EGYPT: HEALTH CARE WORKERS FORCED TO MAKE IMPOSSIBLE CHOICE BETWEEN ‘DEATH OR JAIL’

The Egyptian authorities must immediately stop their campaign of harassment and intimidation against frontline health care workers who express safety concerns or criticize the government’s handling of the COVID-19 crisis, Amnesty International said today.

The organization documented how Egyptian authorities have used vague and overly broad charges of "spreading false news" and "terrorism" to arbitrarily arrest and detain health care workers who speak out and have subjected them to threats, harassment and punitive administrative measures.

Those targeted by the authorities have denounced unsafe working conditions, personal protective equipment (PPE) shortages, insufficient infection control training, limited testing of health care workers, and lack of access to vital health care.

Amnesty International conducted 14 interviews with doctors, their relatives, lawyers and syndicate members, and reviewed supporting evidence, including written correspondence and voice messages from public officials.

“Instead of protecting frontline health care workers by addressing their legitimate concerns over their safety and livelihoods, the Egyptian authorities are handling the COVID-19 crisis with their usual repressive tactics. Health care workers have to make an impossible choice: risk their lives or face prison if they dare to speak out,” said Philip Luther, Amnesty International’s Research and Advocacy Director for the Middle East and North Africa

“Health care workers in Egypt have been arrested, criminalized and prosecuted simply for daring to express their personal safety concerns and, in some cases, have been denied access to adequate health care. Officials have often hailed health care workers as Egypt’s ‘white army’ for bravely fighting at the frontlines to protect people’s health, but apparently with the expectation that they will do so in silence."

According to Egypt's Doctors Syndicate, at least 68 frontline health care workers died and more than 400 tested positive since the outbreak of the coronavirus in Egypt in mid-February. This number does not include doctors who died with COVID-19 symptoms, such as pneumonia, who did not undertake the PCR tests. It also excludes the death toll of nurses, dentists, pharmacists, technicians, delivery workers, cleaning staff and other essential workers who are also on the frontline and have risked their health and wellbeing to ensure that people are able to access health care and other essential services.

Protecting their life or liberty?

Amnesty International has documented the cases of eight health care workers, including six doctors and two pharmacists, who were arbitrarily detained between March and June by the notorious National Security Agency (NSA) for online and social media posts expressing their health-related concerns.

The NSA arrested Alaa Shaaban Hamida, a 26-year-old doctor, on 28 March at the hospital where she works in Alexandria, after a nurse used her phone to report a case of coronavirus to the health ministry’s hotline. According to Alaa's statement during the prosecution’s investigation, the director of El Shatby University Hospital in Alexandria reported her to the NSA for bypassing his mandate by reaching out directly to the ministry. NSA officers then arrested her from the hospital director's office. Alaa, who is pregnant, is currently held in pre-trial detention on charges of “membership in a terrorist group”, “spreading false news”, and “mis-using social media”.

On 10 April, security officers arrested an ophthalmologist, Hany Bakr, 36, from his home in Qalyubia, north of Cairo, for a Facebook post in which he criticized the government for sending medical aid to Italy and China.

On 27 May, another doctor was detained for writing an article criticizing the government’s response to COVID-19, as well as the structural gaps in Egypt's health system. According to his family, four security officers raided his home, confiscated his phone and laptop, and asked him if he attended the burial of Walid Yehia who died after contracting the virus.

On 14 June, the doctors' syndicate released a statement warning that such detentions were creating “frustration and fear among doctors”.

On 25 May, a group of doctors at Al-Mounira hospital submitted their resignations, stating that a lack of training and PPE kits and "the arbitrary decisions [of the health ministry] in relation to [administering] PCR tests and isolation measures" may have contributed to the death of their colleague Walid Yehia, 32, a doctor who contracted the virus and was unable to get a bed for more than two days at a quarantine hospital in Cairo. According to several sources, NSA officers visited Al-Mounira hospital to pressure the striking doctors to retract their mass resignations. The health ministry’s investigation into his death, acknowledged an "administrative failure" but limited responsibility to the hospital alone.

Arrests for raising concerns about the health system predate COVID-19. In September 2019, five doctors were arrested for launching the "Egypt's doctors are angry" campaign which called for reforming the healthcare system in Egypt and preventing further ‘brain drain.’ While four of the doctors were subsequently released, dentist Ahmad al-Daydamouny is still behind bars for views he expressed online about poor remuneration and working conditions, and inadequate health facilities.

Security and administrative threats 

Amnesty International has also spoken to seven doctors who witnessed security and administrative threats against their health worker colleagues for complaining on social media or requesting the health ministry to provide health care workers with PCR tests, PPE, training, and access to health care in cases of contracting the virus.

A source from the Doctors Syndicate confirmed that doctors are being subjected to threats, interrogations by the NSA, administrative questioning, and penalties. He said: “We are receiving a lot of complaints in that regard, while many others are preferring to pay for their own personal equipment to avoid this exhausting back and forth. They are forcing doctors to choose between death and jail.” The NSA is represented in the "COVID-19 crisis committees" established across the country, further confirming the government’s security-based approach of addressing a public health crisis.

Some health workers have expressed concerns for their safety. Doctors interviewed shared with Amnesty International several threatening voice messages they received from district health officials or hospital managers. The voice messages flagrantly threaten doctors who don’t report to work with referral to the NSA which could lead to prosecutions, or proceedings that could lead to salary deductions. In one such message, a doctor who has refused to work [for lack of safe working conditions] is described as "[a] traitorous soldier" who deserves to "suffer the most severe penalties”. 

A written letter signed by the North Sinai governor, seen by Amnesty International, warns: "Any doctor or nurse who refuses to perform their work or is absent from work will be summoned by the NSA.”

Sources from the Doctors Syndicate told Amnesty International that health care workers who speak out have been transferred to isolation hospitals where patients who have contracted COVID-19 are quarantined, or to hospitals in other governorates. This is especially concerning for doctors with pre-existing medical conditions or older doctors who are at greater risk.

For example, following a video posted by a doctor in the Central Hospital in Deyerb Negm requesting personal protective equipment, the health ministry deputy in Sharqia governorate referred him to the health ministry's legal committee for questioning and transferred him to another hospital as a form of punishment.

Pharmacists have also faced abuse and harassment for criticizing the authorities. In response to a complaint from eight women pharmacists in relation to their unsafe working conditions at Damanhour Medical National Institute, the hospital director decided on 9 May to transfer them to different governorates far from their homes and families.

“Amnesty International is calling on the Egyptian authorities to put an immediate end to their campaign of harassment and intimidation against health care workers who are speaking out. The campaign not only further undermines freedom of expression in the country, but also hamstrings the efforts of those tackling the heath crisis and puts their and others’ lives in danger,” said Philip Luther