A deadly fourth wave of Covid-19 has swept across Tunisia in recent days, pushing its healthcare system to the brink. Public hospitals are at or beyond capacity and the World Health Organisation announced on Thursday that Tunisia now has the highest Covid mortality rate in both Africa and the Eastern Mediterranean regions.
At Charles Nicolle Hospital, one of Tunis’s largest public facilities, “the situation is catastrophic,” said a physician who declined to share her name because she was not authorised to speak on behalf of the hospital.
“There’s a line of people outside waiting for someone to die so they can take their bed,” she said.
Another physician at the hospital said Covid patients were being brought to any available bed, even in wards not equipped to isolate Covid cases, risking the contamination of other patients.
“We’re putting them anywhere we can fit them,” he said. “They found an oxygen jack in the medical records office — now they’re not filing there any more — they’re treating patients.”
Donations have streamed in from around the world to help alleviate the strain on Tunisia’s system. But the Ministry of Health has failed to tap into one major resource to treat its sickest citizens: the country’s network of private hospitals and clinics.
Beginning in the 1990s, private clinics and surgical centres sprouted up across Tunisia in hopes of bringing medical tourism to the nation. Most perform elective procedures, including orthopaedic, cardiovascular and cosmetic surgery.
With the downturn in elective procedures during the pandemic, many clinics have spare oxygen-enabled and even ICU beds available. Now some of them are offering them up to those willing to pay market rate to find Covid care rather than wait for a free bed in a public hospital.
Outside the emergency department of Charles Nicolle, Mounira was waiting for word of her 82-year-old mother who, she said, had been sitting in a chair overnight in the Covid ward because there were no beds available.
“We’ve been sitting like dogs waiting since yesterday” for a space to free up, she said.
The family were trying to secure a bed in a private clinic, but the hospital required an oxygen-fitted ambulance to transfer her there, Mounira said. The cost for the ambulance and the clinic fees was more than 40,000 dinars ($14,445), she said, money her family did not have.
The National spoke to several clinics around the country who had beds available for a price.
The Ezzahra Clinic, in the Tunis suburb of Ben Arous, is asking for a 10,000 dinar deposit for an oxygen-fitted bed, and a 20,000 dinar deposit for an ICU bed. Ibn Khaldoon Clinic in the central coastal city of Sfax requires a 3,000 dinar deposit for an oxygen bed and a 6,000 dinar deposit for an intensive care bed. Fees beyond the deposit are calculated according to length of stay and services provided, they said.
More than half of Tunisians live on a monthly income of less than 1,000 dinars, according to Statista, making private health care an impossibility, even in the most desperate of circumstances.
Dr Mohamed Chafik Smida, the general director of El Menzah Clinic in Tunis, recently put a public call out on Facebook, writing, “We have hundreds of private clinics. If each clinic took care of two ICU patients for free, it would solve some problems.”
Dr Smida told The National that many of the country’s private hospitals have both the facilities and staff to take on Covid patients, even when the public hospitals are struggling to cope. Apart from taking charitable cases, he believes a private-public partnership, with the government paying private clinics to take public patients, could expand the country's critical care during a crisis.
“If we shared resources, staffing, and equipment with public hospitals, it would help,” he said. “If there had been any kind of coordination, the situation could have been different.”
But despite clinics’ willingness to coordinate with the public sector for a Covid response, Dr Smida said the Ministry of Health has made no efforts in that direction.
“We’ve spoken about the need to work together for a long time, but there was no response,” he said.
Zied Mhirsi, a Tunisian physician and director of communications and advocacy at Global Health Strategies, says that reticence is long-standing. “In Tunisia, public health care has never aligned with private health care,” he said.
“We created two parallel systems, with a reluctance from the government to align them and have them work together.”
Dr Mhirsi pointed to the government’s initial refusal to allow private labs to perform Covid tests for the first six months of the pandemic as another example.
“It was such a waste of time at a moment when we should have been testing everybody, and anyone who could perform the test should have,” he said.
Tarik Ben Naceur, Tunis regional health director, conceded that little had been done to marshal private-sector resources to combat the current surge. When asked if there were plans for a public-private partnership to cope with the crisis, he responded, “Honestly, no”.
“People who have money generally go to the private sector, while those without means automatically go to the public sector, which is not a small number,” he said.
Ghaya ben M'barek contributed reporting.