Since early March, a new crisis has begun to unfold at the Dar Al-Salam Oncology Center (formerly known as Hermel Hospital), following the signing of an agreement between the Egyptian government and “Elevate Private Equity” in partnership with the French cancer center “Gustave Roussy International.” The agreement transferred the hospital’s management to the private sector under the newly enacted Public Utilities Concession Law. This development has triggered widespread concern among patients regarding the future of free treatment and state-sponsored healthcare services.
Souad (a pseudonym), a woman in her fifties battling breast and liver cancer, shared her experience following the management change. She had been receiving chemotherapy at the center for four years, having fled the overcrowding at the National Cancer Institute. However, she was recently denied entry and forced to wait outside under the sun for hours, leading to a loss of consciousness due to spinal pressure. She was eventually taken to the emergency room. “All we ask for is to be treated like human beings,” she told Zawia3. “I can’t stand in the sun after exhausting chemo sessions.”
The same hardship is echoed by Hanan (a pseudonym), who had turned to Dar Al-Salam for care after facing mistreatment at other hospitals. Recently, she was also denied access to the hospital’s restroom and forced to wait on uncomfortable metal chairs outside. Suffering from pelvic bone cancer, her pain worsened. Additionally, she was not given all of her prescribed medications, as staff claimed they were out of stock. She is now demanding the restoration of patients’ rights to treatment and dignity.
Mohamed, the father of a child with acute leukemia, reported a noticeable decline in the quality of care at the hospital over the past three months. Speaking to Zawia3, he described how the facility has faced frequent shortages of critical medications, particularly Purinethol, which he had to purchase externally at high cost to ensure his son’s treatment continued.
Purinethol, he explained, is essential in treating acute lymphoblastic leukemia, functioning as an antimetabolite that disrupts DNA synthesis in cancer cells. It is a core drug in pediatric chemotherapy protocols.
The issue, however, extends beyond medicine shortages. The hospital’s pediatric ward capacity has been reduced, and many doctors and nurses have resigned, disrupting the consistency of care. Mohamed noted that for the past four months, the hospital has ceased admitting new pediatric cancer patients, particularly those relying on public health insurance—patients who had sought Dar Al-Salam as an alternative to the National Cancer Institute and Hospital 57357 due to long waiting lists.
He called on the Ministry of Health and relevant authorities to intervene urgently, reopen admissions, and resume the free provision of life-saving medications. The service deterioration, he warned, is jeopardizing the lives of children who have no other treatment options.
On March 20, the official gazette published the Egyptian Cabinet’s decree granting a concession to “Elevate Private Equity” and the French National Cancer Center “Gustave Roussy International” for the management, operation, and development of Dar Al-Salam Oncology Hospital. Under this decree, the hospital was transformed into a branch of the French center, renamed “Gustave Roussy International – Egypt,” as part of the government’s strategy to promote public-private partnerships in healthcare.
The decision is based on Law No. 87 of 2024, which regulates the granting of public utility concessions for health facilities. Signed by President Abdel Fattah El-Sisi on June 23, 2024, the law was published in Issue No. 25 bis of the official gazette. It provides a framework for establishing, operating, and upgrading public health facilities through concession arrangements, while excluding basic primary healthcare centers, family health units, and blood and plasma collection services governed by Law No. 8 of 2021, except when such services are considered supplementary.
Since its enactment, the new law has sparked significant controversy among health professionals and unionists. Critics fear it could erode the state’s social role in providing free healthcare and reduce financial support for low-income patients. Some provisions have also raised concerns over the fate of public hospital staff whose institutions are handed over to private companies.
Supporters of the law argue that it creates vast investment opportunities for domestic and international investors in the healthcare sector. They believe it provides the state with additional resources to modernize medical infrastructure and improve service quality without placing further strain on the national budget.
The Hospital in Transition
A former official at Dar Al-Salam Oncology Hospital stated that the complaints circulated on social media by cancer patients are linked to the transitional phase the hospital is currently undergoing due to the agreement signed between the Egyptian Ministry of Health and the French Gustave Roussy Institute. He explained that this phase requires a comprehensive restructuring, during which the majority of the hospital’s medical staff departed and returned to the General Secretariat of Specialized Medical Councils to be reassigned to other public hospitals. Only about 25% of the original staff will remain, and they are expected to undergo training on the French treatment protocols adopted by the institute. Additionally, new medical personnel from outside the hospital will be recruited.
The source attributed the suspension of new admissions — particularly of children with cancer and patients covered by public health insurance — to this transitional period, which involves both administrative and technical restructuring. He stressed that the current situation is temporary and that operations will gradually return to normal once the transition and the new management system are fully implemented.
Speaking to Zawia3, he added that Dar Al-Salam Hospital has long been a significant facility for the treatment of breast cancer and leukemia, offering integrated free services that included the provision of medications and chemotherapy and radiotherapy treatments. He described the partnership with Gustave Roussy as a promising strategic step toward enhancing cancer treatment protocols, training medical personnel, and transferring expertise to other oncology centers and hospitals across Egypt. However, he emphasized that the success of this partnership depends on cooperation and support from all stakeholders.
Meanwhile, a senior official at the General Secretariat of Specialized Medical Centers told Zawia3 that the hospital is currently in the process of being handed over to the French administration and that operations inside the facility continue as usual. He confirmed that Gustave Roussy protocols are already being implemented and expressed optimism that these changes will positively impact the quality of healthcare services in the coming period.
The official downplayed the significance of the complaints circulating online, denying the existence of a genuine crisis inside the hospital. He attributed the overcrowding seen at the entrance to the presence of a large number of patient companions, noting that the new administration aims to regulate this by allowing only one companion per patient to minimize infection risks, especially for chemotherapy patients with weakened immune systems.
According to the contract signed between the Egyptian Ministry of Health and Elevate Private Equity, the hospital will be operated by the company for 15 years, with the goal of enhancing the quality of medical services and increasing capacity from 154 beds to 257 beds. The company is required to allocate 70% of services to patients under public health insurance or government-funded treatment programs. In return, Elevate Private Equity will pay 3% of total annual revenues to the government, with a minimum contribution of 15 million EGP annually. This amount will gradually increase starting from the fourth year of the contract.
The agreement outlines a comprehensive development plan for the hospital, including modernization of medical infrastructure, procurement of the latest equipment and technologies, construction of a new extension building, and management of the facility according to the standards of the French Gustave Roussy Institute. It also includes improvements in service quality, staff training, and coverage of operational and capital expenses. The Ministry of Health, for its part, will provide logistical support, facilitate necessary licensing, and oversee the company’s compliance with operational and quality standards.
An Attempt to Push Patients Out
Mahmoud Fouad, Director of the Egyptian Center for the Right to Medicine, explained that Law No. 87 of 2024 on Public Facility Concessions allows for certain public hospitals to be operated by private entities for a period of 15 years. The government began implementing this plan with Al-Maadi Mabara Hospital, followed by the Dar Al-Salam Oncology Center (formerly Hermel), which had previously received significant public funding and support from civil society organizations. The center included departments for pediatric oncology and subsidized treatment. However, the details of the contract between the Ministry of Health and Elevate Private Equity — a company with no known experience in Egypt’s healthcare sector — were never presented to parliament or made public, raising concerns about the Ministry’s oversight role and whether patient services might be affected.
According to Fouad, patients were shocked last week when they were not allowed to enter the hospital freely. Instead, only 50 individuals were permitted in at a time, with another 50 admitted only after the first group exited. This created a bottleneck of nearly 500 patients and their companions waiting outside for hours, obstructing traffic and prompting police intervention from Old Cairo Police Department to manage the scene.
Fouad told Zawia3: “Some patients were told to go to the National Cancer Institute or 57357 Children’s Cancer Hospital. Patients began to sense that the new hospital management was deliberately discouraging them from returning in order to reduce the number of state-funded cases and make room for new patients in the for-profit section, where treatment fees would be set by the private company managing the hospital. This is happening at a time when the state-funded treatment program is already facing challenges — including non-renewal of approvals for advanced cancer cases and rare diseases — even though these hospitals are built with taxpayers’ money. Currently, the government is building around 14 new hospitals. Are these also intended to be handed over to the private sector?”
Fouad also noted that many doctors and nurses at Dar Al-Salam Oncology Center have either voluntarily left or were pushed out by the new management, which, under the contract, plans to retain only 25% of the original staff, with the rest to be reassigned by the Ministry of Health to other public hospitals. He questioned why the Ministry didn’t sign the contract directly with the French Gustave Roussy Institute and instead brought in a private intermediary company — one that had previously managed New Giza University and reportedly caused several administrative issues.
He added: “This is a new type of experiment, which could bring benefits such as knowledge exchange and technology upgrades, but it will also come with drawbacks that will become clearer over time. This model is expected to be repeated with Agouza and Heliopolis hospitals. The government seems to be reducing healthcare spending in line with IMF recommendations, but surrendering public hospitals to the private sector poses a serious threat to national security and the constitutional right to healthcare — particularly when about 40 million Egyptians remain without health insurance.”
Dr. Mohamed Hassan Khalil, Head of the Right to Health Committee, told Zawia3 that the number of hospital beds in Egypt stands at 8 beds per 10,000 citizens — less than half the global average. He warned that transferring hospital management to private entities will reduce the already limited number of available public beds, worsening the overcrowding crisis. While acknowledging that the French institute is non-profit and that the contract allocates 70% of hospital capacity to state-funded patients, he emphasized that no institution would accept losses: “Even Gustave Roussy did not agree to manage this facility to lose money. Other private entities won’t accept the same conditions, and things could get even worse.”
Khalil also explained that the collapse of the Egyptian pound has severely affected the pharmaceutical industry, doubling the cost of medications and making imports more expensive. This should have been offset by increasing the medication budget within the public health insurance system. Instead, the government is moving forward with austerity measures and privatization policies, even as local drug production declines — particularly in cancer treatments.
According to the official website of the Egyptian Presidency, the cost of constructing the oncology building at Dar Al-Salam Hospital in Cairo was about 235 million EGP. The hospital was officially inaugurated by a former Prime Minister on August 16, 2014, and initially included emergency services, comprehensive diagnostic imaging, a fully equipped laboratory, 14 specialized outpatient clinics, a dialysis unit with 8 machines, four operating rooms, 31 intensive care beds, 84 inpatient beds, a hematology unit for chemotherapy outpatients with 24 beds, a bone marrow transplant service, 18 ICU beds for oncology patients, and 19 additional oncology inpatient beds.
Public Facilities Concession Law
Dr. Alaa Ghanam, Head of the Right to Health Unit at the Egyptian Initiative for Personal Rights, asserts that cancer patients are justified in their complaints and concerns regarding the management changes at Dar Al-Salam Oncology Hospital (formerly Hermel). He explains that the agreement signed by the Ministry of Health, which transferred the hospital’s administration to the French Gustave Roussy Institute, will inevitably impact the quality and accessibility of treatment for patients—most of whom come from impoverished social classes and cannot afford the exorbitant cost of cancer care. Ghanam regards the move as a form of privatization of a public hospital into which the Egyptian state has poured enormous investments. He also criticizes the lack of transparency surrounding the agreement, which was neither published nor presented to Parliament, leaving the public in the dark about the actual benefits that Egypt or its cancer patients might gain from foreign management.
Ghanam further emphasizes that cancer treatment protocols are well-established worldwide and that Egypt is already advanced in oncology, with highly qualified local professionals. He questions the logic of hiring foreign medical staff at a time when the government simultaneously promotes the export of Egyptian medical expertise abroad. He sees this contradiction as reflective of a broader inconsistency in the Ministry of Health’s policy—one that signals a national crisis, not merely a healthcare issue.
Meanwhile, Karim Tarek, a researcher specializing in healthcare and universal health coverage, notes that patients receiving state-funded treatment in Egypt rarely access care that meets global standards for quality, geographical availability, and public acceptability. He adds that for many Egyptians, private hospitals remain the first choice, followed by charitable clinics and institutions—an indication of the perceived shortcomings of public hospitals. This trend, he explains, is driven by human resource shortages due to mass physician emigration and severe funding limitations that impact facilities, beds, and infrastructure—especially amidst ongoing inflation and economic constraints that hinder the health system’s ability to meet international benchmarks.
Speaking to Zawia3, Tarek raised questions that emerged after the ratification of Law No. 87 of 2024 on Public Facility Concessions for the construction, management, and development of healthcare facilities. He stressed the urgent need for a reliable oversight framework—especially as Egypt’s healthcare sector already suffers from governance and regulatory shortcomings. This concern is compounded by recent decisions to raise ticket prices for public hospitals and limit each patient visit to a single prescription. Tarek concluded that the success of the new model depends largely on whether investors commit to training hospital staff and improving service delivery without creating administrative chaos.
For his part, Dr. Ashraf Hatim, Head of the Parliamentary Health Committee, told Zawia3 that the agreement between Egypt’s Ministry of Health and the Gustave Roussy Institute was executed under the provisions of Law No. 87 of 2024, which had already been approved by Parliament. Therefore, he argued, there was no legal requirement for the agreement itself to be presented to the House of Representatives prior to the Prime Minister’s announcement of the contract.
Dr. Hatim explained that the hospital in question—comprising between 100 and 150 beds for oncology patients—has been transferred to Gustave Roussy management with the goal of modernizing its infrastructure and implementing the French institution’s treatment protocols in Egypt. He stated that this move would eliminate the need for patients to travel abroad for care and does not, in his view, constitute privatization. He called for the public to give this unique experiment a fair chance, emphasizing the potential for it to enhance treatment protocols and pave the way for replication in other hospitals.
While the Ministry of Health insists that its agreement with Elevate Private Equity, in partnership with Gustave Roussy International Cancer Center, is meant to improve hospital services and increase capacity, patient complaints have been constant since the deal was publicly announced. Reports have pointed to overcrowding, drug shortages, and a refusal to admit new pediatric cancer patients. Health rights advocates continue to warn of the dangers posed by the new Public Facilities Concession Law (Law No. 87 of 2024), arguing that it could usher in a wave of hospital privatizations that would compromise state-funded treatment programs, reduce the number of public hospital beds available to citizens, and increase the financial burden on patients by raising healthcare service costs.
