Recent days have witnessed social controversy after obstetrician-gynaecologist Wesam Shoaib broadcast a live stream on her personal Facebook page, in which she accused some of her patients of pregnancy outside marriage, calling on men to carry out paternity tests to verify the parentage of their children. This was considered a disclosure of patients’ secrets, an imposition of moral guardianship over them and their social stigmatisation, in addition to incitement to violence against women, as she called for the use of violence against girls on the grounds that positive parenting methods are unsuitable, and for stoning and flogging women who have sex outside marriage rather than settling for the judiciary issuing prison sentences against them. Following the attack on her, the doctor appeared in another video, claiming that her purpose was to raise families’ awareness of the increase in pregnancies outside marriage and that she fears for Egypt.
This was not the first incident for the doctor, who works at Kafr El-Dawwar Hospital in Beheira Governorate and has stirred controversy with videos she posted on her personal account. Last October, she claimed that four girls had visited her clinic for a virginity test in a single day, which the Doctors’ Syndicate considered a medical, humanitarian and legal violation. She also disclosed the secrets of a patient who had been assaulted by her husband with a corrosive substance, but mocked the patient instead of condemning the husband’s act. In addition, the doctor ridiculed the suffering of patients with genital infections or bleeding caused by hormonal pills, accused them of trying to avoid marital relations, and dismissed their pain related to problems with contraceptives such as the IUD.
This is not the first time that the obstetrician-gynaecologist working at Kafr El-Dawwar Hospital in Beheira Governorate has deliberately posted videos in which she morally and socially stigmatises patients. She previously said in a video posted on her personal account last October that four girls had come to her clinic in a single day for her to perform a virginity test on them, which the Doctors’ Syndicate considered a medical, humanitarian and legal crime. She also previously disclosed intimate secrets of a patient whose husband had put a corrosive substance on her genitals, and the doctor herself wrote a post on her page mocking the patient without criminalising the husband’s act. She also dismissed the pain of women suffering from genital infections or problems related to the IUD, one of the means of contraception, accused them of avoiding intimacy with their husbands, and ridiculed cases of bleeding among her patients who had taken hormonal pills to delay their periods during Ramadan.
The Code of Medical Ethics, No. 238 of 2003, indicates that doctors are committed to strict rules aimed at protecting human dignity and safety. Article 1 stipulates the obligation to safeguard human life in all circumstances and to preserve human dignity and keep human secrets, while Article 3 stresses the doctor’s integrity in providing healthcare to citizens.
Article 13 prohibits a doctor from exploiting their position for personal or material gain. Article 20 stresses the need to treat patients equally and relieve their pain without discrimination. Article 30 prohibits disclosing patients’ secrets except by a judicial decision or to avoid serious harm to others. Article 35 obliges doctors to provide equal healthcare to those deprived of their liberty, and prohibits their participation in any acts involving torture or cruel treatment.
Rights Complaints and Security Action
Civil society organisations, including Tadwein for Gender Studies and the Center for Egyptian Women’s Legal Assistance, submitted an official complaint to the Women’s Affairs and Human Rights Unit at the Administrative Prosecution against Dr Wesam Shoaib. The complaint included accusations of disclosing patients’ secrets, inciting domestic violence and passing moral judgements inconsistent with healthcare values. The complainants stressed that these actions threaten the rights of women and girls to safe and respectful healthcare, and called on the Administrative Prosecution to take the necessary legal measures to ensure adherence to professional ethics and protect patients and the safety of the family.
The spokesperson for the Administrative Prosecution, Mohamed Samir, announced in a statement on Tuesday that the Administrative Prosecution in Kafr El-Dawwar is investigating the incident of an obstetrician-gynaecologist at a government hospital posting a video containing a violation of patients’ rights and a breach of medical ethics. He explained that the head of the prosecution office, Atef El-Shawarby, referred the incident to prosecutor El-Hassan El-Sayyad for investigation.
The prosecution also ordered the formation of a committee from the Beheira Health Affairs Directorate, including a doctor from curative medicine, a member of the governance department, another from the legal department and a doctor from the private treatment department. The committee was tasked with examining the hospital’s records and the files of newborn patients, in addition to inspecting the doctor’s private clinic and preparing a comprehensive report to be presented to the prosecution in preparation for summoning the doctor and confronting her with what was stated in the video.
The security authorities had arrested obstetrician-gynaecologist Wesam Shoaib, who works at Kafr El-Dawwar Hospital in Beheira Governorate, last Tuesday, and the Public Prosecution in Kafr El-Dawwar district charged her with offences including violating family principles and values in Egyptian society with the aim of disturbing public order and harming peace, as well as spreading false news that disturbs public peace, in addition to misusing social media, and ordered her detention for four days pending investigation, before deciding on Thursday to renew her detention for 15 days pending investigation.
A Drop in the Ocean
Lawyer Amr Mohamed, founder of the “Haqqi” initiative concerned with gender-based violence issues, explains to Zawia3 that the initiative, together with movements and institutions concerned with women’s issues, submitted an electronic complaint to the Administrative Prosecution against obstetrician-gynaecologist Wesam Shoaib, in her capacity as a doctor at a government hospital, for committing a number of professional violations, most notably: disclosing patients’ secrets, stigmatising them morally, refusing to provide medical service, failing to report a case of child marriage or sexual assault on a minor, inciting virginity testing, which is criminalised by law, and violence against women. He explained that a number of lawyers and feminist movements submitted a complaint against her to the Doctors’ Syndicate, hoping that action would be taken against her such as suspension from work, a warning or withdrawal of her licence to practise, but they were surprised by her arrest and investigation by the Public Prosecution on other charges such as violating family values and disturbing social peace.
The founder of the initiative believes that social media revealed a drop in the ocean of the violations women are subjected to in the medical sector in Egypt, ranging from moral stigmatisation and the imposition of guardianship over women’s bodies to refusing to provide them with medical services without the consent of the husband or father, especially in cases of hysterectomy or caesarean section, in addition to cases in which a medical service provider performed a procedure related to women’s reproductive health, such as circumcision, sterilisation or abortion, without their consent. He noted that the Kafr El-Dawwar doctor incident opened the door to a societal dialogue about forms of medical violence and discrimination against women, and that the initiative has documented violations by other obstetrician-gynaecologists, including a doctor who deliberately prescribed contraceptive drugs to patients who wanted to have children, simply because he is anti-natalist and wants to impose his personal beliefs and choices on others.
Mayar Makkawi, a feminist activist and founder of the “Barr Aman” initiative to create a safe and supportive society for women, in turn condemns a number of professional violations committed by Wesam Shoaib, the Kafr El-Dawwar doctor, namely failing to report a case of child marriage or sexual assault on the girl, especially as her family wanted her to have an abortion while she was eight months pregnant, which poses an imminent danger to her life; passing moral judgements on patients and their families; failing to provide healthcare to the unconscious mother; and inciting domestic violence. She noted that moral stigmatisation, dismissing women’s pain and guardianship over their bodies are deep-rooted negative practices in the medical sector in Egypt, which prompted the initiative, together with human rights institutions and feminist movements, to submit an official complaint against her to the Doctors’ Syndicate and a report to the Administrative Prosecution.
She tells Zawia3: “Not all women suffer violations to the same degree; there are intersecting factors such as sexual orientation, disability or the race to which a woman belongs, which cause double injustice against her. Women with disabilities face double guardianship and deprivation of the right to self-determination, and women in general do not like to visit gynaecology clinics because of the bad experiences and forms of medical violence some of them are subjected to and the dismissal of their pain. The violations revealed by the Kafr El-Dawwar doctor’s video confirm women’s fears in this regard.”
Medical Violence and the Imposition of Guardianship
Mai Saleh, a gender and institutional support consultant, believes that dismissing women’s pain and morally stigmatising them are practices rooted in the medical sector in Egypt, which witnesses many gender-based violations, especially in obstetrics and gynaecology. These violations start with the imposition of patriarchal male guardianship over women’s bodies with regard to some surgical procedures affecting reproduction, such as hysterectomy, or the husband signing the informed consent and hospital admission papers for his wife about to undergo a caesarean section; pass through virginity tests, the violation of the privacy of their bodies in university hospitals, the doctor’s disclosure of the confidentiality of patients’ sensitive cases, and the imposition of moral guardianship over them and their social stigmatisation by the healthcare provider; and extend to caesarean sections without medical need and surgical procedures on women who enter hospitals to give birth without need, such as circumcision or adding the “husband stitch” (extra stitches at the vaginal opening to please the partner) without the patient’s consent, or widening the perineal incision, and the practice of forms of physical, verbal and sexual violence against them.
She adds in her statement to Zawia3: “Medical violence against women and the violations committed against them by healthcare providers have become normal, as they most likely do not care much about the patient’s opinion and her need to understand the nature of her condition and to give informed consent to any medical procedure performed on her. Rather, she is sometimes considered not fully competent, for example when she is in labour, and the husband’s consent is taken without hers for a caesarean section or adding extra stitches at the vaginal opening. Women with disabilities are also the most exposed to violations in the medical field, especially those with intellectual disabilities.”
She goes on: society, the husband and the family control women’s reproductive choices; they are subjected to reproductive coercion or forced to use a specific contraceptive method, or to forced abortion for economic reasons or because the husband does not want more children, and because abortion is criminalised under Egyptian law, they resort to home abortion, whether with medication or through primitive, life-threatening methods, or go to unlicensed medical clinics.
Part Four of the unified draft law on combating violence against women, submitted by MP Nashwa El-Deeb and more than 60 MPs, men and women, stipulates strict penalties against anyone who deliberately causes a pregnant woman to miscarry without her consent, with the penalty reaching aggravated imprisonment and increasing if the person causing the miscarriage is a doctor, surgeon or pharmacist. The husband or any member of the victim’s family is also punished with aggravated imprisonment if he uses violence and harm. The proposed law exempts from punishment the termination of a pregnancy without the partner’s consent only where it is for a necessary medical reason certified by a doctor, or where the pregnancy resulted from rape or incest.
Article 40 of the draft law, which included amendments to Articles 242 and 242 bis of the Penal Code, stipulates that doctors or nursing practitioners who commit the crime of circumcision shall be punished with aggravated imprisonment for no less than ten years if the act results in a permanent disability, and with aggravated imprisonment of 15 to 20 years if the act leads to death. The court is also obliged to bar the perpetrator from practising the profession for three to five years after the end of the sentence, and to close the facility in which the crime took place for the same period and remove its signs and boards, whether the doctor is the owner or its manager was aware of the crime.
The gender consultant explains that most women do not like to visit an obstetrician-gynaecologist because their pain is dismissed and belittled, such as telling a girl suffering from period pain that her pain will end after marriage, scolding women for their fear and pain during the insertion of an intrauterine device, a means of contraception, the hospital sending a pregnant woman in labour pain back home on the pretext that the cervix has not yet dilated, leaving her in pain for long hours in hospital without healthcare, subjecting her to many unnecessary forced vaginal examinations (pelvic examinations), or performing painful procedures such as stitching the perineal incision or episiotomy after natural childbirth without anaesthesia. She pointed to some women being sexually harassed by a healthcare provider, especially when unconscious, considering that confronting these violations requires not only harsher penalties and amendments to laws and to the Doctors’ Syndicate’s regulations on professional ethics, but must be accompanied by training doctors to adhere to these ethics and raising awareness among women about their rights as patients and how to act when these are violated by healthcare providers.
Dismissing Women’s Pain
Maria Armia, an obstetrics and gynaecology specialist, reveals to Zawia3 that the most prominent forms of violations some women patients may be subjected to in the medical sector are belittling the patient’s complaint and accusing her of exaggeration and pampering, a global phenomenon women face, in addition to the lack of full privacy given the absence of female doctors in urology and general surgery departments, and the patient’s ignorance of her condition, either because of the doctor’s failure to explain it or because her family prevents her from examination and medical follow-up, which happens frequently in poor areas. She stressed that a doctor never has the right to impose moral guardianship on a patient, as the doctor’s role is limited to advice only, while in return the doctor has the right to refuse to carry out any illegitimate medical procedure such as aborting an unwanted pregnancy, considering that aborting a living foetus without clear life-affecting congenital malformations is a matter of conscience that she refuses to do, whether the pregnant woman is unmarried or married and does not want the foetus for economic reasons, for example.
The doctor attributes healthcare providers’ dismissal of women’s pain and belittling of their complaints to some women enduring their pain and not seeking healthcare until things get very bad, in addition to doctors’ inability to reach the precise complaint and their attempts to reach a diagnosis, as this is difficult with some cases that cannot express their complaint well. She added that educating women and encouraging them to give birth naturally may reduce caesarean sections without medical justification, as many women panic at the onset of labour and ask for a caesarean. She stressed that hymen repair operations are not medical in the first place, and that there is no such thing in medicine as a virginity test, but rather an external examination that reveals whether or not there are tears in the hymen, for which forensic medicine is responsible, and it should not be carried out in gynaecology clinics; a doctor is also prohibited from performing a gynaecological examination on a virgin girl without a woman from her family accompanying her.
The Need for a Medical Liability Law
Health researcher at the Egyptian Initiative for Personal Rights Ayman Sabae stresses that there are general rules for practising medicine, including preserving the patient’s privacy and not disclosing secrets; some of these rules are part of the oath taken by doctors, and others are stipulated in the Doctors’ Syndicate regulations, but the principle is that health service providers should not cause the patient any harm. He noted that the Kafr El-Dawwar doctor did not mention in her well-known video the names or personal data of any of her patients, but by knowing the doctor’s name, her private clinic, the hospital where she works in Beheira Governorate, the date of the day on which the cases mentioned visited her and the details she gave about them and their families, and with the video’s spread, people in their surrounding circle in the local community can guess the identity of the cases and reveal them. She also committed other violations, represented in refusing to provide medical care to the woman who lost consciousness and passing moral judgements on the cases and their families, and the impact of this on her provision of medical service. However, he categorically rejects punishing a medical service provider with imprisonment for committing similar violations.
He explains that there are violations women are subjected to while receiving health services, or what is known as violence by the service provider, which includes verbal, physical and psychological violence, including dismissing women’s pain and ignoring their complaints or imposing a medical procedure the patient does not need, such as an unnecessary caesarean section, and criminalised procedures such as female genital mutilation and virginity tests. However, there is no reference for medical ethics except the Doctors’ Syndicate regulations, which originally date back to the 1950s, and there is no binding legislative framework, as the Penal Code does not cover cases related to violations in medical practice. Although the draft medical liability law has been circulating for years, it has not yet been passed. He stressed that the law will define patients’ rights and the duties of medical service providers, provided it does not include a prison sentence.
The draft medical liability law published by the Doctors’ Syndicate last July and put forward for discussion in the House of Representatives includes establishing a “Supreme Committee for Medical Liability and Patient Protection”, forming specialised technical committees in each specialty, including consultants in the specialty and forensic medicine, to examine medical error complaints, launching an insurance fund from the contributions of doctors and health facilities to compensate the patient financially, and abolishing the prison sentence for qualified doctors licensed to perform a medical procedure if medical harm results from it due to an error, with the penalty in this case being financial compensation according to the medical harm, provided that any service provider who, through medical error, causes the death of the service recipient shall be punished with imprisonment for no less than six months and a fine not exceeding EGP 100,000, or one of these two penalties.
At a time when obstetrician-gynaecologist Wesam Shoaib faces several charges before the Public Prosecution and the Administrative Prosecution following her arrest, human rights defenders and institutions concerned with women’s issues believe that security solutions, harsher penalties, amendments to laws and to the Doctors’ Syndicate’s regulations on professional ethics, and the passing of the draft medical liability law will not stop violations against women at the hands of healthcare providers unless accompanied by training doctors to adhere to these ethics and raising awareness among women about their rights as patients and how to act when those rights are violated.
