Khanka Psychiatric Hospital and Addiction Treatment is facing growing accusations of financial and administrative violations involving its director and deputy. These violations include physical assaults on psychiatric patients, impersonation of a doctor by an individual, and the issuance of medical and therapeutic reports without valid legal or medical qualifications, in clear violation of the Mental Health Care Law. These incidents led the Mental Health Secretariat at the Ministry of Health to dismiss the deputy director, Dr. Badr Abbas, on April 9, less than two months after he assumed the position.
According to local newspapers, Dr. Badr Abbas, the dismissed deputy director, was accused of assaulting patient “F. H.,” who suffers from schizophrenia and intellectual disability, registered under number 8013, after he attempted to leave the hospital unaware during visiting hours in March. Despite the severity of the incident, the hospital director did not refer the matter to an administrative investigation.
In a separate incident, the deputy director introduced a young man named Mohamed Bakr to the medical teams at the hospital, claiming he was a newly transferred psychiatrist. He asked him to examine patient “H. A. H,” registered under number 16487, who had been agitated on March 16 during an internal tour attended by the Undersecretary of the Ministry of Health in Qalyubia. Later, the content of the medical assessment written by the young man in the patient’s file raised doubts among the doctors, particularly after discussions with him in the doctors’ lounge. This prompted them to request an identity check by security, discovering that he was merely a student, born in January 1996, who had impersonated a doctor.
On April 16, the National Mental Health Council announced the formation of a committee from the patient affairs department that visited Khanka Hospital to investigate these incidents. However, the decision to conduct only an internal investigation and remove the deputy director, without referring the case to the Public Prosecution, drew criticism from medical institutions and civil society organizations concerned with mental health. They considered it a violation of accountability principles and a neglect of patient rights.
In related developments, the Mental Health Secretariat summoned the hospital director, Dr. Mustafa Khalil Al-Sharif, in May for an investigation. Local media attributed the summons to complaints about poor administration, allegations of drug use, and accusations that he signed attendance and departure registers instead of his wife, who also works at the hospital and was absent.
Less than a month after these developments, the Central Administration of the Mental Health Secretariat announced on May 8 the resignation of the Secretary-General, Dr. Manan Abdel-Maqsoud, from her position, which she held since October 17, 2017. The administration confirmed that Dr. Abdel-Maqsoud had been a key figure in the development of mental health and addiction treatment programs, contributing to institutional partnerships, supporting scientific research, and building the capacities of the staff.
On May 9, the Secretariat announced the appointment of Dr. Wissam Abu Al-Fotouh as the new head of the Central Administration for Mental Health and Addiction Treatment. According to information from the Secretariat’s official website, Dr. Wissam Mohamed Abu Al-Fotouh Ibrahim is a specialist doctor who serves on the Addiction Treatment and Patient Affairs Administration. She supervises the psychological support team and the helpline for consultations. She also served as the head of the addiction department at the Benha Psychiatric Hospital from 2013 to 2018 and chaired the Patient Rights Committee from 2011 to 2018.
Khanka Hospital had previously witnessed, on February 10, an incident in which a psychiatric patient escaped between 11 a.m. and 1 p.m., taking advantage of a power outage. The patient had entered the hospital on January 13 for a schizophrenia diagnosis with intellectual disability, according to media reports from sources at the Mental Health Secretariat.
Don’t miss: No Dose, No Relief: Egypt’s Methadone Shortage Hits Patients Hard
Complete Lack of Oversight
On April 24, MP Sana’a El-Sayed, a member of the Egyptian Social Democratic Party, submitted an inquiry addressed to the Deputy Prime Minister and Minister of Health regarding what she described as the administrative instability at Khanka Psychiatric Hospital. In her inquiry, the MP revealed three serious incidents involving violations at the hospital: violation of patient privacy by presenting them to an individual impersonating a doctor, who wrote medical reports and prescriptions without any legal or medical credentials; patients being physically assaulted by one of the hospital’s deputy directors in behavior contradicting basic principles of humane care; and the appointment of a financial and administrative manager to head the hospital despite previous administrative corruption charges filed by the Administrative Prosecution.
The MP questioned the silence of the Mental Health Secretariat in the face of these abuses and demanded clarification regarding the National Mental Health Council’s role and its oversight in such cases. She stressed the need for urgent intervention to correct the situation and protect patients’ rights, calling for the inquiry to be referred to the Health Committee in the House of Representatives for discussion and necessary oversight or legislative decisions.
Sana’a El-Sayed considers Khanka Psychiatric Hospital neglected by the Ministry of Health’s oversight and inspection bodies, while suffering from financial and administrative corruption, as well as violations related to the mistreatment of patients. She confirmed to Zawia3 that she received documents from inside the hospital indicating that the recently dismissed hospital director was running his position while his wife worked at the hospital, in violation of conflict of interest laws. Furthermore, he had his name included in medical boards while also serving as the hospital director, making him both a participant and a judge, thus benefiting from the financial allowances allocated to board members, which amount to thousands of pounds. She pointed out that the deputy director’s dismissal last month came after he was suspended due to accusations of financial and administrative corruption.
The MP also revealed that she had received complaints from the families of some patients regarding physical assaults and ill-treatment of psychiatric patients who were sent from courts to serve their sentences for crimes they committed. This also included those referred from military service for psychiatric treatment or evaluation. Additionally, the family of one patient committed to the hospital under judicial orders complained that the administration refused to release him after completing his sentence, claiming that his mental health condition did not allow for his release. However, the MP noted that she could not confirm the accuracy of the family’s or medical staff’s opinion, as the matter ultimately falls under the judgment of psychiatric specialists, and there is no law regulating such issues.
She stated to Zawia3: “I have a strong interest in the Khanka Hospital case after receiving documents proving financial and administrative corruption, as well as complaints from families and staff inside the hospital. Based on this, I submitted an inquiry to the Speaker of the House of Representatives in April, but a date for its discussion has not yet been set. When it is scheduled, I will present the documents I have and hold the Minister of Health accountable regarding the hospital’s oversight. I have been informed that after the inquiry submission, an investigation committee was formed, and some officials at the hospital were suspended from their duties.”.
Don’t miss: Shortage of Psychiatric Medications in Egypt: A Daily Struggle for Survival
Abuses and Allegations of Patient Deaths
Mahmoud Fouad, former board member of Khanka Psychiatric Hospital and Addiction Treatment and director of the Egyptian Center for the Right to Medicine, tells Zawia3 that around 35% of the psychiatric beds in Egypt are located in Khanka Hospital. However, the hospital has recently faced administrative issues that have led to violations of patient rights. He revealed that he had received calls reporting that the deputy director of the hospital had allowed a final-year psychology student from the Faculty of Arts to pose as a psychiatrist. When the doctors became suspicious and discovered the truth, they reported him to the police, leading to the dismissal of the deputy director by the Mental Health Secretariat.
He also states to Zawia3: “Another crisis involves patients whose families have admitted them to psychiatric hospitals many years ago, and after their recovery, they wish to leave, but the families cannot be traced or refuse to accept them, forcing the hospital to keep them. There are around 300 individuals who have recovered from mental illness but remain at Khanka Hospital, according to the Mental Health Care Law No. 71 of 2009. I remember that we had a patient who recovered and was taken by the doctor to his hometown in Minya but could not find his family, and the police station refused to keep him, so he was returned to the hospital. There is no law that determines the fate of these recovered patients.”
This is not the first time Khanka Psychiatric Hospital has faced accusations of poor management and violations against patients. In a previous incident, 10 patients who had been committed to the hospital based on court orders died between August 1, 2015, and August 10, 2015, due to severe negligence. This prompted the Administrative Prosecution to refer 34 officials from the hospital to urgent trial, including the former director of the hospital, the deputy directors, four doctors, the head and deputy head of the nursing department, 23 nursing staff, and the head of patient affairs and a staff member from the same department.
Investigations in case number 201 of 2015 revealed the responsibility of the accused and their role in the deaths of the 10 patients, which occurred due to the failure to implement the necessary procedures to address the summer heat. Psychiatric patients are highly susceptible to heat stroke as a common side effect of psychiatric medications. This happened during a severe heatwave in August 2015, and due to the negligence of the accused in taking medical measures, the patients’ conditions worsened, leading to heat exhaustion and death. However, the hospital management justified the incident at the time by citing the lack of resources provided by the Ministry of Health, which led some volunteer youths to donate ceiling fans and install them in the hospital to alleviate the suffering of the psychiatric patients from the extreme heat.
According to Egyptian newspaper reports, incidents of patient escapes from Khanka Psychiatric Hospital have occurred repeatedly over the years. Some of these incidents date back to 2008, 2012, and 2014. In July 2008, three patients who were accused of murder and sexual assault escaped from the hospital. The hospital management, with the help of the police, managed to return two of them, while the third, Mohamed Hassan Abu Al-Naga, who had been admitted after being diagnosed with undifferentiated schizophrenia following his involvement in a 2005 murder case, remained at large. In August 2012, a psychiatric patient diagnosed with undifferentiated schizophrenia, “Ahmed B. A. M.” aged 31, who had been committed to Section 9 of the hospital by a South Giza court, escaped. The nurses responsible for the section were accused of causing his escape, and an official report was filed (Case No. 971, Khanka Police Station, 2012). This incident was repeated in March 2014 when Saadallah Abdel-Ghani Tayel, who had been committed to the hospital under a final decision from the Alexandria Court of Appeals after being acquitted in case No. 1936, was accused of attempted murder, also escaped.
Don’t miss: Long Hours and Low Pay: Why Egypt’s Psychiatrists are Leaving
Government Plans for Hospital Development
According to the website of the Mental Health Secretariat, Khanka Psychiatric Hospital in Qalyubia Governorate was established in 1912 during the reign of Khedive Abbas Helmy in a desert area on a land area of 570 acres. Currently, about 171 acres of the original land remain within the actual hospital grounds. It was annexed to the Ministry of Health on September 21, 1997, under Presidential Decree No. 331 of 1997 and later became part of the Mental Health Secretariat on January 21, 1998, based on Minister of Health Decree No. 32 of 1998.
The hospital has 20 departments, including 15 psychiatric wards for men not under judicial orders, 4 addiction departments for men, a psychiatric ward for women, and 10 wards for patients under judicial orders. These wards treat patients who have committed crimes while suffering from mental illness, after being examined at Abbassia Psychiatric Hospital. The hospital has an operational capacity of 1,804 beds and offers a range of services, including clinics for addiction, psychiatry, harm reduction, viruses, community medicine, and disability certification for patients with intellectual disabilities and autism. It also provides routine radiology, ultrasound, and ECG services, as well as brain rhythm regulation services.
A delegation from the National Council for Human Rights visited the hospital in May 2023 and recommended continued efforts to develop the hospital’s infrastructure in line with the Ministry of Health’s plan to support mental health services across all governorates, aiming to protect the rights of psychiatric patients and empower healthcare professionals in the field of psychiatry.
In August of last year, Dr. Khaled Abdel Ghaffar, Deputy Prime Minister for Human Development and Minister of Health, directed the development of Khanka Psychiatric Hospital into Egypt’s first comprehensive medical city for mental health, addiction treatment, and elderly care. The plan includes providing all therapeutic, preventive, and cancer treatment services, alongside mental health and addiction care. The total capacity would be 1,800 beds, with 300 beds for therapeutic and preventive services, two linear accelerators for cancer treatment, and 1,500 beds dedicated to mental health services. The minister also instructed the study of establishing an emergency hospital to provide advanced medical services to patients without the need to transfer them to surrounding hospitals.
In September, Egyptian President Abdel Fattah El-Sisi directed an expansion in the establishment of mental health facilities and supported the state-funded treatment system. He tasked the government with starting the construction of the “Sakina” Psychiatric and Addiction Treatment Hospital in New Alamein City and expediting the development of Khanka Psychiatric Hospital in Qalyubia, along with creating residential medical centers for patients, the elderly, and people with disabilities.
Regarding the inquiry submitted by MP Sana’a El-Sayed in April about Khanka Psychiatric Hospital, Dr. Ashraf Hatem, Chairman of the Health Committee in Parliament, confirmed to Zawia3 that the inquiry had not yet been referred to the Health Committee for review and scheduling.
As for the announcement by the Minister of Health in August about the plan to develop Khanka Psychiatric Hospital into the first comprehensive medical city for mental health, addiction treatment, and elderly care, the committee chairman stated that the new budget for the Ministry of Health would be discussed in Parliament next week. The committee will review the Ministry’s plans for the new fiscal year, and it will become clear whether the development plan for Khanka is included or still under study.
Dr. Ahmed Hussein, former Director of Patient Rights Care at the Mental Health Secretariat and former board member of Abbassia Psychiatric Hospital, explains that the mental health sector in Egypt faces significant challenges, including a severe shortage of medical and nursing staff in psychiatric hospitals due to the lower financial compensation compared to their counterparts who travel to Gulf countries. There are also concerns among doctors and nurses about legal liabilities regarding psychiatric patients and fears of being assaulted by patients undergoing agitation. He cited an incident at Khanka Psychiatric Hospital where a patient assaulted a nurse with an axe. Additionally, the limited number of beds in these hospitals is exacerbated by the fact that recovered psychiatric patients, whose families cannot be traced or refuse to take them, occupy about 20% of the psychiatric beds in Egypt.
He states to Zawia3: “Before 2009, psychiatric hospitals witnessed human rights violations such as physical abuse of patients. However, the Mental Health Care Law No. 71 of 2009 has contributed to reducing such violations, with perpetrators facing imprisonment. Yet, there is an issue regarding the lack of a law to regulate cases of recovered patients whose families cannot be found or refuse to accept them, leaving them in hospitals for life. Furthermore, issues arise with patients under Article 10, whose psychological conditions have stabilized, and they no longer pose a danger to themselves or others, but their families may oppose their release, leading to complaints against the hospital or attempts to bribe the nursing staff to keep the patient in the hospital indefinitely.”
The Mental Health Care Law No. 71 of 2009, Article 13, states that no one may be involuntarily admitted to a mental health facility without the approval of a specialized psychiatrist, when there are clear signs of severe mental illness requiring admission. The law applies in two cases: if there is a risk of severe and imminent deterioration of the patient’s mental health, or if the symptoms pose an imminent threat to the patient’s or others’ health or safety.
Article 14 of the law permits a non-specialist doctor to admit a patient involuntarily for evaluation for a period not exceeding 48 hours, based on a written request from one of the patient’s relatives (up to the second degree), a police officer, a social worker, a health inspector, or a psychiatrist not working at the facility.
Dr. Ahmed Hussein, former board member of Abbassia Psychiatric Hospital, reveals that the state is moving toward replacing several major psychiatric hospitals, including Abbassia, by reducing the number of patients and closing some departments under the pretext of development. He argues that international protocols for mental health contradict the Ministry of Health’s plans to transform Khanka Psychiatric Hospital into the first comprehensive medical city for mental health, addiction treatment, and elderly care. The global shift aims to move away from large psychiatric hospitals with high patient numbers to smaller, specialized hospitals, each accommodating no more than 100 patients.
Regarding the accusations directed at the management of Khanka Psychiatric Hospital, Dr. Ahmed Hussein does not rule out the possibility of a targeted attack on the new hospital management, which took office only two months ago. He suggests that internal collusion may be involved in attempting to entrap the new management. He pointed out that the Ministry of Health allows unregistered freelance doctors to train in its hospitals, provided they pay fees, which has opened the door to less scrutiny of trainees’ identities. He cited a case where a person impersonated a doctor to gain practical training in a hospital, using forged documents. This was later exposed, and the hospital administration reported the incident to the public prosecution and administrative prosecution. He emphasized that this was the proper legal procedure that Khanka Psychiatric Hospital’s management should have followed when they discovered the impersonation case in late March.
Dr. Alaa Ghannam, Head of the Right to Health Unit at the Egyptian Initiative for Personal Rights, stresses the need to establish boards of trustees for psychiatric hospitals with community participation and to have patient rights protection committees in each hospital to prevent financial and administrative abuses or violations of patients’ rights. He also advocates for the formation of a Supreme Health Council to oversee strategic health planning in Egypt.
While the Ministry of Health plans to develop Khanka Psychiatric Hospital into the first specialized medical city for mental health, addiction treatment, and elderly care, observers and experts warn of poor management, weak oversight, and insufficient financial allocations for mental health hospitals in Egypt. These issues could lead to repeated violations and abuses against patients, violating the Mental Health Care Law.
