Less hospital beds

After the outbreak of COVID-19 and space in hospitals became an issue, investigative journalist Mohamed Hamid started investigating the decrease in the number of beds in government hospitals in Egypt, especially in poor areas.

“These hospitals were often called ‘fever hospitals’ and ‘integration hospitals’ and used to serve a large population. Medical and health experts consider them the line of defense against the spread of infectious and viral diseases such as the coronavirus,” said Hamid.

Mohamed Hamid. Image: Supplied

He researched 27 Egyptian governorates to document how many  hospitals had reduced their number of beds, and had subsequently closed or become departments of central hospitals. He found that a series of decisions by the Egyptian government to make hospitals profitable had resulted in thousands of poor Egyptians in need of medical assistance being denied access to services.

“I don’t like to say that I had troubles, but journalism happens to be hard and difficult (and I love it). Obtaining documents was not easy, especially since the problem started about 10 years ago. I contacted all human rights associations and searched all available government websites for published government decisions,” he said.

Hamid chanced upon a government case filed by a civil organisation concerned with citizens’ right to health. Those papers, plus the Egyptian Central Agency for Public Mobilisation and Statistics’s annual reports, which include the number of public and private hospitals, helped his investigation.

After assessing the data, Hamid:

  • went to check which hospitals were indeed closed and/or had reduced the number of beds;
  • interviewed the first Minister of Health appointed after the January 2011 revolution, Dr Ashraf Hatem, who had cancelled the 2010 regulation that had split hospitals into categories with a specified number of beds, yet had not reinstalled beds;
  • checked the website of the finance ministry and drew up an excel spreadsheet detailing the government’s financial allocation to the health ministry;
  • interviewed 10 people with COVID who could not access hospital treatment because of the lack of beds.


The Minister of Health, Hatem al-Jabali, who had issued the decision to cancel certain hospitals, declined to comment. Other citizens were afraid to speak to the media or even to admit they had contracted the coronavirus. “As a journalist working in Africa, I understood that and I did not pressure them, instead only recording their voices on my phone (instead of photographing them). This is something we understand in the profession of journalism in an African country, where freedom of the press is almost non-existent,” he said.

He wrote up the investigation in a narrative style, following the story of Basma Issam and her family who were infected with the coronavirus.  He said the style of the article, published on the website of  Arab Reporters for Investigative Journalism (ARIJ) on 7 November 2020, impressed French newspaper Liberation who posted it on their website (En Egypte, le Covid révèle les dégâts de la privatisation de la santé).

“After publication, I sent a copy of the article to the Egyptian Ministry of Health, in the hope of a positive reaction but, sadly, officials do not care much about matters related to health or any of these issues. In the end, the central authority is in control,” he said.

Hamid started working as a journalist in 2014 and two years later attended a training workshop organised by Thomson Reuters in Tunisia where he learned more about investigative methods, verification, and research. He won the Egyptian Press Syndicate award for best journalistic investigation in Egypt in 2020 for a series of articles.

No Hospitals for the Poor: How 20,000 Beds Disappeared from Egyptian Hospitals

By Mohamed Hamid

In mid-May, Basma Issam felt a high temperature and shortness of breath. Within two days, her family members complained of the same symptoms. At 24 years old, Basma lives in an apartment in a suburb east of Cairo with her mother, sister, husband, her nursing baby daughter and her grandmother.

Two days after the symptoms appeared, she went to a private hospital for a chest CT scan. “At that point it was confirmed that my family and I were positive for COVID-19,” Basma told the reporter.

By July 13, 2020, the number of recorded COVID-19 cases in Egypt had reached 82,000. Since the announcement of the first case in mid-February, 3,858 died from the virus.

After her diagnosis, Basma tried to find a place for her family in a quarantine hospital, but due to its overcrowdedness, had to resort to home quarantine. Basma’s family is not alone in being forced to home quarantine –– the ARIJ investigator documented 10 other families similar to Basma’s that were unable to secure beds in government hospitals.

Between 2005 and 2019, the number of government hospitals in Egypt decreased by 17.6%; from 1,167 beds to a mere 691. Conversely, the number of private sector hospitals increased from 652 to 1,157, marking 77.4% rise, as reported in the health bulletin issued by the Central Agency for Public Mobilization and Statistics in 2019.

This investigation documents how the Egyptian government made a series of decisions that closed 476 government hospitals and ousted 60 infection hospitals –– what have been termed the “hospitals of the poor”. This happened at the end of the 1990s with the health reform plan, in which infection hospitals were transformed into mere departments of central hospitals.

This decrease has left thousands of Egyptians unable to access adequate health care during the COVID-19 pandemic. Exacerbating the situation is the successive increase in the cost of treatment, and a rise in the poverty rate to 32.5%, as reported in the income and spending statement issued by the Central Agency for Public Mobilization and Statistics for 2019.

Egypt bottoms the world’s healthcare index ranking, and ranked 84th out of 89 countries in terms of the level of healthcare provided to its citizens, according to 2019 data from CEOWORLD Healthcare Magazine.



Number of hospitals – Governmental sector

2005: 1167

2018: 691

Decreased by: 40.7%


Number of beds – Governmental sector

2005: 116150

2018: 95683

Decreased by: 17.6%


The number of hospitals – Private sector

2005: 652

2018: 1157

Increased by: 77.4%


Number of beds- Private sector


2005: 18574

2018: 35320

Increased by: 90.1%


The Beginning of Privatization

Dr. Muhammad Hassan Khalil is the general coordinator of the Program to Defend the Right to Health, a health rights organisation. He attributes the decline in the number of government hospitals to the privatization programs that the government has begun to implement.

In a phone call, he said that the health reform program launched by the Ministry of Health in cooperation with the World Bank in 1998 included the transformation of health services to become “profitable”, instead of being available at cost.

Khalil added that Dr. Hatim Al-Jabali’s tenure at the Ministry of Health from 2005 to 2011 marked a crucial step in privatization. It started with the attempt to privatize health insurance services in 2006 and continued with decision No. 637 to establish the Egyptian Healthcare Holding Company in the ensuing year.

Khalil explained that if it had not been for the court ruling issued in 2008 to stop the establishment of this company, the Egyptian health insurance assets would have been sold. After these plans were aborted, the government focused on another aspect of privatization by closing about 70 infection hospitals in February 2008.

This is in addition to the closure of about 500 “Takamol”, or integrated hospitals, established by the former Minister of Health, Ismail Salam, to serve as a link between primary health units and central hospitals. This is all under the pretext of low occupancy rates –– less than 25% –– and the lack of financial allocations. According to Khalil, this is one of the reasons for Egypt’s suffering during the COVID-19 pandemic.

The Unified List of Regulations

Eight days passed in late May, and Basma Issam’s grandmother lost consciousness for more than 24 hours. During this time, Basma and her family searched relentlessly for a hospital to save her life.

After Basma gave up on finding a government ambulance, she was forced to hide her grandmother’s COVID-19 infection and contacted a private ambulance. However, when they saw her grandmother’s condition, they refused to take her down from her fourth-floor apartment. Basma’s family was forced to carry this burden alone.

“I didn’t know what to do or where to go with my grandmother,” Basma says. She decided to go to the Health Insurance Hospital in Naser City –– the closest to her family –– after it was dedicated to COVID-19 patients. However, because she arrived in a private ambulance, the hospital’s security officers refused to receive her grandmother.

Since 2010, management of Egyptian hospitals has changed. The Minister of Health, Hatim Al-Jabali, issued regulation No. 674 known as the “Unified List,” under which Egyptian hospitals were divided into six categories for the first time with a specified number of beds. This was unlike the previous regulation, No. 239 issued in 1997, which did not limit the number of beds in a single hospital.

According to the list, obtained by ARIJ, the first category includes public hospitals located in capitals of governorates, or in administrative centers with populations exceeding 500,000 people. The clinical capacity of the first category was set at 200 beds or more. The second category includes central hospitals of type “A”, serving administrative centers whose population ranges between 100,000 to 500,000 people. The second category names a capacity of 100 to 199 beds.

The third category includes the central hospitals of type “B”. These are located in cities with less than 100,000 inhabitants, with a clinical capacity ranging from 50 to 99 beds. The fourth category covers “quality hospitals” that serve cities also with populations less than 100,000, with the number of beds ranging from 50 to 99.

The fifth and sixth categories are the first and second models of health facilities. These provide primary care and family health services, and are the first point of contact for citizens. These facilities provide 1,000 to 20,000 beds. Once this regulation was implemented, about 60 infection hospitals went out of service as they turned into internal departments of central hospitals. Unfortunately, most of the infection hospitals are located in poor cities and villages; therefore, their affiliation with the central hospitals was changed from category “B,” leading to the elimination of around 5,235 beds.

ARIJ found, by reviewing the annual health bulletin issued by the Central Agency for Public Mobilization and Statistics from 2005 to 2019, that the number of beds in infection hospitals decreased from 9,904 in 2005 to 4,669 beds in 2019 –– marking a 50% drop.

Moreover, the unified list made no mention of integrated hospitals, which contrasts the 1997 regulation which defined these hospitals as those run by a doctor who had previously worked in health services, had a qualification higher than a bachelor’s degree, and was to be assisted by a sufficient number of doctors and technicians needed to perform medical and preventive services.

According to the report issued by the Ministry of Health in 2012, of which ARIJ obtained a copy, the number of “Takamol” or integrated hospitals in all governorates had reached 522. In 2016, the Ministry of Health was preparing to launch these in a partnership system with the private sector based on a suggestion from the former Minister of Health, Ahmad Imad.

Crisis in Hospital Beds

Time passed slowly in front of the Health Insurance Hospital in Naser City. Basma spent it yelling at the security officers, begging them, “By the mercy of the Prophet, please put her on an oxygen machine, even if on a chair!”

Her attempts failed against the obstinance of the iron gate.

Due to the 2010 regulation, the number of public hospital beds decreased from 116,100 beds in 2005 to 95,700 beds in 2019. Reviews conducted on this data issued by the annual health bulletin of the Central Agency for Public Mobilization and Statistics, revealed that 20,500 beds had been eliminated.

In March 2011, the Minister of Health, Dr. Ashraf Hatim, issued decision No. 344 to suspend the implementation of the 2011 unified list. This came after the toppling of the regime of former President Hosni Mubarak (1981-2011) following the January revolution. Even then, Hatim did not reinstall the beds.

Hatim, now the former Minister of Health, explained that his decision to suspend the unified list was based on recommendations by a committee that included lung infection specialists.

In a phone call, he said the committee concluded that, in order to protect the country from epidemics and infectious diseases like bird flu or COVID-19, hospitals dedicated to infectious diseases must be preserved. The committee recommended that they be developed in anticipation of current and future pandemics.

Hatim says that a plan for development was set, but the country’s political conditions at the time prevented it from being executed. The plan remains neglected until now.

Moreover, Dr. Tarek Kamel, former secretary general of the Medical Syndicate Fund, confirms that Egypt suffers from a shortage in beds in government hospitals compared to global population percentages.

In a phone conversation, he attributed the reasons to the lack of financial capabilities. He explained, “80% of health services are about financial capabilities, and only 20% are about good management and recruitment.”

It is noteworthy that the budget allocated to the Ministry of Health did not reach 3% of Egypt’s gross national product, as it is entitled to in the 2014 Constitution. In fact, reviews of the Ministry of Health budgets for the past four years reveal that this percentage did not exceed 1.6% of the gross national product.