“Hunger revolution” and demonstrations of Egyptian people, as said Masri Feki in his interview, concern political and geopolitical aspects of health, and shed a light on the frustrations towards their healthcare system.

Hepatitis C, avian influenza, AIDS are scourges that highlight the apathy of the state and its withdrawal from healthcare system. Health is an important social & geopolitical issue.

1. During 30 years of power Mubarak has locked the political system

Since 1981, succeeding Anwar Sadat, assassinated on October 6, Hosni Mubarak was reelected in 1987, 1993, 1999 and 2005. During the last “parliamentary elections” of 2005,  (see U.S. policy in the Middle East) the main rival to Mubarak, Ayman Nour, leader of the “Tomorrow Party”, was put in jail¹. Ayman Nour was released in February 2009, under U.S. pressure.

The 1971 Constitution does not provide for pluralism: the Arab Socialist Union is supposed to bring together all political forces. The Law No. 40 of 1977 organizes (literally contra legem) political parties albeit the executive has considerable discretion (especially with the Article 8 which prescribes a Committee on Political Parties Affairs). The department of Political Parties Affairs is composed of persons directly appointed by the Minister of Justice and can in fine determine the competitors in the race. So, in theory, the choice of candidates is led by the wisdom of the executive. Create a political party is very difficult because of the many modifications in this law that enshrines the hegemony of the ruling party: the NDP. The National Democratic Party is the gateway to political life.

The second factor contributing to lock the political system is the manipulation of political parties on the fear of chaos. We must bear in mind two essential keys: articles 76 & 62. Firstly, the famous article 76, amended in 2005 and 2007, describes in detail the conditions of candidacy in presidential elections and, simply put, allows a representative of a political party to stand for election but the chances of an independent candidate to fulfill the stringent conditions are almost zero. Furthermore, the article 62 provides that a candidate should receive a support of 250 elected members². This provision is an obstacle to the Muslim Brotherhood who are represented in the People’s Assembly (88 people elected). About the Muslim Brotherhood, the authorities use a clever strategy by imprisoning their progressive leaders, giving the monopoly of the Islamic opposition to their radical branch (advocating a fusion of politics and religion) to strengthen their role as a scarecrow.

2. The Army: a power often undervalued

The army plays a crucial socio-political role. Historically, the army won against the Ottoman Empire and in 1952 has contributed to bring down the monarchy³ . With Nasser, the Army played a key role: in Egypt by providing more than a third of ministers, but also concerning foreign affairs. Actually, the regional and international environment required a reaction force quickly mobilized (especially around the Suez Canal and against Israel).

Since 1981, Egypt is in a state of emergency restricting public liberty and legitimizing arbitrary detentions in the name of stability and internal security. Political reforms initiated by Mubarak did not change this state of exception.

Under Sadat and Mubarak, the military are less represented in political authorities whereas they expand their influence in the civil sector and social development. The Army is an essential element of the overall development of the country. In healthcare, the Army has many hospitals and their expertise extends far beyond military competences (school, dispensary, etc.). Even now, the power succession also depends on the Egyptian intelligence services chief Omar Suleiman. During 20 years, it has been the powerful armed wing of Mubarak and, last Saturday, he was appointed vice-president.

Although Mubarak said last night he wanted to “die on the soil of Egypt”, for his “succession”, the dynastic transmission of power seems the most conceivable scenario if deep reforms are not intended. Furthermore, article 76 preserves from any candidate who does not belong to the NDP. In other words Gamal Houbarak or a chieftain of PND in cases of premature death of the president.

The opposition is purely formal and has no power: the Muslim Brotherhood is repressed and falls down sharply since the municipal elections, the party Kefaya is too eclectic to gather opposition. Only the people in the street seems a lever strong enough to flip over political forces, towards a genuine rethinking of democracy in Egypt.

3. The disappointment of the healthcare system   

Egyptians are proud of their medicine and hospitals. But the historical prestige of Egyptian medicine and the one of some doctors today, well-known and famous on TV, contrast with the frustration of people and what we read in the press. A glaring example of this loss of trust in formal medicine is the disaster of hepatitis C. As the tainted blood scandal in France, an insufficient sterilization of the medical equipment contributed to spread the epidemic during the systematic public health campaigns against schistosomiasis: the authorities reacted very slowly and did not assumed their responsibilities .

Health is an unstable field in which the press often reports the “scandals”.

 

The Maghreb-Mashreq has been relatively spared by AIDS (see the post on this scourge): Dr. Laith Abu Raddad give us the conclusions of its regional epidemiological synthesis in an exclusive interview. But Egypt is not ready to assume an expansion of this scourge to a larger population. The infected population remains stigmatized: since 1994 a plan to fight against the epidemic⁴ was set up but, if it allows mass screening of students, it authorizes on the other hand the authoritarian deportation of foreign residents in HIV cases. Facing a larger epidemic due to drug addiction, Iran has quickly developed information programs for the media.  Egypt, unlike Iran, deals with the problem of transmission of STDs with a so moralistic and authoritarian point of view.

In 2000, as said Françoise Clément, Egypt enacted deep reforms of the health insurance system by extending health coverage to all people. But, as a consequence, most of care providers are private. The financial participation of the patient is often heavy: “households directly pay 70% of total national expenditure.”

As we said in a previous post, disappointments and loss of confidence in the healthcare system lead people, often the poorest, to use a reinterpreted medicine. This medical alternative is usually a default solution to the discontent. But alternative or traditional medicine is often blended with Western medicine in daily life in order to treat primary care for the greater number.

Social unrest is brewing but enhances rather individual and alternative solutions than collective claim

Health is not a media topic in current policy debates; nevertheless, health is an important factor in social unrest: people can no longer tolerate corruption. As Masri Feki said in his interview and owing to the excellente synthesis [in French] Figures de la santé publique en Égypte, corruption is everywhere in the Egyptian healthcare system (to have a better access, to get an appointment with a professional, to purchase medicine, etc..). Will the demonstrators against the ruling government announce the end of a political system and a reconfiguration of health in Egypt?

Bibliography

Quotes are excerpt from: Égypte/Monde arabe, Troisième série, 4, Figures de la santé publique en Égypte, 2007 (in French, online)

Ayad Christophe, Géopolitique de l’Égypte, Complexe, 2002, 143 p.

Cloarec Vincent et Henry Laurens, Le Moyen-Orient au 20^ème siècle, Armand Colin, juin 2002, 244 p.

Corm Georges, Le Proche-Orient éclaté (1956-2006), Folio Histoire, septembre 2005, 1074 p.

Francois-Poncet Jean et Monique Cerisier-ben Guiga, Le Moyen-Orient à l’heure du nucléaire, rapport d’information n°630, Commission des Affaires Étrangères et de la Défense, Sénat, septembre 2009, 249 p.

Moghira Mohamed Anouar, L’Égypte, clé des stratégies au Moyen-Orient, Trente ans de politique égyptienne et arabe sous Hosni Moubarak, Mobiles Géopolitiques, L’Âge d’Homme, Lausanne, avril 2009, 346 p.

Penet Luc, Égypte : les enjeux de la succession de Hosni Moubarak, Mémoire d’optionnel rédigé au Collège interarmées de défense dans le cadre du séminaire « Méditerranée et Proche Orient : Enjeux et perspectives », sous la direction du contre-amiral Jean-François Coustillière, octobre 2008.

Victor Jean-Christophe, Le dessous des cartes, Études de géopolitique : Égypte, Paris, La Sept Vidéo, 1996, 36 min.

1. The official reason for the conviction was forgery in the complex process of certification of his new party in 2004. In fact, he challenged the political power: despite a low level of participation of 10% and a political system locked, the candidate has managed to obtain 7.3% of votes. [↩]
2. At least 65 members of the Egyptian People’s Assembly, 25 members of the Consultative Council, 10 members of regional councils in 14 governorates. [↩]
3. The Military Academy opened its doors to the bourgeoisie in 1936; that is why this coup was indeed possible. [↩]
4. This is the National AIDS Program [↩]