A medical worker disinfects an ambulance which transported a possible patient with coronavirus COVID-19 at fever hospital in Cairo. (Photo by Ziad Ahmed/NurPhoto via Getty Images)

Egyptian Doctors in the State’s Eyes: Rhetoric Versus Reality

07/09/2020 . By Shohdi Mourad

The names of the Cairo-based author and doctors quoted in this article have been changed to reflect their requests for anonymity.

One week before the Egyptian government eased restrictions that had been put in place in response to the COVID-19 pandemic, Prime Minister Mostafa Madbouly blamed the absence of “a number of doctors” from their posts at hospitals as the reason for the recent surge in the number of coronavirus fatalities.

Criticized by the Egyptian Medical Syndicate (EMS) and other doctors and activists online, the speech reflects the contentious relationship between the Egyptian state and doctors since the onset of the COVID-19 outbreak in February.

“Since the start of the pandemic, Egyptian doctors have presented the greatest examples of sacrifice at work, under huge pressure from these difficult circumstances, a lack of personal protective equipment (PPE) in some hospitals, and the continuous attacks on medical teams, while everybody is watching,” the syndicate said in a statement following the prime minister’s speech.

The syndicate, one of a few remaining outspoken and critical professional unions in the country, has been the spearhead since the start of the pandemic in countering government accusations, demanding protection of doctors, reporting their arrests, and providing deaths toll of its members.

This comes as the Egyptian state exerts effort in raising morale via TV promos and news coverage, calling doctors the country’s “white army,” comparing them to soldiers, in keeping with the ongoing hyper-national sentiment that has overwhelmed the country’s visual media since 2013, along with the shrinking of space for independent voices.

However, in reality, away from state-sponsored messaging showing health professionals waving Egyptian flags, doctors have repeatedly voiced their concerns of lack of equipment, adequate safety measures, and the possibility of hospitals running over capacity, all amid a crackdown on critics of how the crisis is being handled.

Reality versus Rhetoric

Outside premises of Imbaba Hospital, several food outlets continued to operate after curfew hours to serve patients, families waiting outside the hospital, and doctors working 12-hours shifts. Among them is Hanan, an internal medicine doctor who took a break to buy food and get new masks from her car.

“Not only we are beaten and insulted, unprotected and underpaid, as well as left alone to fight a [virus] we know [little] about, but we are also accused of causing the surge in the deaths,” said Hanan.

Addressing the shortage in PPE has been one of the most consistent demands the syndicate has called for, amid statements from Egypt’s ministries reporting the sending of equipment to Italy, U.S., U.K., and Sudan.

Hanan said she buys her own PPE from the black market or online from vendors on Facebook, as she and her colleagues are only provided with inadequate amounts of lower-quality equipment. Her cousin is also a doctor and was infected, along with her husband and two children. “Due to the lack of sanitation and sterilizing equipment she sent her clothes to be washed at home and got her family infected,” she explained.

More than 3,000 doctors have been infected according to the syndicate, which also said that around 100 doctors have died after contracting the virus. In addition, approximately 23 nurses, seven ambulance personnel, 30 pharmacists, and 9 technicians have died from COVID-19, according to sources in their respective syndicates.

Nevertheless, the Ministry of Health, on several occasions, has argued that it has adopted a preventive protocol to protect doctors from being infected by the coronavirus by providing preventive medications and training them on using preventive gear, adding that any medical worker with coronavirus symptoms is given a PCR test and that 20 quarantine beds have been allocated to medical workers at each hospital across the country.

One of the doctors who contracted the virus is Samir. “It was shocking and funny to hear the Prime Minister accusing the doctors of the surge [of deaths], keeping in mind the lack of equipment and facilities, let alone training and hospital beds.” Samir, who works in Mounira Hospital, said he requested to be tested, but it was in vain. Coming from a wealthy family, he said that he could afford to go to a private hospital to undergo testing and receive treatment. “My family has spent around EGP 40,000 [$2,481] so far. Imagine a hospital worker, a nurse, or a resident student [who gets infected].”

Civilian attacks also remain an overlooked reality that doctors face. Amr, an internal medicine doctor in Matariya Hospital, said he was assaulted by the family of a dead patient. “The state is giving the news as if we [doctors] are the only ones who are responsible for curing the patients when we are also victims,” he said, adding that such misleading statements will push doctors to simply abandon their posts.

Fears of military trials and arbitrary arrests

Amr is one of the many doctors who are dissatisfied and have criticized unsafe working conditions, insufficient infection control training, shortage in PPE, and access to vital health care.

He fears to voice his anger through social media like others, as Foreign Policy has noted, who have been arrested and accused of spreading false news, and as a colleague of his was threatened with arrest and was referred to investigation by the hospital’s administrative department.

Amnesty International has documented eight health care workers, including six doctors and two pharmacists, who were arbitrarily detained between March and June and were accused of “spreading false news” and “terrorism”.

This week, the Associated Press reported that at least 10 doctors and six journalists have been arrested since the onset of the outbreak.

“Any dissent or tendency to organize, even individually, are crushed,” said Ismail, a medical laboratory scientist from Mansoura. Ismail said that his hospital’s manager took screenshots of posts he wrote criticizing the fact that “police and prosecutors are granted free PCR tests, while doctors are not.”

“I was referred to investigation and threatened by the hospital’s security that I might be arrested.” Since then, Ismail has gone as far as to change where he lives.

He added that a senior colleague, who is diabetic and has asthma, refused to be transported to a quarantine hospital fearing for her well-being but was threatened with salary cuts and promotion delay, potentially affecting her pension.

In North Sinai, Salem, an orthopedist, came in contact with a family member that showed COVID-19 symptoms, and he decided to self-isolate and call in sick. He said he received a phone call from a National Security agent telling him to go to work, threatening to refer him to investigation.

“I was told by senior administrative employees outside the interrogation [off the record] that I could have been court-martialed had I continued to not show up for work,” Salem said over the phone.

Arish hospital turns into a military zone whenever a militant attack takes place in the North Sinai. Salem has been serving in the emergency section for three years, an experience he describes as “traumatizing.”

“We have been there for the country in the most difficult conditions, and this is how they repay us? To threaten us with jail?”

In a statement to General Prosecutor Hamada Al-Sawy, the syndicate has demanded the release of doctors arrested due to their critical views over the Ministry of Health’s handling of the pandemic and over the statements by the Prime Minister. It has also requested that a legal representative from the syndicate be present during interrogations.

Dissent and backlash

Following the death of the 32-year-old doctor Walid Yehia, who was unable to get a bed at a quarantine hospital in Cairo, the syndicate blamed a lack of protective equipment and beds for sickened staff, warning that the system could “collapse.” On social media, several doctors openly discussed the possibility of a strike.

These calls for strikes have led to pro-state media and presenters to accused critical doctors as “agents” of the Muslim Brotherhood group and “victims to plots of the terrorist group.”

After the death of Yehia, more than 18 doctors threatened to resign, accusing the hospital of not providing enough safety measures. One of the 18 doctors, who spoke on condition of anonymity, said that they were called “radicals and Brotherhood members” and were threatened to “have their houses raided.”

A source in the syndicate’s Cairo branch said that the “possibility of a strike is not [tenable], as the repercussions and crackdown will be very rough,” adding that the ongoing crackdown on doctors, a campaign of incitement, and the threat of a scheme to malign doctors as traitors currently prevent an organized strike.

The source cited the harassment the syndicate faced when it announced that it would hold a press conference to discuss the “sacrifices by doctors and what is needed in the coming period.”

While the government may not have to be immediately worried about organized strikes, the syndicate member added, “[It] should be very concerned about doctors simply not showing up to work, not only because they are sick and infected but also because it is not worth it.”

Doctors are physically unprotected, financially insecure, and subject to incitement, added the syndicate member. “If this status quo continues, why would they show up to work, then?”