with the virus”, the Egyptian authorities have already started to reopen hotels, factories and public administrations, while maintaining physical distancing measures, including the wearing of the compulsory mask, which some people no longer respect.

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