25 July 2020
Egypt’s health system problems laid bare
Published online 3 July 2020
The COVID-19 pandemic is bringing broader attention to the longstanding ailments of Egypt’s medical profession.
Ameer, from Cairo, has only two regrets about his career in medicine. One is that he wishes he had started sooner on the certificates and training required of Egyptian physicians to practice medicine in Saudi Arabia or the UK. Now catching up, the 31-year-old divides his time between practicing at a government hospital in Giza, where he earns about US$140 monthly, and training at a university hospital in the Delta, which sets him back about US$170 monthly.
“Unless you have inherited your father’s medical practice, moving abroad, especially to the Arab Gulf states, is an absolute no-brainer,” says Ameer, which is not his real name. Like the other doctor interviewed for this article, he asked that his name not be used so he could speak freely about an issue the Egyptian government deems sensitive1 . Already, many of Ameer’s 2013 cohort are practicing doctors in the Arab Gulf states and Europe, he says.
But while the trend of Egyptian physicians moving abroad in large numbers has not escaped notice2 , it rarely commanded national attention until the arrival of the coronavirus.
COVID-19 laid bare a surprising weakness in Egypt. The country that surpasses every other in the Arab region in population size, and is among the region’s most prolific in medical schools3 , has one of the region’s lowest ratios of physicians per capita.
In the most recent data from the World Health Organization4 , Egypt had 445,000 physicians working in the country in 2018, nearly five doctors for every 10,000 citizens. That ratio is low by regional standards. Compare that, for instance, with 26 physicians per 10,000 people in Saudi Arabia, 23 in Jordan, seven in Iraq and Morocco, and 17 in Turkey.
Egypt has one of the region’s lowest ratios of physicians per capita.
Equally concerning about Egypt’s 2018 data is the trend. After rising between 2003 and 2014, to peak at 11 doctors per 10,000 people, the average plummeted to around eight over the following three years, and further down again in 2018. From a regional perspective, Egypt was an anomaly. In all the other countries cited above, the ratios largely steadied or improved over the same period.
The irony is that some of those other countries, such as Saudi Arabia, appear to attain their ratios by luring Egyptian physicians.
The reason may seem straightforward: “Working in Saudi Arabia for a year can earn you nearly as much as you would in Egypt in 30 years,” explains Ameer.
But it is not only about good pay. At the going rates in Egypt for junior doctors, many must shuttle, in the course of one day, between two or three clinics to make a living. That means scarce attention for each patient, fatigue, and little if any time for studies and career development.
“Only recently have I come to understand the concept of a weekend,” says Sharif, an Egyptian assistant professor in dentistry who now practices at a hospital in Saudi Arabia. With the option of eight-hour workdays, a luxury he never had in Cairo, he can now work on acquiring new digital design and 3D printing skills in his fast-changing field.
The Gulf states are not the only countries beckoning Egyptian doctors. Over the last several years, European countries hit by their own dwindling physician numbers5 have endeavoured to recruit more foreign doctors6,7 .
These trends may partly explain the drop in Egypt’s physicians-per-capita ratio after 2014. They also illustrate something more profound. The market for medical practitioners is a global one. Doctors everywhere, including Egyptians, now factor the “Saudi option” against the UK and Swedish ones into their thinking about their careers.
As a result, even though Egypt graduates about 7,000 new physicians annually 8, it only has 213,000 physicians registered as practitioners, according to a widely cited study by Egypt’s health ministry9. Of those registered, the study noted, only two fifths, or 82,000, actually practice in the country. But even these very low figures still do not capture the full picture. Cairo gets the lion’s share of Egypt’s doctors, starving other governorates, especially those farthest from the capital10 .
The pandemic was going to be difficult enough for this vulnerable health system. Its impact has worsened for doctors, however, by government actions and statements from officials, and a lack of personal protective equipment (PPE) for front-line physicians.
As coronavirus-related fatalities grew among physicians, exceeding 90 as of June 2611 , relations between the Egyptian Medical Syndicate and the government soured. The prime minister suggested in a statement that the blame for Egypt’s growing coronavirus deaths, hovering in the high 80s in the last week of June according to official numbers, falls on doctors not showing up for their shifts. The syndicate condemned the remarks, warning they might incite violence against doctors12 .
The remarks prompted broad discussions in media outlets and social media about the roots of the health system’s longstanding ailments. One was the government’s failure to comply with the constitutional stipulation that at least 3% of the country’s gross domestic product (GDP) be allocated to the healthcare system and for that percentage to rise gradually to match global averages. In the 2020-21 budget approved in April, 3.65% of the country’s GDP encompasses spending on health, pre-college and higher education, and scientific research, instead of the 10% mandated by the constitution13 .
Safety is an enduring problem for doctors.
Amr El Shobaki, a political scientist and politician, rejected in a Facebook post14 the “shocking” statement from the prime minister, noting that “the real reason [for the rising death rate] is the health system’s low capacity, thanks to the state’s inability to furnish the minimum resources for it required by the constitution.”
Another enduring problem is safety for doctors. Tolerance of violence against doctors has not been a rare occurrence in Egypt’s emergency rooms. For years doctors have pleaded for a legislative remedy15. With the coronavirus, the violence problem got worse—and more visible. Now calls for legislation with harsher punishment for violence against medical staff are receiving wider attention and support.
In this regard, too, Egypt trails other Arab countries. In May, Sudan passed legislation that toughens penalties for violence against medical staff16. In Saudi Arabia, transgressions against medical workers can lead to 10 years in prison and a million Saudi riyals (US$274,000) in fines17.
Sharif, the assistant professor in Saudi Arabia, finds the delay in enacting similar laws in Egypt incomprehensible. It adds to the general sense among doctors “who are often overworked and underpaid, that they are thoroughly underappreciated by society; so much so that violence against them is OK,” he says.
Given disaffection among doctors with the state of their profession, it is surprising that so many young Egyptians continue to pursue careers in medicine. Ameer, the young physician from Cairo, sometimes regrets going to medical school. “I told my younger cousins not to repeat my mistake,” he says. But they have not heeded his warning. “They responded the way I did when I got similar advice: they didn’t listen.” That is reason for hope.
* The writer is a science journalist with 15 years of experience writing about science in the Arab world. Due to the current security situation in Egypt and the sensitivity of the topic matter, the editor has decided not to reveal their name.
- Rothwell, James (2020. June 8). Egyptian doctors accused of treason after criticising government's coronavirus response. The Telegraph.
- Abd El-Galil, Tarek (2019. July 19). Egypt’s Doctors are Fleeing, Leaving Behind a Physician Shortage. Al-Fanar Media.
- The World Directory of Medical Schools Last updated 2016, June 1.
- WHO (2020, June 3). Global Health Observatory Data Repository – Medical Doctors.
- Jovetic, Andjela (2019. January 27). German Health Minister Says Rules Needed to Stop Doctors from Emigrating. European Views.
- Torry, Harriet (2015. July 20). Germany Seeks Foreign Cure for Its Doctor Shortage. The Wall Street Journal.
- Campbell, Dennis (2017, October 10). Make It Easier for Foreign Doctors to Work in Britain, Minister Told. The Guardian.
- Abdel Galil, Tarek (2018. September 20). Egypt prescribes changes for doctors in training. Al Fanar Media. Retrieved from
- Al Arabi Al Jadeed (2020. May 25). Doctors Resigning Amid Pandemic Threatens Health System, Prompting Efforts to Assuage Them (Arabic).
- Al Ahram (2013. February 13). The Medical Syndicate: Only 44% of Registered Doctors Registered Practice in Egypt, and Remote Governorates “hit hardest” by shortages (Arabic).
- The Egyptian Medical Syndicate Website (2020. June 26). Doctors Lose More Than 90 Martyrs.
- Badr, Atef (2020. June 24). The Medical Syndicate to Prime Minister: Doctors’ Conduct Exemplary and Selfless Despite the Huge Strain. Al Masry Al Youm (Arabic).
- Al Arabi Al Jadeed (2020. April 21). Egypt’s Budget Flouts the Constitution Again on Health and Education Spending (Arabic).
- El Shobaki, Amr (2020. June 23). On the Prime Minister’s Shocking and Regrettable Remarks (Arabic). Facebook post.
- El Hadary, Hadeer (2016. March 16). The Medical Syndicate Finalizes Draft of Law Criminalizing Violence Against Doctors (Arabic). Shorouk News.
- Abdel Rahman, Kamal (2020. May 31). A Legislation Passed in Sudan to Deter Violence Against Doctors. (Arabic). Sky News Arabia.
- Saudi Arabia Ministry of Health (2017. August 19). Verbal or Physical Assault on Medical Practitioners is a Crime (Arabic). Twitter post.