Investigation: Shehata El- Sayed – Sahar Alhamadany
Over the past seven months, this press inquiry has brought to public notice the fact that poor health care provided to the Syrian refugees in Egypt, by The United Nations High Commissioner for Refugees UNHCR and its partners, has exacerbated their health problems and made them suffer permanent disabilities.
In May 2016, the Egyptian Authorities received information about 300 people trying to flee in a fishing boat in illegal immigration from Alexandria en-route to Europe. The security forces raided the site and arrested everyone, including Gamal Tayseer’s family, a Syrian national.
Tayseer and his family tried to flee in an endeavor to find a cure for his eyes, after his left eye became almost blind when he failed to undergo the Cataracts surgery in Egypt, while the UNHCR didn’t respond to his calls as he told the reporters.
It is worth mentioning that Tayseer has suffered from Cataracts as he grieved over his son Amr who was killed in Syria.
Aside from the story of Tayseer’s left eye which was almost blind, the reporters met 12 Syrian refugees in Egypt, who suffered from chronic health problems, but failed to get access to medical treatment after they had attempted to reach the UNHCR, while the services of the Egyptian Ministry of Health were limited to the primary consultations only, according to the cooperation protocol with the UNHCR.
This press inquiry reveals that over the past seven months, the poor health care provided to the Syrian refugees in Egypt, by the UNHCR and its partners, has exacerbated their health problems and made them suffer from permanent disabilities. Moreover, some risk their lives and flee in crammed death boats in pursuit of medical treatment in European countries.
What made things worse is that the UNHCR has donated 4.5 million dollars, equivalent to 68 million Egyptian pounds, during the period 2014-2018, to the Egyptian Ministry of Health in the form of medical support for 19 hospitals and medical centers, to improve the medical services provided to the Syrians.
Nevertheless, during the preparation of this report, we found out that 12 of these centers are located in distant places, away from the refugees’ concentration area and that they are hard to reach.
Furthermore, the inquiry has shed more light on the poor coordination between the UNHCR and the administration of the contracting hospitals, in treating the emergent and critical cases of the Syrian refugees, as the patients are expelled out of the hospital within 48 hours, unless the UNHCR responds to cover the costs of their medical treatment.
In its report issued in February 2019, the UNHCR stated that “More than 80% of the refugees in Egypt lead a miserable life.”
The WHO Constitution requires governments to strive to create the conditions in which people can be as healthy as possible.
The first paragraph of the Article 25 of The Universal Declaration of Human Rights states that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services.”
Whereas Article 18 of the Egyptian Constitution criminalizes denying any form of medical treatment to any human in emergency or life-threatening situations.
“In general, the refugees in Egypt face difficulties to get access to health and food services and financial support,” according to Tayseer al-Najjar, the head of the General Authority of the Syrian Community in Egypt. Moreover, he went to the UNHCR more than once to offer his assistance and cooperation but the UNHCR’s officials refused to meet him.
The number of Syrian refugees in Egypt is around 500.000, of whom 130.000 are registered in the UNHCR. In this respect, the UNHCR asserted that it provided 175.000 medical consultations in 2018. In 2019, the number decreased to 150.000 consultations in the field of primary health care.
An Unfortunate Trip
Jamal Tayseer (60 years) was an antique dealer and was making a decent income. But after the war broke out and the siege of his town Reef Dimashq, he fled to Egypt in late 2011, where he registered himself in the UNHCR and his wife received financial aid of 455 Egyptian pounds ($40) per month. But six months later the aid was cut off without any reason.
In 2015, Jamal’s eyes developed cataracts as a result of his grief over his son’s death. He tried to reach the Commissioner to be sent to any hospital affiliated to the UNHCR, but the Commissioner neither responded to his calls nor allowed him to enter its headquarters.
He went to a public hospital in Cairo downtown, where he had his eyes checked. After the initial examination, the doctor told him he needed urgent cataract surgery so as not to develop any complications that may lead to blindness.
“I agreed to undergo the surgery,” says Tayseer, “and they scheduled one surgery to be performed on one of my eyes every week, when I went on the scheduled time, they told me “You are a Syrian national, we cannot perform the surgery,” even though this government hospital performs this type of surgery to the Syrians and refugees as stipulated in Article 18 of the Egyptian Constitution that criminalizes denying any form of medical treatment to any human in an emergency or life-threatening situations.”
“More than 80% of the refugees in Egypt lead a miserable life.”
“Every citizen is entitled to health and to comprehensive health care with quality criteria. The state guarantees to maintain and support public health facilities that provide health services to the people, and work on enhancing their efficiency and their fair geographical distribution. The state commits to allocate a percentage of government expenditure that is no less than 3% of Gross Domestic Product (GDP) to health. The percentage will gradually increase to reach global rates. The state commits to the establishment of a comprehensive health care system for all Egyptians covering all diseases. The contribution of citizens to its subscriptions or their exemption therefrom is based on their income rates. Denying any form of medical treatment to any human in emergency or life-threatening situations is a crime. The state commits to improving the conditions of physicians, nursing staff, and health sector workers, and achieving equity for them. All health facilities and health-related products, materials, and health-related means of advertisement are subject to state oversight. The state encourages the participation of the private and public sectors in providing health care services as per the law.” According to the Egyptian Law.
Tayseer managed to save from his earnings part of the costs of the first operation, which amounted to 4800 Egyptian pounds, equivalent to 600 US dollars at the time, and borrowed the rest of the money, so that a private doctor near his residence in the 6th district, 6th of October City, would perform the surgery. He underwent the first surgery and his right eye was cured and back to normal, yet his left eye’s condition worsened and became almost totally blind.
Failing to undergo the operation on his left eye, Jamal decided to flee with his family by boat illegally to Europe. He met two people-smugglers (Nizar and Osama) and arranged everything, but the Egyptian security had been on the alert to frustrate their attempt and detained them for 20 days.
In July 2016, Jamal’s family attempted to flee again but the boat sank and they were sent back to Egypt.
Unanswered Distress Call
For four months, Abu-Sharif al-Najjar has repeatedly tried to contact the UNHCR, to schedule an interview, to demand two surgical operations for his 22-year-old nephew, Sharif, without any response.
Sharif al-Najjar’s hand was injured in the suburbs of Damascus in May 2013 by a rocket-propelled grenade. He was then taken to a field hospital near Damascus, doctors tried to save Sharif’s hand from amputation, but the shrapnel cut the ligaments and nerves, which forced doctors to amputate his hand. Subsequently, the scar was infected and caused skin deformation, so his parents took him to a doctor, who supervised his treatment, but his hand now looks like a triangle.
Despite this amputation, Sharif was required to serve in the Syrian military. He became a deserter, so he fled to Egypt, along with his family in October 2013, to begin another trip of suffering with the UNHCR.
Sharif’s family tried to contact the Commission to attach a prosthetic limb for their son several times by phone, but got no response. Moreover, they were not allowed to enter the UNHCR headquarters.
“Sharif is suffering from hand deformation and needs to get a removable artificial limb,” says Dr. Alaa Musa, an employee of the Egyptian Ministry of Health who has reviewed the case. “He also needs a surgical intervention to treat the deformities and plastic surgery at the location of the injury, so that it does not cause nervous breakdown or psychological harm.”
Abu-Sharif went to the UNHCR office at Zamalek district in central Cairo on the morning of November 4, 2019, to review the case of his nephew Sharif, as well as to apply for a renewal of residence. He entered after a four-month attempt to get an interview date, during which he repeatedly called the Commission through the hotline, which costs 1.5 Egyptian pounds per call. The meeting lasted for more than two hours.
“The staff didn’t care about my problem, didn’t hear my complaint, and they did renew my stay for 6 months, four of which have already gone by while trying to arrange a meeting,” he says, and as for the treatment of his nephew, the answer was “We don’t have this kind of treatment.”
Poor Coordination Between UNHCR and Hospitals
“Syrians should have their own hospital, so that they don’t face what my mother faced when she had an acute heart attack,” said Mahmoud Idris, recounting his mother’s suffering on a treatment journey.
The governmental hospital refused to receive Mahmoud’s mother because she is Syrian. They told him that they had nothing to do with UNHCR, although the Ministry of Health and UNHCR agreed that emergencies should be provided with 48 hours of free treatment, but he did not find that in the hospital.
Amina had a pelvic fracture 6 years ago in Syria while running with her family to escape the bombardment on Salah al-Din area in Aleppo governorate. Her children asked the Commission to provide treatment for her while issuing asylum papers. They were referred to Mahmoud hospital, which did not offer this kind of treatment. When they asked the Commission to refer them to a specialized hospital, they refused, according to her children.
In 2015, she suffered from a clot in the right ventricle, and was subsequently transferred again to a specialized hospital.
Her children tried to contact the UNHCR to get treatment for their mother, but they refused on the pretext that they were not authorized to treat such an illness. This forced them to pay 5 thousand pounds (340 dollars) per night to get her medical help.
In July 2019, Ameena suffered a complicated heart attack, and was transferred to a heart-care unit at a university hospital, because the UNHCR-contracted hospitals do not support heart surgery, according to the UNHCR Manual of December 2019, which has limited the healthcare provided to maternal and child health care, as well as primary health care (examinations) and acute and chronic disease consultations.
The operation cost about 9200 Egyptian pounds ($600) and Ameena suffered from “rapid heartbeat” or “tachycardia” after it. Her son went to a hospital not contracted with the Commission, but if refugee patients arrive, they notify the UNHCR.
The hospital doctor suggested to Ameena’s children that she could receive her treatment at home, by purchasing an oxygen cylinder and some medical equipment to continuously monitor the condition from home, after they received nursing training.
Tayseer Al-Najjar explains that the criteria adopted by the UNHCR for the selection of refugees for medical service may be theoretically correct, but in practice they are wrong, indicating that in rare cases the Commission pays part of the cost of the hospital examination, about 50 to 70 percent, while the remaining 30 percent is paid by the patient, which is equivalent to any private doctor’s fees. This way, a refugee does not benefit from the service.
“The Commission has sent its staff four times to assess my case, and each time I’m told, “You deserve aid”, but it’s all empty talk… where’s my right?” ask Abu-Haitham, a refugee in Egypt who suffers from severe asthma, and degeneration of the joints of his feet.
Abu-Haitham entered a health center in Cairo on Tuesday, May 26, 2015, for medical examinations after he felt pain in the joints of his knees and acute asthma.
The health center is a center allocated by the Ministry of Health to receive refugees and does not need a referral from the UNHCR.
The doctor conducted an initial checkup of Abu-Haitham that showed he had excessive osteoarthritis in his feet joints, and severe asthma in his chest, which developed into a lung problem.
The doctor prescribed medicine for him, and he got it free of charge from the center’s pharmacy. After taking the medicine, his feet started to swell, resulting in bone erosion, to a point where he needed to undergo surgery to install artificial joints to allow normal movement.
Abu-Haitham suffers from five diseases (asthma, osteoarthritis, prostate enlargement, high blood pressure, and diabetes), and says he did not receive any help from the Refugee Agency, although its employees examined his condition four times at his home. The reviews acknowledged his right to disburse aid, but his reality remained unchanged.
In 2015, the Assad regime’s forces arrested Abu-Haitham and his son, took them to the “Palestine Branch” in Damascus, where they remained in detention for 20 days, after which the father was released and the son remained for 11 months, during which he was tortured.
Abu-Haitham’s sadness was not only for his son, but also for his daughter, Amani, who suffers from brain atrophy, a thyroid gland problem and malfunction of the limbs and feet.
Amani became totally handicapped and unable to move, in addition to being severely depressed because of the delay of her treatment, which the UNHCR refused to pay for, as they do not carry out such operations for refugees, according to the Health Services Guide.
The Commission referred her to Caritas for “psychiatric” treatment only, and she was offered a monthly treatment worth 450 EGP, equivalent to $30, but she has not improved because her mental illness is related to her health status, according to the psychiatrist renowned doctor at the government psychiatric hospital.
Amani needs surgical interventions to treat brain atrophy, in addition to the removal of part of the thyroid gland, and an operation to correct the hands and feet, so that they return to their normal state, so that she can continue her life like their sisters, according to Dr. Alaa Musa.
The head of the General ِAgency of the Syrian Community in Egypt says, “UNHCR does not conduct social research, through which they can get to know the living conditions of the applicant and his income, whether he or she receives regular or irregular assistance, or whether he is in debt, or perhaps they conduct incomplete research”, indicating that he who presents himself well can benefit from the services of the UNHCR.
When “Caritas Egypt” organization, which is the medical partner of the UNHCR, referred the Syrian refugee Mahmoud Al Qady and his son Omar to a hospital in Alexandria, that is on the list of hospitals contracted with the organization, the father was relieved, thinking that his son will receive medical care, after visiting the organization’s headquarters several times. However, when he went to the hospital, he found long queues of patients without receiving the minimum healthcare.
Mahmoud and his family fled from Reef Dimashq to Egypt through Sudan, and he now resides in El-Mandara district in Alexandria governorate. His son’s struggle with the “Duchenne muscular dystrophy” (a genetic disorder that affects all the body’s muscles) has exacerbated. His father lost hope in receiving medical treatment at the expense of the UNHCR, having visited the international organization’s headquarters many times since he arrived in Egypt in March 2016 without any response.
“During the journey of seeking refuge, Omar has lost the iron shoe that helped him move after being attacked by bandits en route to Egypt through the desert, as they seized their money and belongings,” says Mahmoud, Omar’s father.
They went to a hospital that prescribed some restoratives for Omar and recommended he would undergo physiotherapy. However, the employees in “Caritas Egypt” told the father they do not cover physiotherapy as they have no contracts with specialized hospitals.
The reporters of this press inquiry referred back to the doctors who followed Omar’s case, who said that “restoratives were useless because he needed to undergo physiotherapy; otherwise, his health situation would deteriorate to that point which poses severe threats to his life in case he undergoes an urgent surgery in his extremities to reduce muscular dystrophy, followed by physiotherapy.
The child’s father tried to medically treat his son in the US on the expenses of the UNHCR or other organizations, but he has been waiting for a response for three years now.
Article no. 24 of the Convention on the rights of the child stipulates that: “States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.”
The reporters of this inquiry contacted “Save The Children International,” as the organization responsible for providing children with a safe environment and because it is among the UNHCR’s partners in Egypt, to ask about Omar’s health situation and the reason why he did not receive medical treatment.
Their reply was: “After referring to the health programs at Save The Children International, we would like to confirm that Omar’s father has never contacted us before to ask for any health services. And the child’s father has been contacted and informed about the health services we provide.”
Supporting Refugees Outside their Areas of Residence
The Ministry of Health, in coordination with the UNHCR, has identified 19 public hospitals and health centers to provide services for refugees. Eight establishments of them offer primary health care services, while the other eleven hospitals are located in remote areas away from the concentration locations of the refugees.
On September 12th, 2018, the UNHCR noted that these hospitals provide primary healthcare for refugees, after receiving in-kind aid worth 4.5 million dollars in the form of medical devices and equipment, on several batches.
Furthermore, the UNHCR published a video highlighting that a range of hospitals and health centers receive refugees in coordination with the UNHCR and its partner medical associations.
However, the memorandum of understanding, MoU, signed by the UNHCR and the Egyptian Ministry of Health, has overlooked the emergency cases and surgical operations and focused only on primary healthcare.
The most striking thing in choosing the locations of the 19 hospitals and health centers was that 11 of them are remotely located away from the refugees’ concentration areas.
The statements of the UNHCR official spokesman in Egypt and a report published by the Arab Reform Initiative pointed out the areas of distribution of Syrian refugees and refugees from other nationalities as well. By comparing the refugees’ areas of distribution stated by the UNHCR spokesman and the report, with the UNHCR supported hospitals areas, the inquiry reporters concluded that refugees’ concentration areas are distributed among the 6th of October City, 10th of Ramadan City, El Obour City, Damietta, Mansoura, Hurghada, Suez, Ismailiya and Alexandria.
On the other hand, the supported hospitals are distributed in New Cairo, a medical center in the first settlement, Nasr City, Eastern Cairo district, a medical center in the 7th district, El Omraniya, a medical center in El Talbia, a medical center in Kafr Nassar, in addition to the Mental Health Secretariat hospitals, the mental health hospital in Abbassiya, Helwan Mental Health hospital in Cairo, and Maamoura Mental Health hospital in Alexandria.
The Map of the Refugees Medical Treatment in Egypt
Sharif’s father says that “the UNHCR does not respond to calls quickly, neither in emergency cases nor in ordinary cases, and thus patients may risk their lives due to red tape if they do not have enough money.”
In January 2019, the inquiry’s reporters contacted the UNHCR via email, asking questions about refugees’ help mechanisms, the reasons for the lack of coordination with hospitals, and the selection process of supported medical centers, but they did not receive any response.
This Investigation has been achieved with the support and supervision of “Syrian Investigative Reporting for Accountability Journalism – SIRAJ” in cooperation with “Daraj Media” and under the supervision of our colleague Ahmed Haj Hamdo.