In July 2024, Abd Al-Hamid Qutb — diagnosed with muscular dystrophy and polio — began a journey of hardship when his Integrated Services Card expired and he attempted to renew it twice, only for his application to be rejected without clear justification. He was also unable to include his deceased father’s pension, which compounded his financial crisis.
In the course of his renewal attempts, Abd Al-Hamid incurred expenses of up to 4,000 Egyptian pounds ($76.92), having undergone multiple examinations — including an MRI scan at the Military Hospital in Shibin El-Kom in Monufia Governorate, as well as a nerve and muscle conduction test at Shibin El-Kom University — in fulfillment of the medical examination requirements. Despite holding a vocational rehabilitation certificate since 2009, having obtained an Integrated Services Card in 2019, and having been previously accepted by the medical commission for the disabled motorists’ scheme and receiving a one-year valid letter, his card renewal application was rejected on two consecutive occasions.
He recounts to Zawia3 that he went to the social rehabilitation office in Shibin El-Kom to inquire about the repeated refusal to recognize his disability — despite his well-established impairments — whereupon the employees expressed astonishment at the decision, given that his disability was clearly evident and all required paperwork had been submitted. Yet this changed nothing, naturally.
Renewing the Integrated Services Card was equally a complex and distressing experience for Ahmed Mahmoud, a polio survivor since childhood residing in Mansoura city in Dakahlia Governorate. It revealed significant complications in the procedures of the medical commission, which he was compelled to navigate over the past two years following the expiry of his card, which had been issued to him in 2019. In 2024, he found himself obliged to reapply through the new system — which requires electronic booking and submission to a comprehensive medical examination before the medical commission.
Following that, Ahmed waited several months to obtain an examination appointment, amid an absence of clear information regarding the location or timing of the examination — which forced him to visit the medical councils in person to inquire — before eventually receiving an examination notice. He subsequently underwent the required tests, including X-rays, at a government hospital designated for him in advance. However, the evaluation result — for which he waited several additional months — classified him under the category of mild disability, something he found illogical, prompting him to question the criteria behind this classification, particularly given the variation in types of motor disability cases.
Disability classifications eligible for the Integrated Services Card, in accordance with Law No. 10 of 2018 on the Rights of Persons with Disabilities and its executive regulations, include: motor disabilities such as cerebral palsy, quadriplegia or hemiplegia, severe polio, limb amputation, and joint rigidity; visual disabilities, including total blindness or severe visual impairment that cannot be corrected by glasses; hearing disabilities: total hearing loss or severe hearing impairment (55 decibels or more); severe intellectual disabilities, autism, and Down syndrome; specific learning difficulties and attention deficit hyperactivity disorder; severe cases of psychological and emotional disorders that impair daily functioning; blood diseases such as hemophilia; muscular dystrophy; advanced life-threatening heart conditions; persons of short stature measuring less than 140 cm; and multiple disabilities.
The Ministry of Social Solidarity had begun in February 2023 dividing the Integrated Services Card according to specific colors indicating the proportion and degree of disability: blue was designated for severe and very severe disabilities, green for moderate disabilities, and purple for mild disabilities.
He tells Zawia3: “Renewing the Integrated Services Card used to be done manually, whereby an employee at the rehabilitation office affiliated with the Ministry of Social Solidarity would review the case and complete the procedures — particularly for severe cases that did not require new medical reports. However, in 2024 the procedures changed: it became mandatory to book electronically for the medical examination through the Ministry of Health, undergo tests and X-rays, then await the result — a process that takes several months.”
These procedures have caused continuous suffering for persons with disabilities over the past two years — whether in obtaining the services card or in benefiting from the privileges associated with it, such as obtaining a medically equipped vehicle, the procedures for which were also stalled for lengthy periods, as Ahmed affirms. He also criticized the long waiting times inside examination venues and the lack of consideration for the circumstances of persons with disabilities — particularly cases unable to endure prolonged periods.
He also complains that the grievance procedures are complex and lengthy, potentially taking more than a year — and in some cases two or three years — given the large number of applications and the small number of cases decided on a monthly basis. A rejected grievance, moreover, leaves the patient with limited options, potentially amounting to waiting for years or restarting the application process from the beginning.
He adds: “The problem is not limited to procedures alone, but extends to the absence of effective channels for communicating with officials or responding to the complaints of those affected” — calling for a review of assessment and classification mechanisms, and for the guarantee of justice and equality among all persons with disabilities, without discrimination between their categories.
For his part, Mohamed Al-Burayshi — a resident of Port Said Governorate with a motor disability — underwent a complex ordeal with bureaucracy and what he described as “conflicting decisions and administrative intransigence” at the medical commission at Al-Takamel Hospital, located in the Gheit Al-Nassara district of Damietta Governorate, while attempting to obtain an Integrated Services Card and renew his special driving license for persons with disabilities — despite possessing documented medical reports proving his condition.
Mohamed, who was involved in a traffic accident in 2013 that resulted in multiple injuries — including fractures to the pelvis, the femoral neck joint, and the knee, in addition to a fracture above the knee — was left with a 35% disability requiring the use of a prosthetic joint. When his special driving license expired in 2024 and he went to the traffic department to renew it, he was referred to the medical commission. Coincidentally, he was in the process of obtaining an Integrated Services Card at the same time, and decided to complete both procedures simultaneously.
He recounts to Zawia3 that he fulfilled all required examinations — including X-rays, medical reports, and a nerve and muscle conduction test — and that the head of the medical commission informed him of initial acceptance, with the card to be issued within one to ten days, and that he should follow up on the procedures through the social affairs office in Kafr Saad. He was subsequently surprised to be notified of the necessity of appearing before the committee for a re-examination session.
He says: “The head of the commission presented me with two options: either the special driving license or the Integrated Services Card — an incomprehensible decision. Despite that, I chose the card given my need for a medically equipped vehicle suited to my health condition.”
Despite this, he was then surprised to learn that the medical councils in Cairo had rejected his case on the grounds of the absence of any impairment — which deprived him of obtaining the services card — while the commission approved granting him the special driving license for persons with disabilities, valid for three years only, which he considered an additional burden of effort and cost, given that he would be forced to repeat the procedures periodically.
During the past year, six-year-old Salim Abd Al-Razzaq — a child diagnosed with muscular dystrophy (Duchenne) residing with his mother in Giza Governorate — had his case rejected twice during the medical examination for the Integrated Services Card, despite his condition being established by medical reports issued by the health insurance authority and a judicial ruling.
His mother, Aya Zaki, recounts to Zawia3 that she brought him for the medical examination at the medical council in the Al-Firdous area in 6th of October City, but the committee deemed him ineligible for the card because he was not yet in a wheelchair — despite the presence of clear symptoms affecting the child’s mobility, such as difficulty climbing and descending stairs and carrying objects.
Following the first rejection, the mother did not give up and submitted a grievance. After waiting several months, another appointment was set for examination before the medical commission at the health insurance headquarters in the Al-Haram district — but he was rejected again on the same grounds, with the mother being told to reapply after 3 or 4 years.
According to official data, the total number of medical examination applications for the Integrated Services Card for persons with disabilities — registered through the website of the Specialized Medical Councils since its launch on January 14, 2022 through April 5, 2026 — reached approximately 2,805,456 applications. Examination appointments were scheduled for 2,798,333 of them; 1,748,509 citizens attended for the medical examination, while 987,724 failed to appear.
Medical examination procedures were completed for approximately 1,194,242 cases, while 554,267 citizens were asked to fulfill additional examinations or tests to determine the degree of disability with precision. The procedures of 1,142,706 citizens were completed and their data transferred to the Ministry of Social Solidarity to complete the remaining procedures. The number of medical committees operating within the system stands at 551 specialized committees at the national level.
Burdensome and Financially Costly Procedures
Over the past two years, patients with muscular dystrophy in Egypt have found themselves compelled to undergo physically and psychologically exhausting and financially costly procedures without clear justification. They are forced to repeat examinations, X-rays, and muscle conduction tests at the medical commission upon the expiry of their Integrated Services Card — despite the fact that the illness is a permanent disability with no prospect of cure. Pensions are also suspended as soon as the card expires, pending completion of the renewal procedures — despite the disability being ongoing and established — a situation described as a legislative flaw requiring review, according to Sharifa Matawi, chairperson of the board of the Egyptian Association for Muscular Dystrophy Patients.
She reveals to Zawia3 that the cost of examinations ranges between a minimum of 2,000 Egyptian pounds ($38.46) and 4,000 Egyptian pounds ($76.92), with a requirement that tests and X-rays be conducted at specific designated facilities, while medical reports issued elsewhere are rejected — which multiplies the burdens on patients. She notes that procedures may be repeated more than once due to the non-acceptance of documents, sometimes according to unclear assessments on the part of those overseeing the evaluation.
She says: “Some patients face rejection the first time they apply for or renew the card, before eventually being accepted after filing a grievance — which extends the duration of procedures to an average of between 3 and 6 months, and increases the suffering of patients and their families, particularly given the difficulty of mobility for advanced cases.”
The association’s chairperson also criticizes the continued requirement for patients to renew the card periodically every 3 or 5 years — whereas it was previously renewed every 7 years — considering this procedure illogical for cases that cannot medically improve. She notes that the classification of muscular dystrophy sometimes progresses from moderate to severe disability in line with the deterioration of the case, yet the evaluation mechanisms do not always accurately reflect this progression.
She adds: “The nature of the disease is one of progressive deterioration — patients gradually lose the ability to move and may reach difficulties in breathing — which makes the repetition of medical procedures an oppressive burden, particularly in advanced stages.” She calls for a more flexible mechanism, whereby the card is issued once or renewed automatically at long intervals (potentially up to 10 years), with only verification of the patient’s survival required — without repeating the full set of examinations.
The situation is not markedly different for patients with blood disorders. A large number of hemophilia cases are rejected — hemophilia being a rare hereditary disorder that prevents blood from clotting properly, causing prolonged or internal bleeding — due to the unavailability of antibody tests associated with Hemlibra treatment, used to reduce bleeding resulting from a deficiency of Factor VIII — a vital protein in blood plasma essential for its clotting — which results in cases being rejected despite their eligibility, according to Abeer Ahmed, the mother of a child with hemophilia.
She reveals to Zawia3 another dimension of the burdens borne by patients and their families, saying: “We used to extract reports from government hospitals, whereas now we are referred to military hospitals — which increases the financial burdens. Costs that previously did not exceed 50 Egyptian pounds ($0.96) may now reach 6,000 Egyptian pounds ($115.38), between medical tests and examination fees. The procedures take several months, and yet may still fail to prove the disability due to the unavailability of the antibody tests associated with the treatment.”
She explains that some patients previously resorted to applying under the motor disability category — due to the difficulty and complexity of blood disorder examination procedures — and were in fact accepted. However, the new amendments, which impose application under only a single classification, led to these patients being rejected — whether applying as a motor disability or as a blood disorder. She considers that the current examinations, such as nerve conduction tests, result in the exclusion of cases arising from hemophilia complications, which means some patients are not accepted under any classification.
The complaints of persons with disabilities regarding the procedures for obtaining and renewing the Integrated Services Card come despite the Ministers of Health and Population, and Social Solidarity, having issued Decision No. 726 in October 2023, regarding the formation of a permanent higher committee aimed at improving the disability identification card and integrated services system.
According to the decision, the committee is tasked with verifying the challenges facing the workflow in social rehabilitation offices and medical committees; establishing new executive frameworks to facilitate the issuance of the Integrated Services Card; devising methods to expedite the access of persons with disabilities to their rights; while Ministry of Social Solidarity officials are granted the authority to review medical examination reports through the shared electronic system.
Egypt: Mothers Facing Their Children’s Intellectual Disabilities Without Support
Reducing the Number of Support Beneficiaries
The number of persons with disabilities in Egypt is approximately 10 million citizens, of whom only 1.2 million hold the Integrated Services Card, according to statements by Minister of Social Solidarity Dr. Maya Morsy in 2024. Meanwhile, estimates cited by Dr. Abd Al-Hadi Al-Qasby, head of the Senate’s Human Rights Committee, in January 2026, put the figure at approximately 12 million citizens with disabilities in Egypt, representing around 15% of the total population.
Mahmoud Fouad, head of the Right to Medicine Association, explains that the medical commission and specialized medical councils system is witnessing repeated changes in examination requirements and procedures — including requests for additional documents and tests — while examinations are restricted to specific hospitals, which imposes additional constraints on patients in terms of both access and cost, which in some cases rises to 6,000 Egyptian pounds ($115.38).
He tells Zawia3: “The medical commission is the body responsible for determining disability rates and citizens’ eligibility for the Integrated Services Card and the pensions linked to it. Over the past two years, cases have been documented of a number of beneficiaries who were excluded from pensions after many years of receiving them, on the grounds that the commission no longer confirms the existence of impairment in their cases — despite their continued suffering from health problems related to mobility, speech, or vision.”
He considers that these procedures come within the context of attempts to rationalize spending and reduce the number of support beneficiaries, warning of their social and humanitarian repercussions — particularly for the most vulnerable groups who suddenly lose their source of income. He also references a recent incident in which a citizen took his own life outside the medical commission in Damietta, considering it a serious indicator of the scale of pressure that those affected by these policies may be subjected to — calling for listening to patients’ complaints and reviewing the assessment mechanisms within the medical commission, to ensure the achievement of justice and the non-exclusion of eligible beneficiaries without clear justification.
The Integrated Services Card system suffers from multiple structural problems — foremost among them the absence of clear criteria for evaluating disabilities, which leads to inaccurate classifications that impinge upon the rights of those eligible. The division of the card into three categories (severe, moderate, and mild) raises concerns and fears among persons with disabilities about discrimination between them in terms of rights and services — such as eligibility to obtain a medically equipped vehicle or certain social benefits — alongside the existence of an undeclared tendency to reduce the number of disability service beneficiaries through downgrading disability degrees or rejecting certain cases, according to Mahmoud Matawi, head of the Shuaa Al-Khayr Association for the Rights of Persons with Special Needs.
The association’s head criticizes the functional assessment mechanism for the Integrated Services Card — the decisive second phase after the medical examination, conducted through a personal interview at the rehabilitation office to measure the extent to which the disability affects the person’s ability to perform their daily functions, with the aim of determining the degree and type of disability to confirm card eligibility. He considers it grants administrative employees the authority to reassess the case even in the presence of medical reports issued by specialized committees, as they can change the disability classification issued by the medical commission — something he regards as a fundamental flaw in the system.
He tells Zawia3: “Obtaining or renewing the Integrated Services Card can take approximately a year, which entails direct harm — such as the suspension of pensions or the loss of certain privileges linked to the card’s validity. This is an administrative procedure that harms eligible beneficiaries, and the requirement that the card be valid to access services places persons with disabilities in a bind.”
He also criticizes the restrictions imposed on the right to file grievances, explaining that the procedures are lengthy and ineffective and may end in rejection without a clear path to redress; nor does recourse to the judiciary represent a practical solution given the length of litigation. He adds that pensions are suspended pending the completion of the evaluation or grievance procedures — which can extend to a year or more — leaving families without a source of income during this period.
Fadi Al-Ibyari, head of Nour Al-Shams Association for Care of Persons with Special Needs, considers that the shift to an electronic booking system for the renewal of the Integrated Services Card and the mandatory examination through specific hospitals has caused delays in wait times for persons with disabilities. Obtaining an appointment may take several months without clarity regarding the timing or location of the examination, forcing some patients to go in person to the medical councils’ premises to inquire.
He tells Zawia3: “The long waiting times inside examination venues, the absence of accessibility, and the failure to take into account the health circumstances of cases represent an additional burden. Grievance procedures also extend for lengthy periods that can stretch to years, given the backlog of applications. Rejection of a grievance places the person with a disability before a complex path that may require reapplying from scratch after a long waiting period.”
He also criticizes the mechanisms for classifying disabilities as mild, moderate, or severe — considering that they create discrimination between persons with the same disability and affect the level of services and rights they receive.
Parliamentary Movements and a Government Decision
Amid the growing complaints of persons with disabilities over the complexity and lengthy duration of procedures, MP Nevine Iskander submitted a proposal on January 29 last year to the Minister of Social Solidarity, calling for the exemption of certain categories of medically and functionally permanent disabilities from periodic re-evaluation linked to the renewal of the Integrated Services Card, due to the unjustified burdens placed on holders of permanent disabilities — such as severe motor disabilities, complete visual impairment, and amputation cases — which represents an unwarranted burden on them and their families.
The MP notes that the Ministries of Health and Social Solidarity responded to this proposal: the re-examination of these categories was cancelled — particularly for holders of the digitized Integrated Services Card — though this decision is relatively recent and is still being monitored to ensure its actual implementation. She attributes the tightening and complication of procedures partly to previous incidents involving the issuance of integrated services cards to ineligible individuals, as a result of some employees exploiting their official positions — which prompted the concerned authorities to tighten oversight. However, she notes, this should not be done at the expense of those who are genuinely eligible.
She tells Zawia3: “Since the beginning of my parliamentary work, I have been receiving repeated complaints from citizens about the complexity of procedures, the length of waiting periods, the absence of clarity regarding the reasons for the rejection of certain cases, and the high cost of required examinations and tests — which represent a heavy burden on persons with disabilities, especially given the limited size of pensions. I believe it is necessary to reconsider these costs, either by reducing them or charging them to the Integrated Services Card, particularly since they are conducted within government hospitals.”
She emphasizes the need to reassess the medical commission’s criteria, and for a clear and publicly announced guide for classifying disabilities as mild, moderate, or severe — to guarantee justice and transparency in evaluation. She criticized certain practices, such as withdrawing the services card from persons with hearing impairments upon their use of assistive devices, considering that the use of assistive means does not negate the existence of the disability, but rather helps in adapting to it.
She also points to the failure to prepare examination venues and rehabilitation offices to receive persons with disabilities — whether in terms of the absence of accessibility codes or the unsuitability of the environment for persons with motor or intellectual disabilities — in addition to the failure to take into account the nature of certain cases that cannot endure long waiting periods or crowded environments.
She adds: “There are some shortcomings in the support disbursement system, among them cases in which the services card did not reach those entitled to it, or pensions were drawn by other individuals — which reflects the continued existence of loopholes despite digitization efforts.” She calls for striking a balance between combating corruption and ensuring that the rights of persons with disabilities reach those who are entitled to them.
In March of this year, Dr. Khaled Abd Al-Ghaffar, Minister of Health and Population, and Dr. Maya Morsy, Minister of Social Solidarity, issued a decision exempting holders of permanent disabilities who possess the digitized Integrated Services Card from undergoing re-examination upon renewal; ensuring the continued enjoyment by all cardholders of all benefits throughout the period of validity without additional procedures; granting a deadline until the end of 2026 for holders of non-digitized cards to update their data within the digital system; and working to reduce waiting periods for medical examination.
In April 2026, the Senate’s Social Solidarity and Human Rights Committee — chaired by Abd Al-Hadi Al-Qasby — approved a proposal submitted by MP Mahmoud Turki to address the crisis of the suspension of financial entitlements for persons with disabilities due to delays in renewing the Integrated Services Card. He affirmed that current regulations forfeit eligibility if the card is not renewed within 6 months — despite delays being typically administrative — which leads to the suspension of pensions without justification and harms the most needy families.
The MP recommended extending the renewal deadline, relieving citizens of responsibility for delays, disbursing entitlements retroactively, and establishing an electronic notification system and text messages to alert beneficiaries before their card expires — to ensure the continuity of rights.
Despite the parliamentary movements and reform decisions whose outlines have begun to emerge, the testimonies of persons with disabilities reveal a human suffering experienced by millions of citizens in Egypt — stemming from the shortcomings of practices on the ground and the slowness and bureaucracy of procedures, which threaten the delivery of rights to those entitled to them and compel them to bear the burdens of waiting and financial costs. This calls for the reform of the medical commission system through reducing or expediting procedures, rebuilding evaluation criteria on transparent foundations, providing an appropriate environment for persons with disabilities, and guaranteeing the continuity of their rights without interruption due to administrative complications.
