Egypt’s parliament approved the Medical Liability and Patient Safety Bill on Tuesday, March 25, after months of debate and objections from doctors. The proposed framework seeks to regulate the relationship between patients and healthcare providers and distinguish ordinary medical errors from gross errors, while preserving patients’ right to compensation.
Doctors’ mobilisation secured significant changes, including the removal of imprisonment as the specific penalty for ordinary medical error and a clearer distinction between ordinary and gross error. Parliament also removed a provision regulating who could order pretrial detention. Deleting that provision, however, is not the same as establishing a blanket prohibition on pretrial detention under all other applicable laws.
At the final sitting, MPs reduced the fine for an ordinary error causing proven harm from a proposed EGP 100,000–1 million to EGP 10,000–100,000. The title was changed from patient “protection” to patient “safety”, and the Supreme Medical Liability Committee was designated the technical expert for investigators and courts.
Health Minister Khaled Abdel Ghaffar described the measure as a balanced framework that would strengthen trust and stability in healthcare. Doctors interviewed by Zawia3 acknowledge improvements but fear continuing legal and financial pressures in a sector already struggling with staffing, pay and working conditions.
Parliamentary approval is the stage reached at the time of this report. The bill’s commencement provision links its entry into force to the passage of six months after publication in the Official Gazette; approval by MPs does not itself bring it into immediate operation.
What the bill provides
The text published on March 25 sets out duties for healthcare providers and circumstances in which medical liability does not arise. These include recognised complications unconnected to a provider’s error, the use of an approach consistent with established scientific principles even where other specialists would choose differently, and harm attributable to a patient’s own conduct, such as refusing treatment or disregarding instructions.
The bill establishes a government insurance fund covering harm from medical errors, directly or through approved insurers or an insurance pool. Coverage includes death, disability and bodily injury under the insurance policy. Compensation may follow an amicable settlement or a final court judgment, with terms and prices determined through the Financial Regulatory Authority’s framework.
It also penalises abuse and violence against healthcare workers. Insulting a provider while working or because of that work carries up to six months’ imprisonment or a fine of up to EGP 10,000. Intentional damage to a medical facility or violent assault carries up to one year or a fine of up to EGP 50,000. Use of weapons or other specified implements triggers a minimum one-year custodial penalty, alongside payment for damage.
The Supreme Medical Liability and Patient Safety Committee is to consider complaints, provide technical expertise, maintain relevant information and develop guidance and settlement arrangements. Its expertise is intended to help investigators and courts assess whether a harmful outcome reflects an error, a gross error or a recognised complication.
The Egyptian Medical Syndicate welcomed the amendments. Syndicate head Osama Abdel Hay thanked parliament and said the committee’s role as technical expert was a central safeguard.
He said a proposal to require its report before prosecutors begin investigating had encountered a constitutional objection: the government considered it a restriction on prosecutorial powers. According to his statement, parliament accepted the proposal in principle for the record and intended to contact the prosecutor-general about instructions on hearing doctors after the committee’s report. Such a parliamentary assurance is distinct from an explicit statutory prerequisite.
The syndicate also welcomed a provision against knowingly false complaints made in bad faith. The published text provides up to three months’ imprisonment and a fine up to EGP 30,000, or either penalty, even where the false complaint does not result in a criminal case.
Gross medical error remains subject to more severe penalties. Article 27 provides one to five years’ imprisonment and a fine of EGP 500,000–2 million, or either penalty, where the offence results from a gross error. The absence of a prison term for ordinary error under that article therefore does not mean all conduct associated with medical practice has been decriminalised.
Improvements—and disputed definitions
Ibrahim El-Zayat, a member of the Medical Syndicate’s council, tells Zawia3 that the bill is an important step in regulating the profession, but that ambiguous wording could weaken its safeguards.
He regards specialist technical assessment, insurance against professional errors, the removal of the ordinary-error prison penalty and sanctions for malicious reports as positives. His concern is whether the details will make those protections effective in practice.
The definition of gross error is his first objection. It describes a degree of seriousness making the resulting harm certain and gives examples including an error committed under the influence of intoxicants or refusing available assistance. El-Zayat objects to the examples being non-exhaustive, fearing inconsistent interpretation.
He also questions Article 7’s restrictions on non-emergency surgery: the clinician must have the appropriate qualifications and clinical privileges, and the facility must be adequately equipped. He says the clinical-privileges system is not yet fully operational and worries that doctors could be held responsible for deficiencies controlled by a facility’s administration.
Article 12 allows complaints to the committee’s technical secretariat, but does not make that route a compulsory first step before approaching prosecutors. El-Zayat fears doctors may therefore face lengthy investigations before an expert assessment establishes whether any medical error occurred.
He makes a related point about Article 18. Naming the committee as technical expert, he argues, does not explicitly make every conclusion binding on a court. He worries about inconsistent expertise and the use of other reports in complex medical disputes.
For El-Zayat, the test is whether the safeguards change what happens to a doctor facing a complaint—not simply whether they appear in the text.
He also raises questions about the insurance fund: the extent of compensation cover, exclusions, and whether a doctor could still face substantial personal liability after paying contributions. The bill concerns insurance for harm and compensation; it does not promise payment of criminal fines.
Fines, compensation and the risk of prosecution
El-Zayat criticises Article 23, which preserves any harsher penalty available under another law. In his view, that leaves doctors exposed to provisions of the Penal Code despite the introduction of a specialist medical-liability framework.
He considers the penalties for attacking staff and facilities insufficiently deterrent compared with the burdens placed on practitioners. The text distinguishes verbal abuse, assault, property damage and the use of weapons; their penalties should not be collapsed into a single six-month maximum.
He is particularly concerned about penalties for breaches of procedural duties, including consent, required examinations and the conditions under which interventions are performed. A doctor may have limited control over equipment or staffing, he says, yet still face an allegation connected with those deficiencies.
There is, however, an important qualification in the approved text: Article 3 makes the provider and facility jointly liable for compensation. Article 26 also provides for liability of the person actually managing a facility where knowledge of the violation and a failure of managerial duties contributed to the offence. It permits licensing sanctions and joint financial liability. The bill therefore does not place every form of responsibility exclusively on the individual doctor.
El-Zayat objects to the EGP 100,000 maximum fine for ordinary error because it is paid to the state, not the injured patient. Compensation is a separate issue. He fears young doctors could face serious consequences if unable to meet criminal financial penalties, although the enforcement of an unpaid fine is subject to legal procedures rather than an automatic consequence in every case.
He also doubts how often malicious intent can be proved in false-report cases. Executive regulations, he adds, cannot override the statute itself. He fears unresolved ambiguities could encourage defensive practice, withdrawal from higher-risk specialties or migration.
Mona Mina, the syndicate’s former secretary-general, shares many of these concerns. She says the continued possibility of applying harsher provisions from other laws undermines claims that the bill fully protects doctors from imprisonment.
Her principal objection is to treating an ordinary medical error as a criminal offence carrying a fine, while leaving a separate civil compensation claim possible. Even after the reduction from the earlier proposed maximum, she argues, EGP 100,000 is a substantial burden for a doctor.
“How many doctors can afford EGP 100,000 for every ordinary medical error?” Mina asks.
She is also concerned about compulsory insurance membership without sufficiently clear limits of cover. Her fear is that doctors might pay contributions and still face both a fine and uncovered compensation. Whether that occurs depends on the policy and rules; the provision permitting the fund to contribute toward other kinds of harm should not itself be treated as proof that all medical-error claims will be only partly covered.
Mina wants the committee’s expertise to carry stronger procedural weight before a doctor is questioned and greater accountability for structural failings in hospitals. She argues that safeguards against bad-faith complaints will be difficult to enforce and that protection from assaults should be stronger.
Her criticism is directed at the balance of risk borne by clinicians. But the text’s express provisions on facility and managerial responsibility remain relevant when assessing that balance.
Before this specialist framework, medical-negligence cases could be addressed through general Penal Code provisions, including Article 238 on causing death by negligence and Article 244 on negligent injury. The applicable offence and penalty depend on the circumstances and any aggravating factors; a criminal fine is legally distinct from compensation owed to an injured patient.
The original reporting also cited estimates attributed to a rights-group report of 180,000 medical errors and approximately 20 doctors struck off annually. Without a clear methodology and reference period, those figures should not be treated as an established nationwide incidence rate.
Implementation will determine the result
Tamer Samir Abou El-Saad, a professor of phoniatrics and swallowing disorders at Mansoura University and a leader of an international professional association in the field, believes the approved version is substantially better than the first draft.
He tells Zawia3 that amendments addressed several contentious points, although he retains reservations about financial penalties. He sees an insurance mechanism as potentially valuable, while stressing that the implementation arrangements must clearly define its role. Compensation insurance and criminal fines must remain distinct.
He wants technical medical assessment to inform decisions before a doctor is routinely summoned over a complaint. Prosecutors have the right to investigate, he says, but specialist analysis should provide a meaningful basis for decisions in medical cases.
Abou El-Saad argues that the state, doctors and insurers must handle implementation carefully to balance the rights of patients and practitioners. A framework intended to clarify responsibility could harm care if applied in a way that deters timely decisions.
He sees protection against bad-faith allegations as positive, while believing practical experience will reveal the law’s effect—especially in emergencies, where clinicians must make rapid decisions and an unexpected complication does not necessarily indicate negligence.
A liability law cannot fix low pay
Asked about the wider problems facing doctors, Abou El-Saad identifies poor remuneration as a central weakness. He says Egyptian doctors earn little compared with the demands of their work and far less than opportunities abroad offer.
Professional commitment remains strong, he says, but younger generations find the financial pressures increasingly difficult. Losing skilled doctors threatens the quality and sustainability of care. He calls for a review of pay that makes remaining in Egypt a viable choice.
Khaled Amin, the Medical Syndicate’s assistant secretary-general, has described legal uncertainty as one of several factors encouraging doctors to leave government employment or seek work abroad. Anaesthesia, intensive care and cardiac surgery are among the specialties he identifies as affected. Resignation from a government post, however, does not necessarily mean emigration.
Earlier figures cited in the report put the doctor-to-population ratio at 8.6 per 10,000—approximately one doctor per 1,163 people, not one per 500. Such figures depend on whether they count licensed doctors or those actively practising and should not be mixed without a common reference year.
A government study discussed in earlier reporting contrasted approximately 213,000 licensed doctors with around 82,000 working in health institutions, about 38% of the total. Other reported figures put doctors in the measured health-sector series at 97,400 in 2022, down from 100,700 in 2021. The difference illustrates the need to distinguish datasets rather than treating each as a count of the same workforce.
Syndicate figures cited in the report recorded 11,536 resignations from government service between 2019 and March 2022. Separately, more than 4,300 were reported for 2022—roughly 12 a day. Reported annual resignations had risen from 1,044 in 2016 to 4,127 in 2021. These historical figures describe government-service departures, not a count of doctors leaving the country.
The syndicate put average resident-doctor pay at about EGP 3,700 a month in 2022 and a pension after long government service at about EGP 2,300. A separate figure cited for the comprehensive health-insurance system was approximately EGP 17,000. These concern different employment arrangements and periods and are not a uniform current national salary scale.
In April 2022, the syndicate issued a report warning about doctors’ growing reluctance to remain in government employment. The concerns voiced in the present debate link legal security with the conditions of everyday practice: pay, staffing, equipment and institutional support.
The government sees the bill as a necessary step toward protecting patients and clarifying accountability. Critics fear that uncertainty and financial exposure will add to pressure on clinicians. Its eventual effect will depend on how specialist assessment, compensation, criminal responsibility and hospital accountability work together—and whether reforms to working conditions accompany the new rules.
