In May 2025, a new wave of strikes and protests by Tunisia’s young doctors exposed the depth of the crisis facing the country’s healthcare system. Faced with deteriorating working conditions, arbitrary assignments, and vague evaluation criteria, doctors mobilized in response to continued inaction by the ministry of health, whose official responses, alongside the government as a whole, inflamed the tensions even further.
Tunisian hospitals have been losing staff, with most newly trained doctors leaving the country in record numbers: around 84 percent of recent medical graduates chose to leave in 2025 alone. This exodus is depleting the country’s most valuable professionals, even as the state heavily invests in the education of doctors. It is estimated that a single doctor costs the government around 150,000 Tunisian dinars (around $50,000) from their first year until they graduate through the public schooling system.
As public healthcare institutions continue to struggle with providing quality healthcare, the state is failing to address the root causes of this brain drain, further fueling the crisis. Without actionable solutions, Tunisia’s vital medical workforce will continue to dwindle.
The evolution of doctors’ grievances through the years
Tunisian doctors have had several grievances with the government. The turning point for the country’s doctors was the death of a 27-year-old surgical resident in December 2020, who fell several floors after using a malfunctioning hospital elevator. The incident caused significant backlash over hospitals’ decaying infrastructure, endangering the medical personnel’s lives. An agreement was found with the government within the month to address safety and work conditions concerns. In early 2021, junior doctors launched periodic strikes after the reforms failed to materialize. This continued in subsequent years, building up frustration that set the stage for the 2025 mass mobilization.
By 2025, doctors started feeling “exploited,” explains Dr. Asma, a young dentistry intern interviewed by TIMEP. “Interns and residents are overworked and exploited, without any real breathing room… the system crushes them.” The challenges doctors face are multifaceted, from a shortage of staff and supplies to dilapidated facilities and heavy workloads. “I even had to perform tooth extractions using my phone’s flashlight multiple times,” adds Dr. Asma.
After years of unfulfilled promises, structural reform in the health sector has significantly stalled amid politicization
Besides the working conditions, the most challenging aspect for young doctors remains the low pay and late paychecks. Residents earn roughly 1,400 Tunisian dinars (around $480) per month and earn even less during their civil service year after graduation—a period of compulsory military service for doctors—receiving between 750 and 1,200 dinars (around $250 to $400). At the same time, night shifts are compensated at an average rate of 1 to 3 dinars per hour, with payments sometimes delayed by up to a month.
Dr. Sonia, a doctor working at a rural public hospital, highlights the importance of drastically increasing doctors’ salaries to ensure they can live with dignity. As Tunisia continues to struggle economically, conditions have worsened for doctors too, who have to deal with accelerating inflation, persistent shortages, and stagnant salaries, much like the rest of the population.
After years of unfulfilled promises, structural reform in the health sector has significantly stalled amid politicization. Budget limitations since the pandemic and a centralized governance model have left hospitals without meaningful or sustainable improvements. With planning and resource allocation concentrated at the national level with limited institutional autonomy, regional hospitals are restricted in terms of decision-making, leading to stagnating structures and persistent inequalities.
Promising a new deal
By spring 2025, tensions between young doctors and the ministry of health intensified after failures to meet the promises made after negotiations, leading to widespread strikes and demonstrations. At that point, the Tunisian Organization of Young Doctors resumed negotiations with the ministry, but without success. Frustration mounted, leading the organization to call for a nationwide strike and a march in May. Many doctors participated, including medical students, interns, and residents. A fourth year medical student stated, “It was so inspiring to see everyone come together despite their exhausting work schedules or upcoming exams.”
The ministry of health responded by threatening retaliatory measures such as random reassignment of internship posts, salary deductions for those participating in the strike, and the invalidation of internships. In 2025, ministry officials escalated the situation further, threatening the Tunisian Organization of Young Doctors representatives with legal prosecution for organizing the protests. Following rolling walk-outs by young doctors, the ministry issued a public statement expressing its intention to meet most of the protesters’ demands, outlining the proposed measures such as salary increases and improvements to working conditions.
However, by November, tensions resurfaced as the ministry delayed promised reforms, leading to another nationwide strike. After a meeting later that month, the Tunisian Organization of Young Doctors suspended the protests following a reconciliation meeting with the ministry of health and getting concrete assurances that resolutions would be implemented.
The exodus of doctors
Young doctors described to TIMEP their decision to leave Tunisia as a rational one, grounded in fears of career stagnation and limited economic prospects. Dr. Amine, a psychiatry resident in France, said: “From my first day at university, I knew, without a doubt, that I would leave by my fifth year of studies.”
While economic factors are central to this exodus, professional growth is equally significant. Dr. Nada, an orthopaedic surgeon currently working in France, left in search of “more resources, continuous training, and real prospects for growth.” She emphasized the difficulty of gaining sufficient surgical experience during her residency and argued that retaining doctors requires changes in “infrastructure and equipment, fairer pay aligned with the profession’s responsibility, and a culture that respects doctors and protects their mental health.”
Other specializations, such as radiology, also face limited prospects in the country and are still underdeveloped, as flagged by Dr. Khaled, a first-year radiology resident.
Concurrently, students who have not started their residency are noticing structural issues through their internships. Amine, a fifth year student, cited corruption, supply shortages, and the lack of beds, while Rihem, another fifth year student, expressed concerns about “injustice toward doctors from patients, their families, and the system itself.”
“With how the government is acting through threats and talks of replacing us with foreign doctors, there’s nothing that would stop this exodus,” Dr. Amine said.
The state’s inability and unwillingness to reform the system has made migration a survival mechanism for young professionals. Although Tunisia invests significantly in training its doctors, their departure eases the wage pressure on a collapsing system, thus functioning as a silent cost-saving mechanism.
The healthcare system at a breaking point
The emigration of doctors and other medical professionals has severely impacted the healthcare system’s capacity to deliver quality care. As Tunisia loses a growing share of its doctors, the public healthcare system bears the heaviest burden. Many of the physicians who remain shift to the private sector, exacerbating staffing shortages in public hospitals. At the same time, economic hardship in the country has left fewer households able to afford private medical services, making the public health system the only option for many.
Dr. Sonia described a sharp decline in public hospital conditions, noting that “routine items that were once taken for granted, such as gloves, probes and disinfectant, are missing or of poor quality”. High turnover among nurses and technicians—many of whom leave after two to three years—means hospitals are “constantly [staffed] with inexperienced staff.” This issue extends beyond doctors to all healthcare professionals who are looking for better opportunities. This high turnover rate subsequently affects the quality of care provided since staff are constantly being trained only to leave as soon as they acquire the necessary skills to be employable abroad.
The emigration of doctors and other medical professionals has severely impacted the healthcare system’s capacity to deliver quality care
Dr. Sonia recounted a devastating example in her hospital where a female patient diagnosed with endometrial cancer needed an MRI, yet had to wait six months to get one or face an unaffordable option in the private sector. Her case could have been easily curable with a simple surgery. Instead, it became inoperable with significant metastasis. In Dr. Sonia’s words, it was “a very preventable case if the MRI had been performed on time.”
Dr. Mouna, a pediatric resident, mentions the unsafe work conditions, explaining that aggression from a patient’s relatives can take place, and “you can be exposed to violence without anyone protecting you.” She stated that the promised reforms always lag, especially after the June 2025 agreement. “They said that by the end of October the changes would start, but right now, nothing’s different,” she noted.
Necessary reforms to retain doctors
Addressing this crisis requires a comprehensive approach. It starts with improving the safety and infrastructure of public hospitals to guarantee a healthy work environment. Concurrently, trust in the system needs to be restored through transparent training systems and objective evaluation criteria. Another important measure to enact would be the improvement of the financial compensation of doctors to make them feel more valued. The mandatory civil year must also be restructured to be a meaningful professional opportunity for doctors’ careers rather than a burden. By implementing these reforms, Tunisian doctors abroad might feel more incentivized to come back, especially if the government builds a smooth re-entry system.
Ultimately, the healthcare system must center both patients and doctors. Stories like Sonia’s case should guide policy decisions across supply chains, staffing, pay, governance, security and more. Young doctors are the backbone of Tunisia’s healthcare system, and have clearly voiced their needs and concerns on multiple occasions to government officials. The solution is simple; they need to be heard.
Iyed Hamadi is a Nonresident Fellow at TIMEP focusing on migration and displacement in Tunisia.