Healthcare Services

5.2 Healthcare Services

According to the World Health Organization (WHO), Egypt has a broad network of easily accessible healthcare services, including public clinics and hospitals, private healthcare facilities, charitable healthcare services provided through mosques and churches, and NGO-provided healthcare for refugees. Public clinics and hospitals provide inexpensive

services to Egyptians and foreigners alike. However, both Egyptians and refugees complain about the low quality of public health services and as a result many locals and refugees choose to utilize parallel systems of private medical facilities and NGO- or faith-based clinics.

Healthcare: Obstacles to Quality Affordable Care

• Low quality public services • Expensive private health services • Inconvenient refugee specific health services • No dental services in refugee specific clinics • Variable quality of all types of health services • Refugees with closed cases are not eligible for

most NGO health services

Public Health Services

when they require medical care (WHO and MOH 2009).

Governmental medical facilities are the most numerous in Numerous NGOs exist to provide various types of

CH3:

Egypt, yet they are the least popular among Egyptians and medical and psychosocial support to refugees. There refugees alike. One Egyptian told us, “The public health are three basic types of NGO-based health facilities:

services, like those at the university, are so overcrowded

efugee

1. Those that provide primary care through their that the doctors can barely give each patient two minutes of

own medical clinics;

their time. Doctors barely look at their patients and quickly

Liv

write a prescription for something. This leads to constant

2. those that provide referrals and financial

elihoods

misdiagnoses.” Refugees repeated many similar claims about

assistance; and,

public facilities, and as a consequence, overwhelmingly chose alternative medical centers for treatment.

3. those that provide psychosocial and mental health support.

Private Health Services

Refuge Egypt and Caritas are the two largest NGO primary

All refugees interviewed for this project perceived private healthcare providers. Refuge Egypt has a staff of four clinics as the highest quality of care. Those who were able doctors, and its main primary care clinic is open twice a to afford private healthcare through their own means— week for examinations, seeing between 150-200 patients Iraqis, mostly—often elected to do so without taking a per day. Refuge Egypt specializes in women and children’s

e time-consuming trip to Caritas for a referral and subsidy. health, providing antenatal and postpartum care, anti-viral

CH5:

Refugees without adequate financial means were able to and retro-viral treatments, and immunizations for adults and

ff

access private clinics for secondary and tertiary care with

children. It provides these services through its five Well Baby

or Healthcar

assistance from Caritas. In a study by the WHO and Egypt’s and Well Child clinics throughout Cairo. Caritas also provides

dable

Ministry of Health (2009), 63 per cent of Iraqis preferred primary care at its clinic, serving approximately 1,000 patients private sector treatment, whether paid for through their own per month and assisting an additional 750 with chronic

dable

Healthcar or

resources or with subsidies from Caritas. Sixty-two per cent diseases. With the exception of economically self-sufficient

ff of Iraqis participating in the WHO study had never visited refugees, these NGO clinics are the most common place for

A a public health facility. When it came to advanced care, an refugees of all nationalities to seek primary care treatment. CH5: even higher percentage preferred private services: 80 per

They have received health services on many

cent of Iraqis preferred private hospitals to public ones. occasions from Caritas, due to health problems With the suffering and the money you spend

among family members. However, they are at times [to get healthcare at refugee NGOs], it is better

exasperated with Caritas as it is a great distance form that you go to the closest private doctor where

their home, it is often very crowded with refugees, the fee is 20LE instead of going to Caritas as

involves long waiting times to see a doctor and early as 6am and the suffering. It is not good

is very bureaucratic in nature. There are complex service—[people often] go and come for nothing

rules necessitating multiple trips to see the doctor as well as to collect medicine from the clinics. All of

this proves particularly troublesome for the family. An Iraqi Family We didn’t use any refugee health services because

An Ethiopian Woman

Several organizations exist to provide referrals (and subsidies) we live far away, and because we didn’t have any

to refugees with advanced medical needs. Caritas is the information about the organizations that offer

primary referral center, though UNHCR-Egypt and Africa and free healthcare for refugees. No one from the

Middle East Refugee Assistance (AMERA) sometimes provide UN contacted us about this subject. So we have

referrals as well. Caritas, the main “gatekeeper” NGO for been getting healthcare from private clinics.

refugee healthcare, works with 142 different medical centers

An Iraqi Man

throughout Egypt, including 25 hospitals and 48 private clinics.

Many refugees self-medicated; they sought advise and In addition to referrals, Caritas will usually subsidize up to 80 remedies from private pharmacies, especially for common per cent of treatment costs for even very costly treatments ailments or when they thought it was too difficult or too like chemotherapy and surgeries (Note: this is very different costly to travel to Caritas for a subsidized prescription. In from Jordan, where refugees have to pay for tertiary care at Egypt, most medications are available without a prescription, the same rate as foreign nationals, without subsidies. See: which makes self-medication both easy and dangerous. Martin and Taylor 2012). However, Caritas reserves the right

to deny subsidies or referrals based on its assessment of need.

NGO-Based Health Services

Nearly all refugees who had sought medical care in Egypt

Refugee-specific NGOs operate a parallel medical system in interacted with Caritas to some degree. Those who had Cairo, which in many ways duplicates the services available complex medical conditions were especially dependent through public and private facilities in Egypt. Refugees on their financial subsidies. For example, one Iraqi woman frequently use these NGOs because they are less expensive relied on Caritas to pay 70 per cent of costs for her than private facilities but perceived to provide higher daughter’s Thalassemia treatment, and another Iraqi family quality care than public health services. African refugees praised Caritas for providing their disabled son with a were the most likely to seek care at refugee-specific NGOs: much-needed wheelchair and medications. In this instance,

67.7 per cent of Sudanese refugees use NGO medical clinics Caritas also helped to pay for funeral arrangements when 67.7 per cent of Sudanese refugees use NGO medical clinics Caritas also helped to pay for funeral arrangements when

While the proliferation of NGOs has worked to ensure

that a variety of health services are available to refugees and to prevent any one particular NGO from being overburdened, this has also created a complex and often confusing environment of overlapping services, duplication and sometimes opaque referral protocols.