FOR THOSE with money, Lebanon’s health-care system was once the envy of the Middle East. Private clinics and hospitals were staffed by doctors trained at top places in the West. Wealthy patients from across the Arab world jetted in for treatment. Today, though, it is the doctors getting on planes. One surgeon says his salary, paid in local currency, is worth about $200 a month—less than a dollar an hour. Another says his hospital was wrecked in the explosion on August 4th at Beirut’s port. Both are applying for jobs abroad, joining a long exodus of Arab doctors.
The Middle East, like much of the northern hemisphere, is hunkering down as covid-19 cases climb. In Lebanon, where more than 80% of intensive-care beds are occupied, the government ordered most businesses to shut on November 14th. Tunisia has imposed a curfew and halted travel between regions. Other countries are considering similar measures. But the closures offer scant relief for doctors forced to fight the virus short-handed.
Though there is no universal standard for a well-staffed health-care system, the World Health Organisation suggests a minimum threshold of 45 skilled personnel—doctors, nurses and midwives—per 10,000 people. At least nine Arab states fall below that benchmark. In some the shortfall is particularly stark (see chart). Egypt had fewer than five doctors per 10,000 people in 2018, down from more than 11 in 2014. The number of doctors in government hospitals, which serve the bulk of the population, fell by one-third during that period.
This is not for lack of talent. Arab universities produce plenty of doctors. In Egypt about 7,000 of them graduate each year—15% more than in America, adjusted for population. Careers in medicine offer prestige and stability. Competition for university places is fierce. (Nursing is a less desirable career, and many Arab states rely on nurses hired from abroad, a problem that is not unique to the Middle East.)
Once they graduate, though, many doctors are eager to leave. Money is the most obvious reason. A newly minted doctor in Egypt can expect to earn just 2,000-2,500 pounds ($128-160) a month. For a typical family, that is not even a subsistence wage: the average Egyptian household spends more than 4,000 pounds a month on living expenses, a figure that has soared since the pound was devalued in 2016. In Tunisia a specialist with decades of experience, working in a public hospital, may take home the equivalent of $15,000 a year. She could earn the same sum each month practising in a rich Gulf country.
Working conditions are better abroad, too. State hospitals in many Arab countries are notoriously crowded and short of equipment. Iraq has just 13 hospital beds per 10,000 people, compared with 22 in Saudi Arabia and 28 in Turkey, its neighbours to the south and north. The Iraqi health-care system was shattered by decades of war and sanctions, and successive governments have invested little in rebuilding it. In 2017 Iraq spent just $210 per person on health care, estimates the World Bank (the regional average was $459).
Egypt’s constitution, approved in 2014 after a coup, committed the state to spending 3% of annual GDP on health care. That provision has gone ignored: spending in 2018 was just 1.4% of GDP. The constitution also promises free speech, which has not stopped police from arresting doctors who complain about the government’s poor handling of covid-19; the disease has killed an estimated 200 medical staff. Underfunded hospitals cannot keep pace with a fast-growing population. In the three years after the constitution was approved, the number of hospital beds per 10,000 people fell by 8%, from 15.6 to 14.3.
In Lebanon an worsening economic crisis means even basic medical supplies are scarce. Chemists are running out of everything from blood-pressure pills to paracetamol. An estimated 400 Lebanese doctors, almost 3% of the total workforce, have left in the past year. The National Council of the Order of Physicians of Tunisia says 40% of its members practise outside their home country. In Egypt the figure is closer to 50%. The exodus has given rich countries a glut of doctors to hire. But it has left much of the Arab world short of them—just when they are needed most. ■
This article appeared in the Middle East & Africa section of the print edition under the headline "Out of practice"
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