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Egypt: World Bank Funds Health but Neglects Jailed Doctors

Crackdown on Health Workers, Independent Union Tests Bank’s Anti-Reprisal Policy

A nurse helps a colleague put on personal protective equipment at the 6th of October Central Hospital, an isolation hospital for Covid-19 patients, in Giza, Egypt, in July 2020. © 2020 Menna Hossam/picture-alliance/dpa/AP Images

(Washington, DC) – The World Bank’s Covid-19 support project does not adequately address the Egyptian government’s arrests and intimidation of health professionals, Human Rights Watch said today.

The Bank is set to disburse up to US$50 million for Egypt’s healthcare system but has not spoken out publicly about at least six doctors and pharmacists who remain jailed, apparently solely for criticizing the government's response to the pandemic, in violation of the Bank’s policy opposing retaliation or reprisals. The government also did not consult with the elected council of the Doctors’ Syndicate, Egypt’s main medical association, which the authorities have increasingly targeted as one of the last independent health professionals’ groups in the country.

“Egypt’s arrests of medical professionals who criticized its Covid-19 policies warrant unambiguous opposition from the World Bank, in line with its commitment not to tolerate reprisals,” said Amr Magdi, Middle East and North Africa researcher at Human Rights Watch. “The World Bank should recognize that the government’s crackdown on the Doctors’ Syndicate, as the last venue for doctors to independently voice their concerns and raise reprisals, hurts the public health goals its investments are meant to achieve.”

In May 2020, the World Bank approved the Egypt Covid-19 Emergency Response, a $50 million project to support the government’s capacity to detect, prevent, and treat the novel coronavirus, including financing the operations of medical facilities and procuring supplies such as personal protective equipment. This project expands an ongoing $530 million project the World Bank initiated in 2018 to support primary and secondary healthcare services in Egypt.

The World Bank’s significant investment in improving Egypt’s ailing health sector comes amid a government campaign of arrests and harassment aimed at silencing critical voices, notably the Doctors’ Syndicate, an independent union representing nearly all of Egypt’s doctors, as well as individual health care workers who publicly or privately raise concerns about shortcomings in the country’s health care system. The repression and intimidation have intensified since the onset of the Covid-19 pandemic.

The authorities arrested at least nine medical professionals between late March and late June for criticizing the government’s Covid-19 response, particularly insufficient protection equipment and testing for health care workers. They face charges such as “spreading false news,” in violation of Egypt’s obligations under international human rights law protecting free speech, and other charges under abusive penal code and terrorism laws such as “joining an unlawful organization” and “misusing social media.”

In October and November, judges ordered the conditional release of three doctors, but did not drop the charges against them. Six health care workers remain in jail.

Two of those arrested were members of the Syndicate’s council, its elected governing body. In addition, the authorities have sought to rein in the association in other ways. Two medical professionals with direct knowledge of the issue told Human Rights Watch that the Syndicate’s secretary-general, Dr. Ihab al-Taher, resigned on August 19, allegedly following threats of arrest from security agencies.

The authorities intimidated health workers who reported or tried to report Covid-19 cases in the early phases of the pandemic or criticized the hospital administration. The two health professionals said that threats by the National Security Agency or by hospital and Health Ministry officials were “routine.” They and two doctors, one in a hospital in Cairo and the other in Giza, said that National Security officers were part of the committees supervising Covid-19 work at their hospitals.

In March, the World Bank made a formal commitment that it “would not tolerate reprisals and retaliation” against people who comment on bank projects. In a written response to Human Rights Watch, a World Bank representative reiterated that commitment and noted, “We continue to remind all groups of stakeholders of the World Bank’s zero tolerance for reprisals or retaliation for those participating in project consultations, voicing an opinion, or raising a complaint.”

The representative stated that the Bank had “not been made aware of any allegation of reprisals related to any of our projects in the health sector in Egypt,” implying that it does not view the arrests of the nine health care workers as a reprisal because they were not part of the medical projects funded by the Bank. However, health care workers were arrested for complaining about Covid-19 response that the Bank has been supporting nationwide. Furthermore, these arrests have much broader, chilling effects on health care workers across the country, including those directly working on Bank-financed health projects.

The World Bank should ensure that its newly adopted anti-reprisal policy is not implemented so narrowly as to undermine its objective. Bank officials should publicly insist that the government immediately free medical professionals and others jailed for speaking out about government healthcare policies, drop the abusive charges against them, and make clear that such arrests and intimidation are incompatible with the Bank’s anti-reprisals commitment.

The World Bank should also insist that the government formally consult with the elected board members of the Doctors’ Syndicate in any project involving the health sector. All World Bank projects have Stakeholder Engagement Plans to ensure direct communication between Bank staff and groups potentially affected by projects or best able to assess the risks and impacts.

While the Egyptian government has yet to publish an updated version of its Stakeholder Engagement Plan for the Covid-19 Emergency Response, a Bank representative said on November 27 that it was in the final stage of being cleared for publication. The representative said the Doctors’ Syndicate would be identified as a project stakeholder. However, while many of the doctors consulted are members of the Syndicate, neither government officials nor Bank staff has held consultations with its elected council – an omission that has practical as well as symbolic significance given the government’s intensifying campaign against it. In contrast, the government did formally consult with the pharmacists’ and nurses’ unions, and both have made numerous statements supportive of the government.

Another recently approved Bank project in Egypt, a $400 million program supporting universal health insurance, similarly recognized the Syndicate as an important stakeholder on paper, while sidelining it in practice. The Stakeholder Engagement Plan, published in February 2020, described the Syndicate as “among the most powerful professional association in the health sector” and noted it “will closely monitor the implementation of the Program and potential impacts on its members,” yet a person with knowledge of the matter said the Syndicate was never consulted. Moreover, the World Bank remained silent despite authorities’ attacks on the Syndicate that severely hamper its ability to effectively monitor that project and advocate for its members.

Egypt has recorded 109,000 confirmed Covid-19 cases and 6,250 deaths. However, medical professionals told Human Rights Watch they believe the numbers are much higher. The government rarely releases figures on testing capacity and the number of tests administered. A Health Ministry official told the pro-government al-Shorouk newspaper on November 7 that the government has conducted about one million tests, a relatively very low number – only 100 tests per 100,000 people in the population.

Access to testing remains limited, including for medical professionals. According to Amnesty International’s data gathered from the Doctors’ Syndicate, Egypt has some of the highest reported Covid-19 deaths among health care workers. The government releases no official figures on these deaths despite the World Health Organization’s recommendations to keep such records.

The Doctors’ Syndicate said 218 doctors had died as of December 4. An official at the Pharmacists’ Syndicate published a list of 58 pharmacists who died of Covid-19 as of November 15 and the head of the Nurses’ Syndicate, Kawthar Mahmoud, said in a media statement on September 13 that Egypt lost 57 nurses to Covid-19. This does not include other health care workers such as technicians and cleaners who most likely have died due to Covid-19.

Egyptian authorities have also waged a campaign of arrests and intimidation against journalists and critics on social media, arresting dozens under the guise of “publishing false information.” Security officers arrested Hadeer al-Sayed, an accountant at a pharmaceutical company, at her home on March 20 after she posted on social media a video of nurses protesting at Damietta Hospital concerning Covid-19 infections among their colleagues. A terrorism court conditionally ordered her release in August but she was not actually freed until September 13.

The authorities arrested a social science researcher, Abdo Fayed, at his home on May 26 after he published Facebook posts criticizing the government response to doctors’ protests. He remains in pretrial detention on abusive terrorism-related charges in Case 535 of 2020, in which several doctors remain under abusive investigation.

Government entities overseeing the media said they would punish, including by “legal actions,” media outlets and journalists who report on Covid-19 in Egypt in ways that depart from official statements. The government withdrew the license of a Guardian journalist, Ruth Michaelson, and expelled her from the country for her Covid-19 coverage and issued a warning to a New York Times correspondent, Declan Walsh, for the same reason.

“Health care workers are the best eyes and ears to assess how the Bank’s massive investment in Egypt’s healthcare system is operating, but Egyptian authorities make it intimidating for any health professional to speak and act independently,” Magdi said. “Calling for the release of all health professionals who remain jailed for criticizing the government and bringing the Doctors’ Syndicate into the consultations is the least the Bank can do.”

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