di Sofian Philip Naceur
Healthcare systems in Tunisia and Egypt are in a catastrophic state. The governmental response to the crisis in both nations could not be more different.
The streets are totally deserted; an eerie silence descends after dusk sets in. The only sounds in the distance are that of a car accelerating and the muffled hum of a military helicopter circling over a Tunis suburb. For days now, the helicopters have been doing their rounds patrolling the national night-time curfew from the skies.
In Tunisia, people are now only allowed to leave their homes during the day in an emergency or absolutely essential errands. Public life has ground to a halt. Schools, universities, cafes, restaurants and mosques have been shut until further notice. Industry has been paralysed as well as all public transport, ferries and air traffic.
After the epicentre of the Covid-19 pandemic moved to Europe, the virus is now spreading rapidly through North Africa and forcing authorities to react. Governments in Tunisia and Egypt are utilising more or less the same measures applied in China and Europe to stop the pandemic in its tracks; drastic restrictions on everyday- and economic life and limitations on freedom of movement. The actual number of cases may still be far behind that of Europe and China. But the confirmed infection rate has risen sharply in recent days here too.
Thus far, Tunisia has confirmed 173 infections and five deaths; in Egypt there have been 456 confirmed corona cases and 21 deaths (25 March). But the true figures are likely to be much higher. The World Health Organisation (WHO) is now advising nations to conduct mass testing, not just in suspected cases.
But neither Tunisia nor Egypt have the means to do this. The healthcare systems of both nations are nowhere near ready to overcome the pandemic. Public hospitals lack essential equipment as well as an adequate supply of medication, gloves and masks. Even before this crisis took hold, the health service was stretched to breaking point.
Tunisia: proactive and transparent
Consequently, both nations could be heading towards disaster. It is therefore crucial how and above all when the relevant authorities react and their rhetorical presence in the crisis. The approach of governments in Tunisia and Egypt could however not be more different. While Tunisia responded proactively, throwing its weight behind a robust public relations offensive, Egypt has reacted to Covid-19 in a tardy, trivialising fashion – with potentially devastating consequences.
By April we will know whether Tunisia, with its strategy of anticipation and transparency, has weathered the crisis more effectively than Egypt. So far however, the Tunisian government – led by Prime Minister Elyes Fakhfakh and formed just a short time ago in late February – is credited with a relatively prudent and swift response.
Directly after it became known that the first patient had tested positive for the virus in early March, the authorities began taking the temperatures of passengers arriving in the country at ports and airports and placing people arriving from Italy in quarantine.
When on 9 March the number of confirmed infections rose from two to five, the government wasted no time in ramping up the precautionary measures. Over the two weeks that followed, President Kais Saied and Fakhfakh enacted new restrictions on a daily basis and have since then taken consistent and straightforward steps to bring the country to a halt.
In the meantime, the government’s public relations strategy was even more important that the concrete measures taken to combat the virus. The health ministry media briefing, held every morning since the beginning of March, conveyed the seriousness of the situation not only to local media, but also encouraged the general population to take greater care. Suddenly, respiratory masks and gloves became a common sight on the streets.
Following the attainment of pandemic phase 1 and despite the low number of cases, the government enacted the steps in place for phase 2 – a strategy that the authorities justified with explicit references to the limited capacity of the healthcare system. The police force is also taking rigorous action against those who flout curfew restrictions.
But despite this proactive approach, the crisis in Tunisia is far from over. Hospitals in Sousse and Monastir are reporting their first infections among staff, while the health ministry recently explained with some consternation that many of the new cases could not be traced back. This means the actual number of cases is probably much higher than the official statistics suggest, the ministry says. The pandemic has not yet peaked in Tunisia and is likely have a serious impact on southern and western regions of the country where infrastructure has been neglected.
Egyptian crisis management sluggish
Egypt, on the other hand, could be even harder hit by the pandemic; authorities there have reacted to the crisis with extreme sluggishness. After the first domestic case was confirmed in early February, government representatives and pro-regime media initially actively played down the dangers of the pandemic. One TV show even staged an interview with the virus itself – represented by someone wearing a green mask speaking to the presenter of the show, explaining that Egyptians were immune – as members of the government continued to appease public fears.
After dozens of people tested positive for the virus on a Nile cruise ship in Luxor, staff and passengers were placed in quarantine. But it took almost two weeks for the government to switch from a cautious strategy to crisis mode – this despite mounting evidence that the virus could have spread much more quickly that the authorities were prepared to admit.
It was mid-March before the government announced the closure of schools and universities, recommended that the public stay at home and reduce social contact, and began work to disinfect public buildings. As Prime Minister Mostafa Madbouly announced these measures, he also made the absurd claim that the chances of being infected in Egypt were less than in other countries, due to the relative youth of the Egyptian population.
It took a few days before patients with breathing difficulties were separated from people with other health issues in public hospitals and special areas for possible corona cases were set up. Half-hearted calls to also stay away from mosques were largely ignored. Again, it took the government days to react, eventually instructing mosques and churches to close their doors.
In the meantime elsewhere in the public sphere, the regime led by President Abdul Fattah al-Sisi flexed its muscles in the usual way and had several people arrested for spreading “rumours and false information” on social media about the allegedly much more rapid spread of the virus in Egypt. The Egypt correspondent of the British newspaper The Guardian was stripped of her accreditation for an article quoting figures calculating the potential infection of several thousand people in Egypt.
Public health storm in the offing
It is clear that for a long time, Sisi’s regime has been more concerned about its reputation than about the consequences of the pandemic itself. At the latest after two high-ranking generals died of corona infections in late March, the government finally introduced more drastic measures, massively curtailing public life and imposing a curfew.
It remains to be seen whether these more stringent measures were introduced early enough. There are already increasing indications that the nation is about to be hit by a public health storm. Drawing on sources from the country’s association of medical professionals, the Internet daily Sada El Balad is reporting at least 26 infected hospital staff, including doctors and nurses, in several provinces. Several public clinics have also contacted the association to complain about the lack of masks and antiseptic, says the news platform Mada Masr.
In the fight against the coronavirus, the country is facing two main problems: the healthcare system is already in ruins and there are nowhere near enough beds in intensive care, let alone staff. Moreover, the two main high-risk groups are elderly people and smokers. Members of the latter group are two-a-penny in Egypt.
Should the pandemic hit Egypt even remotely as hard as Italy, the nation will face disaster. The authorities’ hesitant response could therefore have fatal consequences for many people in Egypt.