Egypt: Healthcare and Military Domination (2)

Militarization is mainly based on glorification of the army and military power, with intervention with administration of the country’s ministries and politics, replacing politicians, managers and personnel in the private and public sectors alike. In this regard, the Egyptian model is considered an apparent example of such military hegemony. With General Abdel-Fattah El-Sisi’s seizure of power after the military coup on 3 July 2013, Egypt witnessed a significant increase in militarization of civilian sectors, that it has become clear that the army’s militarization of the country would continue long decades^[1].

In part 1, we addressed the military dominance of health care, as manifested in tackling the law establishing the Egyptian Health Council and the military dominance over top management, especially in the Ministry of Health’s central office; and the military dominance over middle management, including managers of model hospitals.

In part 2, we continue handling this important topic, as will discuss: the military dominance over the outlets that provide health care services to citizens, as well as domination of provision of health services to citizens through increasing numbers of military doctors.

The dominance of the Egyptian military over health care has extended, starting from the vision, manifested in setting policies, through the domination of top management, middle management and terminal management; up to operative management with directly dealing with citizens at service delivery outlets, within the framework of a desire to control all joints and dynamics of health care services materially, financially, morally and humanly.

Military dominance over the outlets for providing health care services to citizens:

The health care services provided to citizens were mainly based on the government-owned (public) hospitals and investor-owned (private) hospitals, where the role of military hospitals in provision of some health care services to citizens was extremely limited (to treatment of some few cases of a special nature). However, in March 2012 after the January Revolution, even under the rule of the Supreme Council of the Armed Forces (SCAF), some members of the Egyptian Medical Syndicate called on the Armed Forces Medical Service Department to transferring three closed (non-operative) military hospitals to the Ministry of Health, and allotting the Salloum and Sidi Barani hospitals to provision of health care for those stranded on the borders between Egypt and Libya, and for the returnees from African countries across the western borders^[2]. However, the situation completely changed after 2013, amid successive steps for military dominance over the health service outlets.

This was carried out on several axes:

1- Expansion of establishment of military hospitals in governorates:

Head of the Armed Forces Engineering Authority (AFEA) stated in a conference attended by Sisi on 16 February 2021 that the AFEA achievements in the field of health included the establishment of 19 new huge military hospitals on areas ranging between 3 to 5 feddans (acres) each, at a cost of about half a billion pounds per hospital, with an accommodation capacity of a large number of diverse beds, equipped at the highest level; the development of other military hospitals in Cairo, Alexandria and other governorates^[3]; the establishment of eight oncology centers in the hospitals owned by the Armed Forces^[4]. Therefore, the number of military hospitals and military medical centers has clearly increased by more than 40% compared to their numbers prior to 2013.

On the other hand, the number of government-owned hospitals  declined from 691 hospitals in 2018, according to a report by the Central Agency for Public Mobilization and Statistics(CAPMAS)^[5], down to only 662 hospitals in 2020, according to CAPMAS bulletin issued on 6 April 2022^[6].

The regime’s keenness to establish military hospitals and expand the scope of their deployment throughout Egypt is due to a decision of Dr. Mohamed Maait, the (current) head of the Health Insurance Authority, allowing police, military, and private hospitals to join the comprehensive health insurance system, if they met required conditions. He explained in a press conference at the headquarters of the Council of Ministers, on 25 October 2017, that the supervisory and control authority, established at that time, would ensure and verify existence of standards in the hospitals expected to operate under the Comprehensive Health Insurance Law^[7].

Added to this, Dr. Soheir Abdel Hamid, head of the General Authority for Health Insurance, on 17 December 2018 signed a contract with Major General Dr. Magdy Amin, Director of the Armed Forces Medical Services Department, under which medical services are provided within all hospitals of the Armed Forces and for all health insurance patients^[8]. Accordingly, the armed forces hastened to start activities and take required measures. On 9 September 2020, the Armed Forces Medical Complex in Maadi organized a workshop in cooperation with the General Authority for Accreditation and Health Control, including more than 100 specialists to explain registration requirements and standards of military hospitals. This comes within the framework of preparations to join the comprehensive health insurance system and based on keenness that the Armed Forces Medical Complex in Maadi would be one of the first hospitals to apply health quality standards approved by the General Authority for Health Accreditation and Control, which reflects keenness of military hospitals to join the comprehensive health insurance system, being one of the most important national projects^[9].

2- Dominance of the Armed Forces Engineering Authority over financial appropriations of the Ministry of Health’s investment plan:

A study issued by the Egyptian Center for Strategic Studies’ Almarsad Almasry monitored development of the health sector in Egypt during eight years, indicating that during the period from 2014 to 2020, the Egyptian state was able to complete implementation of 960 projects in the field of health and population with total investments amounting to EGP 81,290 million, noting that the most prominent achievements were implementation of about 200 projects related to development of hospitals, medical institutes and specialized medical services centers. Some 40 projects related to the Egyptian Ambulance Authority and about 19 national projects for model hospitals, were also implemented, in addition to the development of health units^[10].

The study did not indicate establishment of new government-owned hospitals during that period, 2014/2020.

3- Dominance of Unified Procurement Authority

 The Egyptian Authority for Unified Procurement, Medical Supply, and Technology Management (UPA), a body with a legal personality, affiliated with the Prime Minister, was established by Law No. 151 of 2019 and its executive regulations issued by Decree No. 777 of 2020. The UPA is chaired by Major General Bahaa Zeidan, as it acquires all financial appropriations allocated to the budget of the Ministry of Health to be spent on purchasing. It was entrusted with full responsibility for everything related to health, including supplying equipment, importing, storing, distributing medicines and others, as well as everything related to health needs, in general, and maintenance of hospitals!!

Law No. 151 of 2019 stipulates that the competencies of the Egyptian Authority for Unified Procurement, Medical Supply, and Technology Management include “managing the unified maintenance system for medical devices to improve after-sale services”^[11].

4- Domination of maintenance of medical devices in hospitals after closure of the main government maintenance center:

It is known that maintenance of medical and non-medical devices in hospitals is one of the most important and serious challenges that preserve the security and safety of citizens, by ensuring the provision of a sound health service with high efficiency, and maintaining validity of devices for the longest possible period, which preserves public money, and saves effort and time of the medical team. Based on a decision by the Egyptian Minister of Health in 1996, the Regional Center for Hospital Maintenance was established for the maintenance of equipment in hospitals, to be affiliated with the Ministry of Health’s General Office, and be located in Shebin El-Koum, Menoufia, north of Cairo, as it is geographically located in the middle of the Delta region and all northern Egypt. The center is a non-profit health service institution, and is self-financed through the proceeds of periodic maintenance activities for equipment in hospitals and emergency repair of malfunctions to ensure continuity of providing health services. Despite repeated cries of distress from the center’s staff, and despite requests for briefing from parliamentarians since 2016, the government’s policy has continued to thwart this medical institution with the aim of completely liquidating it.

In early 2020, the executive regulations of the law establishing the UPA was issued to serve as a bullet of mercy for the Regional Center for Hospital Maintenance. Immediately after that, the decision of the Assistant to the Minister of Health (Major General) was issued to close the center, where its closure expressed the presidential directives regarding militarization of the state, and the consequent waste of the rights of civilian workers to a decent life, job security and community stability. Thus, the financial credits of the Ministry of Health have been seized and redirected to serve the interests of a handful of senior military personnel affiliated with the ruling Egyptian regime^[12].

Military hegemony over provision of health services via increase of military doctors

The Armed Forces College of Medicine opens its doors to accept high school students for the first time in Egypt in October 2013, in addition to expansion of the Military Medical Academy’s area of admission, as well as specialized military medical colleges and institutes, including^[13]:

1- Military Medicine Sciences Institute,

2- Hygienic Studies and Preventive Medical Sciences Institute,

3- Aviation and Aero-Space Medical Sciences Institute, and

4- Marine and Deep Diving Medical Sciences Institute.

At the Armed Forces College of Medicine’s first batch graduation ceremony in October 2019, with 200 graduates of young military doctors, a large number compared to graduates of the Military Medical Academy, Sisi spoke about the efficiency and quality of the study at the college, and that it was at the highest technical level, amid communication and twinning with major international universities, with fully boarding accommodation, and promising to allow graduates to continue their study programs, complete postgraduate studies and obtain master’s and doctoral degrees as soon as possible^[14]. Students at the college graduate at the rank of first lieutenant on probation and are given all the privileges of officers of the armed forces. Although the path of service varies according to specializations and the military corps, yet, In all cases, a graduate is allowed to obtain all academic degrees and continuous qualification, internal and external missions, and continuous training throughout his service period and in accordance with the terms and conditions issued in this regard^[15].

The irony was shocking with respect to the clear distinction between a graduate of the Armed Forces College of Medicine in provision of a full, easy and free opportunity in postgraduate studies  and an outstanding salary for a doctor with a military rank, while his fellow graduates of 30 governmental and private civil medical colleges do not find suitable appointment opportunities, nor opportunities for postgraduate studies, which is governed by the high-cost Egyptian board system, according to the Egyptian Health Council law.

This severe problem was further exacerbated by the fact that in September 2022, the Minister of Health agreed on a mechanism that assignment of doctors and the rest of the medical professions would be according to needs, starting from the 2025 assignment movement, amid existence of an operational gap of 65 % of the number of manpower due to migration of doctors overseas^[16].

Under the title “Egyptian Medical Syndicate Is Sounding the Alarm”, the Syndicate revealed in a report that 11,536 doctors have resigned from working in the government sector since 2019, noting that it had monitored the resignation of 934 doctors from early 2022 until 20 March. The Egyptian Medical Syndicate warned of the increase in the numbers of resigning doctors year after year, and called on the government to seriously and urgently intervene, warning at the same time of acts related to localities, administrative abuse and criminal accountability, which would lead to demolition of the health system. It is noteworthy that neglect in the health sector is due to the fact that it serves ordinary citizens, while employees in security and judicial institutions, who represent the least segment, are receive medical services in hospitals designated for them at nominal prices, or with medical treatment subscriptions in private hospitals^[17].

This means widening the operational gap that the health sector actually suffers from due to the migration of civilian doctors abroad, while providing more benefits and financial and academic facilities to military doctors, in procedures that bear the content of displacement of doctors and other members of civilian medical teams and replacing them with other graduates of military colleges and institutes.

Conclusion:

A systematic policy of military dominance at all levels of performance in health institutions is currently underway in Egypt, turning these institutions to tools for serving the military regime and development of its leaders’ wealth, within a framework of tyranny and arbitrary decisions, amid claims that non-military personnel do not understand what a state is, or that civilians are unable to understand the reality; as stated in Al-Sisi’s comment on the problem of pensioners, accusing a former minister and professor of economics of not understanding, only because he had expressed an opinion that differed from the opinion of the ruling authority, although it was within the area of his specialization^[18]. = ^[19]

Egypt Healthcare and Military Domination (1)

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Footnotes