The lack of regulation, widespread presence of unlicensed centers, and exploitation of patients by unqualified individuals have become defining features of Egypt’s physiotherapy sector. In an incident that sparked widespread controversy on social media, Ammah El-Dawly, a fan of Al-Ahly Club and a person with Down syndrome, suffered a severe spinal injury after undergoing an unprofessional physiotherapy session. The session resulted in fractures of the 11th and 12th vertebrae and cracks in other vertebrae, leaving him unable to stand or move, according to medical reports.
Video footage circulated online shows Ammah undergoing chiropractic treatment, a technique that relies on direct pressure on the spine, commonly known as “cracking.” While this technique is used for minor cases, it poses serious risks to patients with structural or joint problems, as in Ammah’s case.
Elham Mostafa, a 60-year-old woman, is another example of this crisis. Suffering from chronic knee osteoarthritis, she underwent 12 physiotherapy sessions based on her doctor’s recommendation. However, her condition did not improve; instead, her pain worsened after extending the sessions. She later discovered she had developed a herniated disc due to incorrect exercises. It turned out that the specialist overseeing her treatment had only completed a basic training course and worked in a physiotherapy center without any academic qualifications.
Elham told Zawia3: “After learning about the therapist’s actual qualifications, I decided not to return to the center and sought a qualified specialist to avoid further complications.”
This crisis stems from weak legal oversight of medical centers. Article 10 of the Medical Practice Law stipulates that practicing medicine without a license is punishable by up to two years in prison or a fine of up to 200 Egyptian pounds. However, the practical application of this law seems insufficient, especially given the increasing number of unlicensed centers. Article 212 of the same law states: “Any individual not holding a public position who commits forgery as specified in the previous article shall be punished by rigorous imprisonment or imprisonment for up to ten years.”
In September 2021, the case of the so-called “Human Chiropractor” dominated headlines after the arrest of an unlicensed center owner who promoted faulty treatments with the help of celebrities. Despite the closure of more than 300 fake centers over the past three years, unlicensed physiotherapy centers continue to operate under the guise of false advertising, exploiting patients’ need for treatment.
Impersonation
Ahmed Reda, 43, had a similar experience with unqualified physiotherapy practitioners in Egypt. After injuring his right foot during a football match and being diagnosed with ligament tears, he had his leg cast for a month. Once the cast was removed, his doctor recommended physiotherapy sessions to restore his normal movement.
However, his treatment journey took an unexpected turn. Ahmed told Zawia3: “I went to a physiotherapy center and attended six sessions, but I noticed no improvement. In fact, I began to experience additional pain in other areas.”
Ahmed later discovered that the person supervising his sessions was not a qualified physiotherapist but a graduate of the Faculty of Physical Education. Although experienced in physical exercises, this individual was not qualified to handle delicate ligament injuries, which worsened Ahmed’s condition.
“I didn’t know the center lacked qualified physiotherapists. After finding out, I went to another specialized center but was shocked by the significantly higher session costs compared to the first center,” Ahmed explained, highlighting how the absence of standardized pricing and fluctuating fees leaves patients vulnerable to financial exploitation.
Physiotherapy costs in Egypt vary significantly depending on the location, governorate, and services offered. Prices also differ between public and military hospitals. While sessions in private physiotherapy centers range from 600 to 1,000 Egyptian pounds, sessions in public hospital outpatient clinics cost around 20 pounds for manual therapeutic exercises, up from just five pounds—a 300% increase. Shockwave therapy now costs 125 pounds per session, hydrotherapy sessions cost 100 pounds, and sleep study sessions cost 400 pounds. These increases are not uniform, with some sessions doubling from 10 to 20 pounds, and others rising from 30 to 50 pounds.
The Ministry of Health has about 761 physiotherapy departments, including 277 in hospitals and 484 in primary care units across the country. In 2024, over 442,803 citizens received physiotherapy services from public hospital outpatient clinics out of a total of 26.6 million outpatient visits.
Despite this widespread access, Abdel Aati Mohsen, a physiotherapy specialist, points out that the sector suffers from increasing cases of impersonation and a lack of strict oversight. Mohsen explained: “Physiotherapy is the art of scientifically handling body tissues through massage and therapeutic exercises, but it can become a real danger if practiced by unqualified individuals.”
Mohsen emphasized that only graduates of physiotherapy faculties are legally permitted to practice the profession, noting that the field has been increasingly infiltrated by graduates of physical education faculties, which violates the Professional Practice Law No. 3 of 1985 and the General Syndicate Law No. 209 of 1994.
He added that bone injury cases in physiotherapy centers are on the rise due to the employment of unqualified individuals, who are supposed to be limited to motor rehabilitation after medical treatment. However, some centers allow them to conduct therapy sessions without adequate qualifications, even granting them diplomas to practice, exposing patients to serious risks.
Mohsen pointed out that the problem extends beyond physical education graduates to individuals with no connection to the healthcare field, who obtain short training courses or unaccredited diplomas and start practicing the profession without any scientific qualifications. “These practices can lead to severe complications such as paralysis, chronic pain, and numbness, and in some cases, worsen the patient’s condition instead of improving it.”
Absence of Oversight
Article 211 of the law punishes any public official who exploits their position to forge official documents, reports, or other government papers with rigorous imprisonment or imprisonment. According to Article 2 of Law No. 3 of 1985, regulating the practice of physiotherapy, a license is granted only to Egyptian nationals or citizens of countries that reciprocate treatment to Egyptians. Applicants must hold one of the following qualifications: a Bachelor’s degree in physiotherapy from an Egyptian university, a Bachelor’s degree in physiotherapy from the Faculty of Physical Education before the law came into effect, a domestic physiotherapy diploma from the Faculty of Physical Education before the law came into effect, or a foreign degree equivalent to any of the aforementioned qualifications, as per applicable laws and regulations.
In a related context, Alaa Ghanem, a health rights official at the Egyptian Initiative for Personal Rights and an expert in healthcare sector reform, stated that the physiotherapy sector in Egypt suffers from disorganization and chaos, particularly with the proliferation of unlicensed centers amid a lack of legal oversight. This exposes patients to increased risks when turning to these centers, which often employ unqualified individuals.
Ghanem emphasized the need for regulatory authorities to monitor these centers to protect patients’ health and work towards legalizing their operations. He noted the increase in the number of private physiotherapy colleges from 15 at the end of 2022 to around 60 at the beginning of last year, suggesting this could benefit the labor market and help address the presence of unqualified individuals in the field.
Number of Physiotherapists
Egypt has long faced a shortage of physiotherapists. A 2019 study by the Supreme Council of Universities, in collaboration with the Ministry of Health, found that each physiotherapist was responsible for 1,000 patients. While there were 15 physiotherapy faculties—four in public universities and 11 in private institutions—spread across nine governorates, the Physiotherapy Syndicate announced in September 2021 that it had 70,000 registered physiotherapists from 26 colleges across Egypt.
Annual graduates ranged from 1,000 to 1,870 students between 2014 and 2018, with numbers increasing from 3,500 to 4,000 students according to the study. In practice, there are about 640 specialist physiotherapists in the field.
Sami Saad, the head of the Physiotherapists Syndicate, stated: “The number of physiotherapy colleges has increased across public, private, and foreign branches. This calls for a review of the educational system’s impact on the profession, graduates, the labor market, and geographical distribution. We have over 69 physiotherapy colleges across various universities and departments, but they are not well-distributed across Egypt’s 27 governorates.”
Law No. 3 of 1985 prohibits those holding diplomas in massage or electrotherapy, or any equivalent qualifications, from working in any center without the supervision of a physiotherapy graduate registered with the Ministry of Health. Practitioners must take an oath before the Minister of Health or their representative to perform their duties honestly and maintain patient confidentiality. Violators face up to two years in prison and a fine of up to 500 Egyptian pounds or both.
Amid the lack of oversight and chaos in Egypt’s physiotherapy sector, patients’ suffering increases with the absence of qualified professionals and the proliferation of impersonators, coupled with rising session costs that are not regulated by relevant authorities.
