Egyptian anaesthesiologist Dr Ahmed Salah El-Din lies between life and death after being stabbed earlier this week in Luxor Governorate, in southern Egypt. The incident is not the first of its kind but part of a growing pattern of assaults against doctors in Egypt, throwing open the doors to mass resignations and emigration. This trend, also fuelled by other factors, has inflicted heavy losses on the country due to the ongoing brain drain and the exodus of rare talents.
About two weeks ago, a surgeon at Al-Manzala General Hospital in Dakahlia Governorate was physically and verbally assaulted by a member of the Egyptian parliament. Last month, the director of Al-Nasr Health Insurance Clinic in Helwan was beaten severely by a patient, according to Egyptian media reports.
The rate of resignations among Egyptian doctors is alarming. In 2016, 1,044 doctors resigned; in 2017, the number rose to 2,549; in 2018, it reached 2,612; and 2019 saw a significant increase to 3,507 resignations. In 2020, the number dropped slightly to 2,968.
Following the Covid-19 pandemic, the resignation rate surged dramatically, with 4,127 doctors resigning in 2021, and 4,261 in 2022, culminating in 7,000 resignations in 2023, according to Dr Osama Abdel Hay, head of the Egyptian Medical Syndicate. Thus, more than 28,000 doctors in Egypt resigned between 2016 and 2023, worsening the conditions of the healthcare system — comprising 1,798 public and private hospitals — in the most populous Arab country.
According to Dr Mohamed Awad Tag El-Din, the Egyptian President’s Advisor for Health and Prevention Affairs, 700 Egyptian doctors died during the pandemic. He pointed this out during a telephone interview with Al-Hadath Al-Youm TV channel on 14 September, 2022.
Roughly 120,000 Egyptian doctors currently work abroad, out of a total of 220,000 registered with the Medical Syndicate.
This means that over half of Egypt’s medical workforce has opted to work overseas. According to data from the Central Agency for Public Mobilisation and Statistics (CAPMAS), the number of practising doctors in Egypt fell to 97,400 in 2022, down from 100,700 in 2021, a 3.3 per cent decline.
The Egyptian Medical Syndicate states that the doctor-to-population ratio in Egypt is 8.6 doctors per 10,000 people, while the global average is 23 doctors per 10,000. Globally, there is one doctor for every 434 people, while in Egypt there is one doctor for every 1,162 people, according to a study by the Supreme Council of Universities headed “The Labour Market Needs for Medical Professions in the Next Five Years Starting from 2020″.
The Syndicate estimates that the average resignation rate is 12 doctors per day, driven mainly by poor salaries, a hostile work environment, frequent assaults, lack of proper hospital security and the absence of moral and professional appreciation.
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Dr Ahmed Kamel refused to seek public sector employment, preferring instead to work independently at his private clinic, stating that what he could earn in one or two days at his private practice in an upscale Cairo district would match an entire month’s salary at a government hospital. An independent doctor holds an official licence to practice but chooses to work in private hospitals or own a private clinic rather than work in public healthcare institutions.
At the entry-level, a government-employed doctor earns 5,900 Egyptian pounds (approximately $116) per month.
This isn’t enough to meet basic needs for food, clothing and shelter, especially amid the collapse of the local currency (where $1 equals approximately 51 pounds).
A source from a government university hospital told me that additional allowances for doctors are extremely low: the infection hazard allowance, for example, is 30 pounds per month (about $0.60); the day shift allowance (8am to 8pm) is 120 pounds ($2.30); and the overnight shift allowance (8pm to 8am) is 185 pounds ($3.60).
After years of study and earning a master’s degree, a doctor’s salary may increase to about 8,000 pounds ($157) per month, and to 10,000 pounds ($200) after gaining a PhD.
An assistant professor, who requested anonymity, stated that his salary does not exceed 11,000 pounds ($215), and that even professors barely earn around 15,000 pounds ($300). Thus, private sector work becomes necessary to compensate for the severe income shortfall, demanding longer hours and greater effort.
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When comparing the salary of an Egyptian doctor with that of doctors in other countries, the difference can be striking. A doctor in the United States earns $22,000 per month, while in Canada the salary exceeds $15,000 per month. In an Arab country like the United Arab Emirates, a doctor’s monthly salary is around $16,000, whereas in an Asian country like Pakistan, it is about $650 per month, according to World Population Review and Insider Monkey platforms.
The desire to emigrate among Egyptian doctors is fuelled not only by lucrative offers from Gulf and European countries, but also by the immense work pressures at home. Doctors may be required to examine 50 patients per day or perform numerous surgeries in a single day.
A doctor at a public hospital, speaking anonymously, explained that resident doctors work 24 hours a day, six days a week. They are forbidden from leaving the hospital, rotate among outpatient clinics, emergency rooms and operating theatres, and can be called for at any time during the night without adequate rest.
Dr Ibrahim El-Zayat, a member of the Medical Syndicate Council, reported 149 doctor deaths in 2022 that were due to work-related exhaustion. Doctors’ stress is compounded further by poor hospital infrastructure; shortages in equipment, supplies and medications; and restrictions on leave and forced relocations to distant workplaces.
Adding to their hardship, a recent television programme highlighted a proposal to restrict doctors’ ability to travel abroad unless they repay the cost of education, as a deterrent to emigration. Egyptian MP Rifaat Shakib proposed legislation requiring doctors to work domestically for two to five years before being allowed to travel abroad or otherwise pay financial penalties.
The Medical Syndicate described the proposal as punitive and foolish.
Egyptian President Abdel Fattah Al-Sisi acknowledged over two years ago that doctors’ salaries are inadequate. He justified it by citing the country’s longstanding challenges and burdens.
Around 9,000 doctors graduate annually from medical schools in Egypt, and for many of them, emigration is a dream, not merely for financial reasons, but also because they have lost hope of achieving parity with other professional groups such as police officers and judges. They seek appropriate recognition, well-equipped facilities, better training opportunities and a safe working environment that offers them a lifeline from early death.
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