At seven in the morning in early July, at the appointment her cardiologist at a public hospital had set about a month earlier, Naglaa Ahmed, a woman in her fifties, sat on a metal bench outside the cardiac surgery clinic. In her hands was a medical file filled with scans and test results collected over months. She hoped to undergo an operation that had been postponed month after month for five consecutive months, to no avail.
On her sixth visit, Naglaa tried to convince the doctor that she could no longer keep coming for follow-up appointments. Her home was more than 20 kilometres from the hospital, and her deteriorating health made it impossible to continue. Although her turn had not yet come, the doctor sympathised and promised to secure an appointment and an intensive care bed within a week.
Naglaa is not an exceptional case. She is one of thousands of patients caught between limited resources and pressure on treatment services at public hospitals. Despite the Ministry of Health and Population’s announcement that millions of operations have been performed under the initiative to eliminate waiting lists, doctors, experts and patients who spoke to Zawia3 say the lists have not disappeared. Rather, their nature has changed, reflecting a broader crisis in the health system’s capacity to accommodate growing patient numbers amid shortages of beds and medical staff and weak public spending on health.
By contrast, Health and Population Minister Khaled Abdel Ghaffar maintains that eliminating waiting lists entirely is not a realistic goal, since the health system receives new patients requiring surgery every day. He stresses that the primary objective is to shorten waiting times and ensure patients receive medical care as quickly as possible.
In a television interview, Abdel Ghaffar explained that waiting lists are not unique to Egypt but affect most health systems worldwide. He said waits in some countries, such as England, can reach around six months, while in Egypt they do not exceed three months for non-emergency cases, with urgent interventions carried out immediately according to medical priority.
The minister said the state’s initiative to eliminate waiting lists covers 11 specialised surgical interventions, including open-heart surgery, cardiac catheterisation, organ transplants, joint replacement and other priority specialties.
He said the initiative had performed around 3.3 million operations since its launch, at a total cost of EGP33 billion. He emphasised that these efforts had shortened waiting times and eased pressure on patients, and that the initiative continues as part of the state’s plan to expand access to specialised surgery and prioritise those most in need.
Waiting Lists Between Reality and the Official Narrative
Patient testimonies documented by Zawia3 in several governorates reveal another side of the daily suffering. In Cairo, Ibrahim Abdel Nabi, 58, has been waiting four months for an appointment for open-heart surgery at a public hospital in Sohag governorate, to no avail. Each time, doctors tell him there are no beds and a severe shortage of medical supplies.
He tells Zawia3 that breathlessness now prevents him from walking even short distances, while repeated visits to the hospital yield no firm surgery date. He adds that buying medication elsewhere has become a heavy burden on his family, while he cannot afford the operation at a private hospital, where the cost exceeds approximately EGP300,000.
In Minya, Mona Hassanein, a retired teacher, has been waiting several months for knee replacement surgery. She tells us that she can no longer move without help and that severe pain has forced her to give up many daily activities. Doctors repeatedly tell her that the intense pressure on surgical waiting lists is the direct reason for the delay in scheduling her operation.
In Beheira governorate, the parents of Youssef, a boy not yet four years old, fear that delays to his cochlear implant operation will affect his speech and language development. His father tells Zawia3 that the family completed the required medical tests many months ago but is still waiting for the procedures to be finalised and the operation scheduled. Doctors following his case stress that timing is crucial to the child’s chances of benefiting from surgery and regaining his ability to communicate.
How Far Has the Presidential Initiative to End Waiting Lists Progressed?
When the Egyptian government launched the presidential initiative to eliminate waiting lists for critical surgical interventions in July 2018, it said it was targeting one of the health sector’s most pressing crises. Thousands of patients had been forced to wait months, sometimes years, for open-heart, cancer, brain, neurological and orthopaedic surgery, as well as cerebral catheterisation.
Since the initiative’s launch, the Ministry of Health has announced the completion of more than 3.7 million surgical interventions by February 2026 at no cost to patients. The government says the initiative has saved hundreds of thousands of lives and reduced waiting times.
In addition, the National Health Strategy (2024–2030) and Egypt Vision 2030 set an overall direction of reducing premature deaths from non-communicable diseases by one third, achieving 85% insurance coverage by 2026/2027 and renovating 520 healthcare facilities.
The Ministry of Health and Population alone operates more than 5,300 primary healthcare centres and 521 hospitals. The public sector has around 83,000 beds, according to 2021 data from the Central Agency for Public Mobilisation and Statistics, while the private sector operates more than 1,100 hospitals with approximately 33,000 beds. According to World Bank data, Egypt provides around 1.4 beds per 1,000 people, far below the global average of 2.9.
This physical shortfall is accompanied by markedly low spending. In fiscal year 2025/2026, the national health budget reached EGP245 billion, equivalent to just 1.1% of gross domestic product. Although the Egyptian Constitution explicitly requires a minimum allocation of 3% of gross national product to health, actual allocations have in practice ranged between 1% and 1.4% of GDP since 2021.
Total current health expenditure, including private spending, reached around 4.6% of GDP in 2024. This remains below the research-based benchmark of 5%–6% for countries seeking universal health coverage.
Analysing these structural dimensions, Mohamed Hassan Khalil, head of the Committee for the Defence of the Right to Health, says the most important issue is not waiting time itself but the efficiency of health-sector infrastructure and its real capacity to accommodate patients.
Speaking to Zawia3, he explains that waiting lists in some specialties are not exceptional. All health systems distinguish between emergencies that require immediate attention and cases that can be scheduled according to medical priorities. Heart surgery, cardiac catheterisation and other procedures include urgent cases that cannot be postponed and others that can wait following a medical assessment. Announcing that critical cases face no wait is therefore not an achievement in itself, but part of sound medical practice.
Khalil says the real problem lies in Egypt’s weak healthcare infrastructure. One of the main international indicators of a health system’s capacity is the number of beds available relative to the population. In 1936, Egypt had around eight beds per 10,000 people. The figure gradually rose to about 23 in the 1960s, but has now returned to approximately eight per 10,000. In other words, he says, the country has returned to a level seen around ninety years ago.
Khalil attributes this decline to two main factors: continued population growth and the failure of bed capacity to keep pace. He notes that the latest statistics show only around 83,000 beds in public hospitals, a number out of proportion to a population exceeding 109 million. This explains the continued pressure on hospitals and prolonged waits in many specialties.
The head of the Committee for the Defence of the Right to Health links this decline to government health spending. He says the World Health Organization recommends spending approximately 6% of GDP on health, while Egypt’s Constitution requires the state to allocate at least 3%, with gradual increases towards international levels.
He adds that actual spending remains around 1.3% of GDP, meaning the system operates far below its funding requirements. He stresses that an effective health system cannot be built when actual spending is less than a quarter of what the sector needs according to international standards, because underfunding directly affects beds, equipment, medicines, supplies and staff wages.
Khalil considers that some government measures have succeeded in reducing waiting lists for simpler operations by extending doctors’ working hours and offering financial incentives. However, this model cannot be applied to complex procedures such as open-heart or brain and neurological surgery, which depend on specialised operating theatres, intensive care units and costly equipment and facilities, resources that remain limited in many public hospitals.
He stresses that the health-sector crisis extends beyond bed shortages to a lack of medical personnel. Doctors’ salaries in Egypt are among the lowest compared with other African countries, he says, contributing to their continued emigration. Estimates suggest that more Egyptian doctors work abroad than at home, affecting public hospitals’ ability to provide care. The shortage also includes nurses and technicians, reducing service quality even in hospitals with adequate infrastructure.
Khalil points out that the pound’s depreciation since 2022 has intensified the crisis, given the health sector’s heavy reliance on imported medical equipment, spare parts, supplies and pharmaceutical raw materials.
He says the currency’s depreciation, combined with difficulties obtaining foreign exchange, has worsened shortages of supplies and medicines in several public hospitals. He cites cardiac surgery, where some centres may spend months without essential supplies such as heart valves, postponing operations even when patients are ready. Some hospitals are forced to ration limited supplies across the months of the year, he stresses, directly lengthening waiting lists.
Khalil emphasises that focusing on announced numbers of completed operations or shorter waiting lists is insufficient to assess the health system’s performance. Genuine reform starts with addressing the crisis’s structural causes, particularly increasing public health spending, expanding infrastructure, improving doctors’ and nurses’ wages, and ensuring a sustainable supply of medicines and medical equipment. Unless these roots are addressed, he says, waiting lists will keep recurring regardless of how many initiatives or media campaigns are launched.
For his part, Mahmoud Fouad, head of the Egyptian Centre for the Right to Medicine, explains that presidential health initiatives operate through a system relatively independent of the Ministry of Health. They have their own funding sources, contracted hospitals, doctors and vehicles, and run early-detection and treatment-referral programmes. He adds that these initiatives cannot be treated as a direct reflection of public hospitals’ performance, because they rely on a broad network of teaching hospitals, treatment institutions and private hospitals, not all of which are directly managed by the ministry.
Fouad tells Zawia3 that surgical waiting lists persist in several specialties despite the presidential initiative’s success in reducing them. Routine cardiac catheterisation at the Heart Institute may take around 60 days, according to what officials there have told him, while waits for more complex operations, such as open-heart surgery and artificial joint replacements, may reach five or six months. There are also waiting lists for kidney transplants, corneal transplants and other specialised procedures.
Although he stresses that the presidential initiative has substantially eased the crisis and that ‘without this initiative, patients’ conditions would have been more difficult’, Fouad believes the problem has not been fully resolved. Gaps remain in access to its services: many patients do not know how to register or complete the procedures after diagnosis, preventing some from benefiting.
Fouad says the economic crisis has changed patterns of demand for healthcare. People increasingly rely on public hospitals as the least expensive option, after private-sector treatment moved beyond the means of large sections of Egyptian society.
He says criticism previously focused on the fact that most health spending came out of citizens’ pockets. But declining purchasing power has driven more patients towards public hospitals, producing unprecedented overcrowding, whether outside clinics, ticket windows or pharmacies.
He adds that underfunding has also affected the availability of medicines at health units. He cites information received from an official at the health directorate in Fayoum governorate, who said that one health administration covering 18 health units had received only about 25% of its usual medicine requirements in one month. Fouad regards this as an indication of the severe pressures on the free-treatment system.
The head of the Egyptian Centre for the Right to Medicine believes the presidential initiative shoulders a substantial part of the burden on public hospitals because it draws on the resources of teaching hospitals, the Curative Care Organisation and private hospitals, providers whose services the Ministry of Health alone cannot direct in the same way. But he stresses that many citizens do not know how to access the initiative and continue going straight to public hospitals in their governorates, perpetuating overcrowding.
He also points out that the existence of waiting lists in European countries does not mean conditions resemble those in Egypt. Those countries have integrated monitoring and healthcare systems that ensure patients are medically followed up while waiting and reduce the likelihood of complications, whereas the Egyptian system lacks sufficient mechanisms of this kind.
On treatment costs, Fouad says patients now bear additional expenses inside some public hospitals. Delays in issuing state-funded treatment authorisations push some towards paid clinics or services within the same hospital to speed up the start of treatment until approval arrives. Some must also have scans and tests at outside centres, adding to their financial burden despite initially choosing the public sector for low-cost treatment.
Fouad criticises the expansion of private-sector participation in managing and operating public hospitals. He believes implementation of the 2024 law regulating public-service concessions for establishing, managing, operating and developing healthcare facilities raises concerns about the future of free healthcare, particularly if it is not accompanied by clear guarantees protecting low-income patients’ right to treatment.
Despite these criticisms, Fouad stresses that presidential health initiatives have achieved an important gain by creating electronic medical records for large numbers of citizens. The next step, he argues, should be to complete a unified health database enabling doctors to view patients’ medical histories at any hospital nationwide, speeding up diagnosis and improving care. He cites haemophilia patients, whose immediately accessible medical information at any hospital could save their lives in emergencies, reduce repeated tests and unnecessary travel, and ease pressure on hospitals.
He stresses that waiting lists remain a real crisis, particularly for open-heart surgery, catheterisation, cochlear implants and artificial joints. Waiting lists for joint surgery among older people and pensioners are among public hospitals’ most complex issues, he says. Addressing the crisis requires comprehensive restructuring of the health system, faster implementation of universal health insurance, and sufficient funding and equitable services for all citizens.
Will the Crisis End?
Government data indicate that the average wait for an intensive care bed fell from 26 hours in June 2024 to just 13 hours in June 2025. In 2026, the government announced billions of pounds in allocations to clear waiting lists before the holidays, maintaining that current waits had become much shorter than in some developed countries’ healthcare systems, such as Britain and Canada, where certain non-urgent operations may involve waits of months or even years.
Important as these figures are, they do not mean the crisis has been resolved at its roots. Health-economics specialists believe the initiative has successfully addressed accumulated cases but has not tackled the structural causes that continually create new waiting lists, above all public hospitals’ limited capacity, weak public health spending and shortages of medical staff.
World Bank and World Health Organization data show that Egypt has had between 1.1 and 1.43 beds per 1,000 people in recent years, far below the global average of approximately 2.9 per 1,000. It also remains well below rates recorded in many middle- and high-income countries.
In practice, this means Egyptians’ share of hospital beds remains extremely limited at a time when the population exceeds 120 million. Demand for healthcare is rising because of rapid population growth, longer life expectancy and the increasing prevalence of chronic diseases such as cancer, heart disease, kidney failure and diabetes.
The data also show a marked decline in the number of public hospitals over the past two decades, alongside moves towards health-sector privatisation. Their number fell from 1,167 in 2005 to around 691 in 2018, before settling at 677 according to the latest available data for 2024. This indicates that recent construction and renovation have not yet restored the system to its level of two decades ago.
The enactment in 2024 of the law regulating public-service concessions for establishing, managing and developing healthcare facilities sparked wide debate after private operators were allowed to manage some public hospitals. This raised concerns about lower-income groups’ ability to access affordable care.
Although university hospitals have become the backbone of specialised healthcare, providing around 34,600 beds, approximately 30% of all hospital beds, they bear the greatest burden of receiving cases referred from different governorates. This is particularly true for oncology, heart surgery, and brain and neurological surgery, alongside continued direct pressure on intensive care beds and neonatal incubators.
Experts believe waiting lists are not a separate crisis but a reflection of structural imbalances within the health system. Whenever the number of patients needing complex surgery grows without a corresponding increase in beds, operating theatres, intensive care capacity and medical staff, waiting lists reappear even after government initiatives succeed in reducing them.
Furthermore, the concentration of advanced medical services in a limited number of university and teaching hospitals forces patients from less well-equipped governorates to travel to Cairo, Alexandria, Mansoura and Assiut. This raises occupancy rates and intensifies pressure on referral hospitals.
The crisis in public hospitals is exacerbated by periodic shortages of medical supplies and medicines. Import disruptions and delayed payments to companies lead to shortages of essential products, disrupting surgical schedules and increasing the burden on patients and their families.
Alongside the waiting-list initiative, the state launched the universal health insurance system, which has already begun operating in six governorates and aims to cover all citizens by 2032. However, most experts believe implementation remains slower than actual needs demand, particularly amid persistent disparities in service quality between governorates.
Finally, despite progress through initiatives such as eliminating waiting lists and ‘100 Million Healthy Lives’, and the expansion of hospital construction, health experts believe these efforts will continue to face challenges unless accompanied by structural reform. This must include raising government spending to the constitutionally mandated level, expanding public hospitals and intensive care beds, improving doctors’ and nurses’ conditions to curb emigration, and accelerating universal health insurance to cover all sections of society.
