On March 16, Egypt had 126 confirmed cases of the new coronavirus. By mid-April, that figure had reached 2,700. A week later, cases had grown by more than a third. While the outbreak is just beginning, Egypt’s fragile health care system is already struggling. So too is its population. A long-troubled economy and a government that has not prioritized spending on health services is adding tinder to the fire. Should the coronavirus continue its rapid spread, it is only a matter of time before the current health crisis explodes into a political one.
The steep increase in the number of coronavirus cases has underscored the dire shape of Egypt’s health care system. Some 5,000 cases have been confirmed and 359 people have died of the coronavirus as of April 28, though with so little testing the real figure is doubtless higher.
Throughout the country, there is a shortage of doctors, nurses, drugs, medical supplies, and beds, leaving the health care system ill equipped to manage a fast-moving and highly lethal pandemic. Low pay and bad working conditions have led many physicians to leave the country, including around 10,000 over the past three years alone. According to an estimate by Egypt’s Medical Syndicate, out of a total of 220,000 registered medical doctors, around 120,000 work outside Egypt. Public hospitals are understaffed by some 55,000 to 60,000 nurses. Egypt has 1.3 hospital beds per 1,000 people, compared with around 13 in Japan, 8 in Germany, and 6 in France. Unsurprisingly, according to Arab Barometer, only 31 percent of Egyptians said they were satisfied with the overall performance of their government’s health care service in 2018-2019, a 19-point drop since 2010.
Doctors, nurses, and medics now account for 13 percent of Egypt’s coronavirus cases, roughly the same percentage recorded in Italy and Spain. Despite the danger of speaking out, many doctors have resorted to social media to raise awareness over the working conditions, mismanagement, and supply shortages that they say are endangering their lives. Videos of health workers protesting in the hallways of hospitals have become common. If the crisis escalates, attempts to muzzle their voices may prove unsuccessful.
For decades, health care has been all but ignored by the government—particularly when compared with the sizable share of the national budget allocated to security forces. Government funding for health declined from 6.7 percent of the national budget in 2000 to 4.2 percent in 2016.
The growing coronavirus caseload will serve as a tragic reminder to the country’s leaders that not all threats are military in nature. Since Abdel Fattah al-Sisi became president in 2014, he has overemphasized the threat of terrorism and the sacrifices made by Egypt’s military and police to curb it. This came at the expense of other risks. The military is Egypt’s most powerful political, economic, and security institution. Since 1952, its role in the political system, the economy, and society has been central and decisive. It has been heavily engaged in fighting Islamist militants in Sinai for the past seven years.
Entrenched corruption and mismanaged state resources have exacerbated public frustration. Rare protests against Sisi broke out last September after a former army contractor living in self-imposed exile, Mohamed Ali, released viral videos in which he accused senior leaders of corruption. Sisi’s assertions that the presidential palaces he was criticized for constructing were for the greater good—necessary to build “a new state”—only added to public outrage. Meanwhile, the Egyptian government continues to construct a glitzy new capital east of Cairo, estimated to cost $58 billion.
This is all the more disturbing given the country’s economic woes. Egyptians still bear the brunt of the 2016 float of the Egyptian pound, which led the pound to lose half its value against the U.S. dollar. In 2018, the nationwide poverty rate rose to 32.5 percent, a 5 percentage point increase from two years prior. Economic recovery has been lethargic, so much so that Egypt’s non-oil private economic activity contracted in January to its lowest point in nearly three years. There is no doubt that the coronavirus-induced global lockdown will cause a sharp decline in the country’s main sources of badly needed hard currency: revenues from tourism (which accounts for some 12 percent of Egypt’s GDP), fees from shipping through the Suez Canal, foreign investment, and remittances from workers abroad—many of whom work in sectors that have been immediately affected by restrictive anti-coronavirus measures and the drop in consumer spending.
Inevitably, rates of unemployment and poverty will grow. Egypt’s temporary labor force, estimated at somewhere between 5 million and 12 million, will be hit the hardest. Of them, only 1.5 million workers will receive aid from the Ministry of Manpower—an allowance of 1,500 Egyptian pounds (around $95) over three installments. The rest will not receive payments because they are not registered with the ministry. Without social insurance or regular pay, the forgotten millions constitute a ticking time bomb.
As the health sector continues to crumble under the weight of the pandemic and public struggles mount, the government will find it impossible to continue justifying its vast expenditures on gated cities, presidential palaces, and a bloated security apparatus.
In the coming months, Sisi will likely seek to mitigate public anger by paying homage to the doctors and health workers (already hailed as Egypt’s “white army” in the state-run media) and injecting more resources into the health care system. He has already taken a number of steps on that path. Ramping up its efforts to stem the tide of COVID-19, the government has opened more testing centers, purchased additional testing kits and medical supplies, and raised the salaries of intern medical doctors.
Meanwhile, to support the industrial sector and boost investment, the government has reduced the price of natural gas and electricity provided to factories and delayed property taxes for three months. The government has also reduced taxes on equities, and the central bank has cut interest rates by 3 percent and postponed by six months the due dates for small-business and consumer loans.
But these efforts may not be enough.
Observers of modern Egyptian politics know how rapidly calls for change can snowball in times of crisis. If the government does not take drastic steps—particularly to buttress the health sector—a new season of discontent can be expected.
In January 2011, Egypt’s entire police force vanished into thin air—battered by three days of protests and clashes. The sudden withdrawal emboldened the revolutionaries and eventually led to the resignation of President Hosni Mubarak after 30 years of rule: Egypt’s Arab Spring. Decades earlier, Egypt’s massive military defeat against Israel in June 1967 prompted its charismatic leader Gamal Abdel Nasser to resign. Nasser later withdrew his resignation, but the defeat shattered Egypt’s image in the Arab world. In the same vein, the frantic events of 1981, dubbed in Egyptian political parlance as “the autumn of fury,” climaxed with the assassination of President Anwar Sadat, which, in turn, triggered violent clashes between security forces and armed Islamists that snuffed out more than 100 lives in the southern city of Asyut.
Without much legitimacy to lean on, Egypt’s political class today is feebler than at those other moments. Already, the current crisis has fostered visible cracks. Egypt’s minister of health, Hala Zayed, has become a source of ire on social media after flying to Italy to provide medical aid while supplies at home remained unavailable or overpriced. Last month, crowds assembled in various parts of Alexandria to chant prayers against the virus, a rarity under a draconian 2013 law that bans unauthorized protests and public gatherings. On April 11, police forces fired rounds of tear gas in a village in Dakahlia after its inhabitants prevented the burial of a doctor who had died from COVID-19 for fear of getting infected. Dissent could find a fertile ground in the convergence of political, economic, social, and health grievances.
The current crisis may trigger another change, this one concerning political perceptions and preferences. Since Egypt’s ruling elite recaptured power in 2013, they have been preaching a gospel of ultranationalism, spinning its tenets, rituals, and myths. The government uses the law, public discourse, state media, education, film, and television shows to stress that heroism comes exclusively in uniform and that a strongman at the helm is the only remedy for the country’s ills.
A blend of nationalism, militarism, and masculinity has become a sort of state ideology. But it is doctors and nurses now on the front line, defending against the deadly virus with little support; white has been shouldering khaki aside. Social media is already replete with praise for doctors and complaints about the poor working conditions they endure.
If it seems far-fetched that a virus could reshape Egyptian politics and society, there’s a precedent. In 1918, the Spanish flu devastated Egypt, killing 138,000 people—about 1 percent of the population, mostly in its impoverished countryside. The historian Christopher S. Rose, who studied the political impact of the pandemic, notes that military needs had supplanted those of civilians. The hospitals were quickly overrun, and agricultural production ground to a halt as the virus swept through the countryside. The catastrophe, coming on the heels of World War I, pushed Egyptians to the brink. In 1919, mass protests against British rule roiled the nation. Hundreds of people were killed, but the revolution was a success: Within three years, Egypt gained its independence.