When twelve-year-old Amira fell from the first floor and was left fighting for her life, her family did not call an ambulance. A neighbour carried her into the nearest tuk-tuk and rushed her to hospital. Her mother says an ambulance would once have been the family’s most trusted option in an emergency. That trust has eroded.
“An ambulance used to be a safe haven, a lifeline in a crisis,” Asmaa Youssef, 42, from Sohag, tells Zawia3. “Now we dare not wait for one. It might not arrive in time, or it might turn up with hardly any equipment.”
The nearest hospital was only ten minutes away, she says. Yet previous experiences of waiting more than an hour and a half meant the family did not consider calling. “People now act on the principle of saving themselves. Depending on an ambulance can mean watching a patient die slowly.”
Drivers, paramedics and other Egyptian Ambulance Authority employees interviewed by Zawia3 describe persistent structural and financial problems: low wages, long shifts, inadequate equipment and insufficient staff to provide an equitable service.
Some workers say vehicles remain in service long beyond their useful life. They describe ambulances lacking basic equipment for measuring blood pressure or oxygen levels, and sometimes resuscitation equipment. In some vehicles, they say, a stretcher is practically all that is available. These are workers’ accounts of the conditions they encounter, rather than a comprehensive inventory of the national fleet.
Workers describe a service stretched between too many calls and too few equipped vehicles and trained crews. For the families waiting, the consequences are measured in minutes.
Officials have put the fleet at around 3,300 ambulances, alongside plans to add 1,000 vehicles under the Decent Life initiative. But an aggregate fleet count cannot establish whether vehicles are distributed effectively, operational, equipped and staffed.
A 2020 research paper on emergency services in low- and middle-income countries cites a benchmark of one ambulance per 50,000 people. That source does not establish the original article’s attribution of the benchmark to the World Health Organization. Nor does comparing it with a fleet of 3,300 support a calculated shortfall of 2,080 vehicles. The central questions are geographic coverage, readiness and response times.
Workers and families describe particular difficulties in remote areas, including New Valley and Sinai, alongside pressures in major urban centres. They also point to shortages of advanced equipment, including ventilators and vital-signs monitors. Modernising vehicles, they argue, must include the equipment and personnel needed to deliver care during transport.
When delays cost lives
In May 2025, Health Minister Khaled Abdel Ghaffar described eight minutes as a target response time. It should not be confused with a verified nationwide average. Accounts collected by Zawia3 describe much longer waits, both in congested areas and in distant governorates.
One case that attracted widespread attention was the death of a child, Sofia, following a crash on the Wadi El Natrun–El Alamein road on 10 May 2025. Her father said ambulances took 25 minutes to arrive and that the vehicle carrying her changed destination during the journey. In his account, it returned to the crash location after about 50 minutes on the road; that was not the total time taken to reach hospital.
The case prompted calls for accountability under a social-media campaign demanding justice for Sofia. The minister ordered an urgent investigation. On 25 May, he said a paramedic had committed an administrative failing by not going to the nearest hospital and that the case had been referred to public prosecutors. That announcement did not itself establish criminal liability or the medical cause of death.
Congestion, shortages of trained staff and weak coordination recur in accounts of delays. The Ambulance Authority has also warned that misuse of the emergency number, 123, takes resources away from genuine emergencies. Uneven vehicle distribution compounds the difficulties in remote areas.
Naglaa tells Zawia3 that her brother Karim Ali, 29, died after a cardiac emergency in the village of Mit Rakab. “We called at three in the morning. They knew it was an emergency, but the ambulance did not arrive for about 40 minutes. Karim had already died.”
She says the vehicle arrived with a driver and a paramedic but without the equipment she expected. The crew told the family they could no longer help. Naglaa believes better-equipped assistance might have saved him. Her account expresses the family’s anguish and assessment; it cannot establish what the medical outcome would otherwise have been.
In Maghagha, Minya, a falling pane of glass left a girl with a deep wound in her thigh. Her mother, Siham Ibrahim, says repeated calls went unanswered. “We had to take her in our own car. She was bleeding all the way.”
“There should have been an ambulance station nearby, or at least effective coordination,” Siham says. “We are not asking for a miracle—just a decent life and emergency care that respects time and human beings.”
At a factory in Kafr El Dawwar, Beheira, Emad Mahrous says a colleague suffered severe bleeding from a head injury after being struck by a metal tool. He says an ambulance arrived half an hour later without the supplies needed, leaving workers to try to stop the bleeding themselves.
“What use is a vehicle without its equipment? How can we call that an ambulance?” asks Mahrous. “What I saw was closer to a transport vehicle than an emergency unit.”
Crews working under punishing conditions
Ahmed, an ambulance driver with more than twelve years’ experience in Sharqia, says shortages sometimes leave drivers responding to night calls without a paramedic. “We work in conditions no one should have to endure, but nobody feels what we are going through.”
He says crews face attacks from distressed relatives over delays or poor equipment, without adequate physical or legal protection. Old vehicles struggle over long distances, he adds, and workers sometimes pay out of pocket to keep them running.
“Allowances are not paid regularly, incentives are not distributed fairly, and our demands for higher pay or shorter hours are ignored,” Ahmed says. Shifts can sometimes last sixteen consecutive hours.
Hossam, a paramedic serving Greater Cairo, describes a workload beyond his team’s capacity. He says crews are sent to simultaneous incidents far apart without sufficient backup or planning. Sometimes they arrive too late, yet the call is subsequently recorded in the system as having been handled.
“We pay the price, whether through blame from families or being held responsible for late responses, even when the problem is management and lack of resources,” he says. He also describes insufficient training, no clear development plan and occasions when workers buy uniforms or medical supplies themselves.
Mona, who works at the authority’s central call centre in Cairo, describes receiving hundreds of calls from people pleading for help. Staff log the calls and pass them to the nearest unit, she says, but vehicles are not always available.
“I have to keep saying, ‘We will get there as soon as possible,’ knowing the wait may be hours, or that the ambulance may never come.”
She describes severe psychological pressure on call handlers, who become the focus of public anger despite being unable to fix shortages. She says staff lack a direct channel to senior officials to improve procedures and the digital system.
Tarek, a paramedic in Assiut, calls the work physically and mentally exhausting. Rural and mountainous roads can be especially difficult for ageing vehicles. “Sometimes we arrive too late and everyone blames us, even though we are working at full capacity.”
He says persistent staffing shortages, low pay and a lack of psychological or social support leave colleagues burnt out. Some resign; others wait for a better opportunity.
From road congestion to hospital bottlenecks
Mahmoud Fouad, head of the Egyptian Centre for the Right to Medicine, describes ambulance care as the first line of lifesaving treatment, preceding hospital admission. It matters in crashes and medical emergencies at home, particularly at night. The service also undertakes paid transfers between hospitals and transport to available specialist care.
Fouad considers a fleet of around 3,300 inadequate for a population exceeding 110 million and argues it should at least double. He traces the service’s development back to its early twentieth-century beginnings and the establishment of the Egyptian Ambulance Authority in 2009.
He says progress towards mobile treatment units has not removed workforce problems. In his assessment, nursing graduates are reluctant to join ambulance services, while appropriately trained medical personnel remain scarce. Emergency treatment depends on skills as well as speed.
Traffic is another major obstacle. “Sometimes the ambulance is sounding its siren and nobody makes way,” he says. He recalls being caught in congestion on El Mazallat Bridge while his mother was in an ambulance and arguing at a police checkpoint that he believed was blocking its passage.
Digital dispatch to the nearest station is a useful development, Fouad says, but implementation needs improvement. He cites Sofia’s case as an illustration of the consequences of poor coordination and changes in hospital destination.
He also points to false calls and requests unrelated to genuine emergencies as a burden, although he believes linking phone numbers to registered users has helped curb misuse. Stations may serve neighbouring areas depending on demand, he says, but vehicles need capable medical crews, not merely transport staff.
Problems continue after arrival. Ambulances can wait while hospitals search for beds or seek instructions from doctors. Fouad argues hospitals should receive advance clinical information and prepare to take over care immediately.
He criticises the shortage of emergency-medicine specialists in public hospitals and calls for better continuity between treatment on the road and hospital care. He also credits Hani Gemea’s earlier work developing ambulance services in the Delta. Gemea was the Health Ministry’s undersecretary in Beni Suef at the time of publication, not Fayoum’s governor.
Fouad describes paid transport as particularly burdensome for families needing to move a child to an incubator or a patient to another governorate for unavailable specialist treatment. Charging according to distance, he argues, can deepen unequal access. He calls for reform covering the entire journey, from dispatch to admission.
At the service’s 123rd-anniversary celebration on 24 May 2025, Prime Minister Mostafa Madbouly said the state had prioritised a more efficient, modern ambulance system. Officials inaugurated a new headquarters and round-the-clock call centre and launched the Esafni application.
The app was introduced for booking non-emergency ambulance services; 123 remains the emergency number. The distinction matters: a booking tool is not a substitute for an emergency response.
New technology and a control centre may improve coordination, but do not by themselves resolve staffing, equipment or geographic gaps. The experiences described by families and workers also raise questions about whether investigations produce visible accountability and sustained improvements.
A wider healthcare crisis
Public-health researcher Karim Tarek sees ambulance failures as part of a broader healthcare crisis, with social, economic and administrative dimensions. He says research and policy often address emergency medicine as a whole without examining ambulance provision in sufficient detail.
Population growth and urban expansion are increasing demand faster than the state’s capacity to respond, he argues. He views the gap as inconsistent with Article 18 of the Constitution, which guarantees access to healthcare.
Tarek cites an estimate of one ambulance for roughly 43,000 people against what he describes as an official target of one per 25,000. However, that estimate does not match the article’s separate figures of 3,300 vehicles and a population above 110 million, which yield roughly one per 33,000. The difference between population-per-vehicle ratios is not itself a count of missing ambulances, and national averages do not measure local availability.
His wider argument is that increasing vehicles alone will not suffice: expanding the fleet requires more drivers and paramedics, salaries, training and continuing professional development.
He also highlights class and geographic inequalities. In areas such as New Cairo, Sheikh Zayed and 6 October, he says, clearer addresses, better infrastructure and easier access can facilitate faster responses. Poorer and informal neighbourhoods face different conditions.
“Real reform starts by recognising that ambulance services are not a luxury. They are the first line of defence for people’s lives,” says Tarek.
He questions whether vehicles are allocated according to population density or other, less transparent considerations. He argues that unclear accountability and weak governance hinder improvement, with official responses too often following publicity rather than routine oversight.
The Finance Ministry reported EGP 496 billion in health allocations for 2024/25—EGP 99 billion more than the preceding year—under its calculation of the constitutional health allocation. This is a broad health figure, not an ambulance-service budget, and cannot establish the resources available for vehicle maintenance, staffing and equipment.
In October 2024, the authority increased charges for non-emergency services. Its head, Amr Rashid, defended the increase as a way to manage demand and relieve pressure on the fleet, while saying such fees accounted for only a small share of resources. Emergency care and paid non-emergency transport must be distinguished when assessing the effects on patients.
A wider policy debate concerns Law 87 of 2024, passed by parliament on 20 May and ratified on 23 June, allowing private operators to manage public health facilities. Amnesty International warned that it could undermine access for people living in poverty or without insurance. The Doctors’ Syndicate also opposed the law and criticised the lack of consultation.
The law excludes primary healthcare centres and requires that services the state must provide free of charge, including ambulance services, should not be diminished. Its implementing regulations had already been issued under Prime Ministerial Decree 2856 of 2024, published on 8 September 2024—before this report. The original statement that they had not yet been issued was incorrect.
Ambulance provision is a direct test of the state’s ability to protect people at their most vulnerable. The accounts in this report point to the need for more than announcements: functioning vehicles, equipped crews, effective dispatch, prepared hospitals and transparent accountability throughout the emergency-care pathway.
