The medical sector in Egypt faces numerous accumulated crises resulting from misguided policies that have persisted for years, leading to the formation of a debilitated and troubled healthcare system, as described by analysts who spoke to Zawia3. The shortage of doctors and healthcare providers in hospitals tops the list of these crises, along with the continuous deterioration in doctors’ conditions, driving many to emigrate. With the increasing scarcity of medical services and medications recently, the Egyptian citizen faces additional hardship in relying on the public health system, which has long been their primary refuge.

A recent announcement by the Physical Therapy Syndicate on its official Facebook page regarding the abolition of the mandatory appointment system for doctors and the restriction of hospital appointments based on the needs determined by the Ministry of Health has sparked widespread controversy and warnings of the collapse of the public healthcare system. Concerns are heightened as this decision coincides with the official approval of a law allowing the leasing of public hospitals to the private sector, described as a step toward the privatization of the medical sector in Egypt.

In its post, the Physical Therapy Syndicate warned high school students before enrolling in medical faculties, including medicine, dentistry, physical therapy, pharmacy, and nursing, emphasizing that the Egyptian Ministry of Health has decided that the mandatory appointment of graduates is no longer compulsory but will be based on labor market needs. In Egypt, the appointment of medical graduates refers to their direct employment in government hospitals and medical centers immediately after graduation and the completion of the “internship year,” an obligatory year for students after completing their academic courses, during which they practice clinical training in hospitals or government centers. Students are not considered qualified to practice the profession until they pass this stage.

The appointment of doctors in Egypt means their assignment to work in government hospitals and health centers immediately after graduation, where they begin work after completing the “internship year.”

The law grants the Ministry of Health the right to compulsorily appoint graduates of medical faculties to work in government hospitals or affiliated units, as stipulated by Law No. 29 of 1974: “The Minister of Health shall assign graduates of faculties of medicine, pharmacy, dentistry, and institutes, schools, and centers that prepare or graduate nursing and health technician personnel and other medical and technical assistants to work in the government or local administration units, public authorities, or public sector institutions for two years, with the possibility of renewing the appointment for other similar periods.”

Following the announcement of the decision, there was confusion in government statements about its implementation. However, Dr. Osama Abdel Hay, head of the Doctors’ Syndicate, confirmed in press statements that “the Supreme Appointment Committee at the Ministry of Health decided in 2022 that the appointment of medical faculty graduates would be according to needs, i.e., the shortage in hospitals and health units, starting from 2025.”

In the same context, Khaled Amin, assistant secretary-general of the Doctors’ Syndicate, told Zawia3 that the decision is old and its purpose at this time is to create a “trend” coinciding with university admissions for high school students, saying, “We don’t know who is responsible for this.” He explained that the appointment according to need was approved in November 2022 by the Supreme Appointment Committee and was approved by the Prime Minister. Based on this, appointments will be made according to need starting from 2025 for all members of the medical professions. He pointed out that the decision aims to redistribute specializations to cover shortages in some areas and address the significant surplus in specializations such as pharmacy, dentistry, and physical therapy.

Amin explained that the Ministry of Health faces a major problem due to the increase in these specializations compared to the population, and it is trying to take measures to address this crisis as part of the solution. He pointed out that this increase is partly due to the incorrect culture among students about the necessity of enrolling in top faculties, in addition to the resort to private colleges and medical schools abroad. He added, “The most important part of the solution involves the graduates themselves, as the continued granting of licenses to private colleges in medical and pharmacy specializations without setting strict conditions and standards has greatly exacerbated the crisis.”

On the other hand, doctors and activists in the medical sector commented on the decision via social media, pointing out that abolishing the mandatory appointment would pave the way for the privatization of health services and the sale of hospitals in Egypt, especially as the discussion about canceling the mandatory appointment of doctors, nurses, and pharmacists coincides with the issuance of a law allowing the government to lease hospitals to Egyptian or foreign investors under the pretext of encouraging investment in the health sector. The law allows the Egyptian government to lease public hospitals for no less than three years and no more than 15 years.

In his comment, human rights lawyer Mahmoud Fouad, executive director of the Right to Medicine Association, told Zawia3 that the decision to cancel the appointment is directly related to the hospital privatization law recently approved by the government to reduce spending on health facilities, in line with Egypt’s commitments to the International Monetary Fund to cut expenses and wages.

Fouad explained that the government seeks to reduce overall health spending, having already raised the prices of consultations and medications, then moving towards privatizing health facilities. It began with Mabra Maadi Hospital, and about 360 hospitals will be leased under the new law. The goal is to pave the way for investors in the health sector, especially since the law gives them the right to hire foreign workers without specifying their type, whether doctors, nurses, pharmacists, or others. Therefore, canceling the appointment is a new step in the government’s agenda to reduce costs and support investors in the health sector, which will increase the burden on citizens who will bear a significant increase in the cost of health services.

Fouad pointed to the shortage in several health sectors, particularly in anesthesiology, vascular surgery, and neurology. He added that the government should have worked to increase the number of these specializations instead of canceling and reducing appointments. On the other hand, there is an increase in the number of doctors in specializations such as pharmacy and dentistry, but the significant shortage in other specializations requires support.

Fouad added, “Medical professionals in Egypt prefer to emigrate due to poor working conditions, low wages, and other daily crises. The privatization of hospitals is expected to lead to the layoff of a large number of workers to reduce costs and increase investor profits, which citizens will pay for with a significant increase in the cost of all health services provided to them.”

On June 24, President Abdel Fattah El-Sisi ratified a law granting the concession of public utilities for the establishment, management, and operation of health facilities, opening the door to their privatization and the entry of the private sector into partnerships with the government to manage and operate them. Article 1 of the law, as published in the Official Gazette in issue No. 25, dated June 25, stipulates that the provisions of this law regarding the organization of the granting of public utility concessions and its accompanying law shall apply to the establishment, management, operation, and development of health facilities.

Read also: Egyptian Government Restricts Healthcare Access with New Regulations

How Does Egypt Deal with the Doctor Shortage?

Egypt faces a significant crisis in the shortage of doctors, with a ratio of 8.6 doctors per 10,000 citizens, which is less than one doctor per 500 citizens, while the global average is about 23 doctors per 10,000 citizens. This shortage raises important questions about how the state is dealing with this escalating crisis.

According to data from the Egyptian Ministry of Health, about 9,000 doctors graduate annually, but more than 60% of them choose to work abroad. In 2018, a government study warned of a decline in the number of working doctors, showing that out of 213,000 licensed doctors, only 82,000 actually work in various health authorities, representing only 38% of the core workforce. These figures highlight the crisis of doctor migration abroad, leaving the Egyptian healthcare system in a state of deficit.

The Central Agency for Public Mobilization and Statistics reported a decline in the number of doctors to 97.4 thousand in 2022, compared to 100.7 thousand in 2021, a decrease of 3.3%.

Despite this massive shortage, the government justifies the decision to cancel the mandatory appointment as a measure to reduce the significant increase in the number of graduates. But this decision raises questions about how to train graduates and distribute doctors in Egypt, who is responsible for the poor distribution of doctors, and why more than half of the doctors are emigrating while the healthcare sector suffers from a significant shortage.

Dr. Ahmed Rushdi El-Agamy, professor of rheumatology at the Faculty of Medicine, Sohag University, told Zawia3 that the new decision effectively means the cancellation of the appointment for medical school graduates, despite justifications that appointments will be made according to need. El-Agamy questions the criteria for determining need and the authority responsible for setting them, and whether doctors will be involved in the decision-making process or if it will be made unilaterally.

He cited the previous cancellation of appointments in faculties of education, resulting in unemployment for hundreds of thousands of teachers, while the ministry’s sectors suffer from a shortage that could reach 300,000 teachers, with nearly half a million graduates facing unemployment annually. The same can be applied to doctors if this decision is implemented, according to El-Agamy.

He says that doctors in Egypt suffer from two main problems: the shortage of numbers and poor distribution. In Sohag Governorate, for example, there are 90 obstetrics and gynecology specialists at Sohag General Hospital, a suitable number to cover the entire governorate. However, due to poor distribution, for example, the Dar Al-Salam Center does not have a single obstetrician, and the one doctor who was there has retired.

He adds, “We are talking here about vital and important specializations. A woman and her family may have to travel a very long distance if they face an emergency during pregnancy, which poses a danger to her.” He stressed the importance of appointing medical graduates to provide them with sufficient experience and training in government medical centers and health units to practice the profession, confirming that the real learning phase begins after graduation. During this period, the graduate registers with the Ministry of Health as a doctor, then registers successively with the university to pursue postgraduate studies in their specialization, ensuring their preparation for the labor market.

El-Agamy explains that if the appointment is canceled, the graduate becomes a free doctor, leading to a problem related to completing postgraduate studies, which is a mandatory requirement for practicing medicine. The selection of specializations in the health sector is done through an internal coordination process. For example, this year, we have 100 doctors, and we need ten in internal medicine, ten in dermatology, and five in obstetrics and gynecology. The students submit applications, which are studied by the Ministry of Health and sent to the universities according to sector needs. The university deals with state institutions, not external entities. This is another problem graduates will face.

He explains, “A medical graduate cannot begin practicing the profession before receiving the necessary training from qualified medical professionals, which the doctor receives after graduation through the medical entity they work for according to the appointment order. If the appointment for doctors must be canceled, it can be replaced with a temporary employment or assignment period, with the same existing benefits, for a specified period that ensures doctors receive the necessary experience and preparation for the labor market. During this period, the graduate can complete postgraduate studies without any procedural problems.”

All medical sectors in Egypt suffer from a shortage of doctors, according to El-Agamy, increasing the pressure on governorate centers and public hospitals. “In the event of a medical emergency, citizens sometimes have to travel more than 100 kilometers to receive treatment due to the lack of specialists in their area, putting their lives at risk. Therefore, all specializations must be provided in peripheral centers, especially surgeons and other specialties that require urgent intervention.” He stressed the need to solve doctors’ problems before canceling the appointment, to avoid forcing them to emigrate in search of job stability and a better standard of living.

El-Agamy also pointed to another issue related to doctors’ fear of providing support outside their specialties, fearing legal accountability or attacks from families. If a doctor receives a case outside their specialty and provides support, and an unintended mistake occurs, they are often defamed, held accountable, and even imprisoned. This has led doctors to practice what is known as “defensive medicine.” He explained, “In some hospitals, there may be a surgeon, but no anesthesiologist is available. Therefore, the surgeon cannot perform their work without the anesthesiologist, fearing legal issues, even though the doctor has the ethical and humanitarian motivation to save the patient or injured person as quickly as possible.”

Read also: Privatization of Healthcare in Egypt: A Step Backward?

Why Are Doctors Fleeing Egypt?

According to data from the Egyptian Doctors’ Syndicate, about 11,536 doctors resigned from government work in just three years from 2019 to March 2022. These data show that in 2022 alone, more than 4,300 Egyptian doctors working in government hospitals resigned, representing the largest number in the past seven years, with an average of 13.5 doctors resigning every day. This number has quadrupled from 1,044 resignations in 2016 to 4,127 in 2021.

According to the Egyptian Doctors’ Syndicate, the average salary of a resident doctor in Egypt is 3,700 Egyptian pounds ($77), and the average pension for a doctor after about 35 years of government work is 2,300 pounds ($48). Meanwhile, the Health Insurance Authority indicated that the average salary of a doctor in the comprehensive health insurance system implemented in some Egyptian governorates reaches 17,000 pounds ($354) per month.

In April 2022, the Egyptian Doctors’ Syndicate issued a report titled “The Doctors’ Syndicate Sounds the Alarm,” warning of the continued reluctance of doctors to work in the government sector and their increasing desire to emigrate abroad.

Former syndicate board member Ahmed Hussein described the situation of doctors in Egypt as “collapsed,” moving from bad to worse. Instead of providing and implementing a plan to save and improve the current situation, systematic plans are being carried out to replace competent and distinguished doctors with graduates from medical schools who are not qualified to practice the profession.

He told us that “the conditions in the health sector in Egypt force competent doctors to emigrate abroad, while systematically replacing them with a group of graduates who entered medical schools due to cheating in high school. The idea of appointing based on need is old and impractical. Currently, various sectors suffer from a shortage of doctors, so it seems illogical to cancel the appointment decisions.”

Hussein believes that what will happen based on the decision is a “crackdown on doctors,” distributing them according to what the workplace sees fit, with the aim not being to cancel the appointment, but rather to abolish the system of preferences and geographic distribution based on grades, relying instead on the opinion of the distribution authority alone, without specific standards.

He does not expect the appointment to be canceled before at least ten years, given the current need for doctors in various health sectors. However, the new procedures will exacerbate the crises facing the healthcare system in Egypt, especially the problems doctors face.

He says, “Medical education at the university level suffers from a major problem related to cheating in high school. Some colleges have a success rate of no more than 25%. Therefore, there are a large number of medical school graduates who are not qualified, and thus cannot be relied upon. It is expected that competent doctors will be replaced by these graduates, posing a serious threat to the health sector in the future.”

Hussein, a former member of the Doctors’ Syndicate board, outlines the main problems facing the medical sector and doctors in Egypt: First, the lack of professional security, with doctors continually exposed to attacks from families or criminal prosecution and imprisonment for any reason related to unintended mistakes. Second, the lack of job security and abuse by the Ministry of Health and related authorities, including amendments to appointment procedures and discrimination between graduates. Third, low wages and the failure to provide a fair financial return for doctors, in addition to placing financial barriers and difficulties in front of students, citing the recent decision to double the prices for registering for postgraduate studies, which poses an additional obstacle for doctors that exceeds their financial capabilities.

Doctors, according to Hussein, face significant psychological pressure related to the deliberate tarnishing of their image, highlighting and promoting their negative aspects. He emphasizes that not all doctors are angels, and mistakes are inevitable, but in some cases, it seems more like systematic campaigns to target and pressure doctors.

In contrast, Khaled Samir, professor of cardiothoracic surgery at Ain Shams University and former treasurer of the Doctors’ Syndicate, sees no flaw in the idea of appointment based on need, criticizing the (communist) approach of providing job opportunities for all graduates, regardless of their numbers, without a real need for them. He adds, “Appointments have been canceled in all fields in Egypt—except for the medical field. There was a discussion ten years ago, especially regarding faculties of pharmacy and physical therapy, in light of the significant increase in graduates compared to the demand.”

He agrees with the poor conditions faced by doctors in Egypt and notes that the pharmacy appointments stopped years ago due to the excess number of graduates, and the same applies to medical schools. In recent years, a large number of private medical schools have been opened, without the need for such numbers. However, Samir argues that Egypt’s problem is not the number of medical school graduates but the fact that a large number of doctors are emigrating abroad due to poor living conditions, the severe crises they face, and mistreatment, both financially and psychologically.

He explains, “The conditions faced by doctors in Egypt do not exist in any other country in the world. A doctor receives a meager salary of 3,000 pounds ($62) per month, not to mention the repeated insults and assaults they suffer from patients’ families, and the lack of any sense of professional or job security.”

Doctors, according to Samir, also face constant pressure due to statements from some officials who hold doctors responsible for any mistakes and claim that all resources are available in hospitals, leading to a state of agitation from families and citizens against doctors, sometimes resulting in assaults with weapons.

He adds, “Most countries apply what is known as the medical structure system, meaning a specific number of doctors, nursing staff, and assistants are available, and the vacant positions are known. Based on this, job openings are announced. But in Egypt, there is poor distribution; a doctor may be appointed in Cairo despite the urgent need for them in another governorate. The solution is to ensure fairness by offering jobs according to need in different governorates, and those who find the location suitable can apply.” He also points out the importance of conducting real tests for granting licenses to new doctors, as the current tests are merely a formality to collect money from graduates. If the situation continues as it is, the state and citizens will pay the price, and the system will collapse.

Where Will the Poor Go?

The vast majority of Egyptians rely on the public health sector as their primary source of healthcare, a right guaranteed by the constitution under Article “Every citizen has the right to health and to comprehensive healthcare in accordance with quality standards. The state is committed to preserving public health services that provide services to the people, supporting them, and working to raise their efficiency and equitable geographical distribution.”

Egypt operates 662 public hospitals at a cost of 147.8 billion Egyptian pounds ($3.08 billion), providing healthcare services to citizens for nominal fees, according to data from the Central Agency for Public Mobilization and Statistics. The 2023-2024 fiscal year, which ended in June 2024, allocated 147.8 billion Egyptian pounds to health sector spending, equivalent to $3.08 billion, an increase from the previous fiscal year 2022-2023, when the health budget was 128.1 billion pounds ($2.67 billion).

The total number of beneficiaries of health insurance reached 57 million citizens by 2020, according to the statistics agency, and the total number of health facilities affiliated with the government and private sectors in Egypt in 2020 was about 2,034 facilities. The cost of developing infrastructure and medical equipment in 18 model university hospitals, including emergency departments and hospitals, was 2.7 billion pounds ($56 million).

Despite this, there are no clear plans to save the health sector in Egypt. According to the Egyptian Doctors’ Syndicate’s estimate in March 2023, there is no real intention or action to support the government’s declared understanding of the problems and its statements about efforts to solve them. The shortage of doctors continues to grow due to an unsuitable working environment, starting with repeated assaults, low wages, exposure to imprisonment in professional cases, and administrative harassment.

The private sector mirrors its public counterpart, according to the syndicate, in the types of problems it faces, which are exacerbated by many entities deliberately imposing extortionate fees and requirements, making it difficult to continue providing satisfactory and affordable medical services to Egyptian patients. Today, the most pressing question remains: where will citizens go for treatment?