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13 January 2021updated 30 Jun 2021 10:41am

How Egypt’s authoritarianism is harming its Covid response

The Egyptian government seems more interested in suppressing negative coverage and maintaining the illusion of control than tackling the country's healthcare crisis.

By Ruth Michaelson

A camera pans around a hospital ward, showing unmoving bodies atop hospital beds. “They’re all dead,” says the man shooting the video, blaming a lack of medical oxygen. Nurses struggle to resuscitate a patient, and another crouches on the floor nearby in shock.

The scene from Hussainiya hospital in Egypt’s Sharqiyah province went viral, sparking fears that Egypt’s strained healthcare system is struggling to cope with the Covid-19 pandemic. It was quickly joined by other videos, such as one showing a woman screaming for help inside Zeftah hospital in Gharbiyah, and a bed-bound man in Damanhour, in Egypt’s Nile Delta, who held an oxygen mask as he described supplies running out. “Join us, minister,” he wheezed, asking local health officials to come to the hospital and see the situation for themselves.

Although the official cause of death among patients in Hussainiya and Zeftah hospitals remains unknown, the videos provided a rare glimpse into how the Egyptian public sector is responding to desperate Covid patients in some government-run hospitals across the country. Egyptian medical experts stress that many citizens avoid public hospitals and only resort to them in the most desperate cases, increasing the likelihood that patients will need supplemental oxygen and straining supply networks. On 8 January seven patients were urgently transferred from Hehya hospital in Sharqiya to Zagazig hospital after the oxygen system within the intensive care unit at Hehya failed.

Yet the Egyptian state is attempting to stifle fears about oxygen shortages. Local security forces in Sharqiya summoned Ahmed Mamdouh, who shot the original video in Hussainiya hospital, for questioning. Prosecutors later questioned the head of the hospital and four doctors who work there, before the Sharqiya governor, Mamdouh Ghorab, accused hospital security of being at fault for allowing the recording “and causing confusion”. Egypt’s public prosecution opened an inquiry into the deaths of seven patients who died at Hussainiya.

Two days after the inquiry was opened, the Egyptian ministry of health suspended Ahmed Mosbah, a doctor in Mansoura who posted a request for oxygen cylinders on Facebook, and referred him to a disciplinary inquiry. He was later reinstated, essential in a country with fewer than one doctor per 1,000 people, but the disciplinary action reportedly remained.

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Although the Egyptian health minister has since claimed that “oxygen is always available” and launched an electronic system intended to keep a check on supplies in government hospitals, some doctors remain unconvinced. “They only care about appearances,” said one working at a state-run hospital in Giza, who cannot be named for his own safety. The same doctor previously described how doctors bought their own PPE to avoid any suggestion they were complaining about the lack of supplies, fearing arrest, as had happened to colleagues elsewhere in Egypt.

“Everyone is scared to raise problems, for fear of being accused of causing trouble,” said a medic working at 6th October University hospital in Giza. She was dismissive of the new system for monitoring oxygen supplies. “The bureaucracy and fear of reporting any flaw in the system can dismantle this electronic system and make it obsolete,” she said.

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The controversy surrounding a potential shortage of oxygen in Egypt is yet another example of the government’s errors in handling the Covid-19 pandemic. Since the first case was identified in the Arab world’s most populous nation in February last year, the Egyptian authorities have worked to ensure the appearance of control, even as patient numbers rose sharply.

“Egypt’s handling of Covid has exposed a phenomenon often observed in police states: the massive capacity they build up to control and repress the population is not to protect the public but to protect the rulers,” said Timothy E Kaldas of the Tahrir Institute for Middle East Policy. “In a country where holding a placard encouraging the public to vote against the regime can lead to an immediate arrest, the authorities failed for several months to enforce a simple mask mandate.”

The Egyptian authorities’ desire for control led security officials to arrest at least eight medical personnel who spoke out about the government’s handling of the pandemic. Most have since been released, but the arrests seemed intended to scare other doctors into silence. Security forces also intimidated members of the Egyptian Medical Syndicate, physically preventing them from holding a press conference to discuss its conflict with the Egyptian prime minister, Mostafa Madbouly, who blamed rising coronavirus cases last spring on “a lack of discipline” among doctors.

“We are not an opposition party,” one syndicate member told the local news outlet Al Masry Al Youm in response. Egyptian media, largely if not entirely state-controlled, accused the syndicate of being infiltrated by the banned Muslim Brotherhood group. Outspoken members said they faced pressure to resign. At least 309 medical staff have died from Covid-19, according to the Syndicate.

“The regime has shown more interest in repressing reports about their shortcomings, arresting critical doctors, human rights defenders and journalists, than it has in securing a remotely accurate tally of the scale of the problem,” said Kaldas.

The government has branded doctors “the white army” due to their white coats. But it becomes harder to massage the public perception of a crisis when people die gasping for breath. Egyptian officials have worked to stifle clear public information about the pandemic, notably through a limited testing regimen where only select cases in government-run hospitals are PCR tested and added to the official daily case number released by the health ministry. Other Covid-19 cases, notably from the many citizens using private hospitals, go unrecorded even if they are confirmed by a positive test. The result is a lack of public health information and limited trust in the government that distributes it.

Fear of mass panic and the resulting loss of control has prevented the Egyptian government from seeking to inform its citizens about the reality of the pandemic. Since coming to power in a military coup in 2013, the Egyptian president, Abdel-Fattah al Sisi, has treated information as a greater public danger than any virus: Egypt now holds 23 journalists behind bars.

“For [al Sisi], reporting problems or talking about them is the thing that tarnishes Egypt’s image, not the problem itself,” said Amr Magdi, a Middle East and North Africa researcher with Human Rights Watch. “This is also the mentality of the government. The minister of health [on 4 January] said that taking photos or videos inside hospitals is no longer allowed, by decree. Rather than addressing or acknowledging mistakes, which could be unintentional, the government response revolves around denial or minimising the problem.”

Magdi said that Covid-19 has exacerbated the Egyptian government’s desire to appear to be in control, as the pandemic has heightened pressure on its citizens. “This is a government that knows it lacks legitimacy,” he said. “Rather than properly addressing the crisis, this becomes a security question of preventing awareness and stopping things from getting out of hand, how to make things appear in control all the time. This means the problem is managed behind closed doors without much public exposure.”