The Algerian Healthcare System in the Time of COVID-19

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Aug 20, 2020 Algeria
Sisters of Bedj Hospital in Algeria. Photo by Knight of honor via Wikimedia Commons. Sisters of Bedj Hospital in Algeria. Photo by Knight of honor via Wikimedia Commons.

The Algerian Healthcare System in the Time of COVID-19

By : Thomas Serres

[This article is part of a special bouquet on the interrelationship between the COVID-19 pandemic and social mobilization in the Middle East, North Africa, and the United States. Click here to view the entire listing of entries.]

Algeria is among the countries in Africa that have been the most impacted by the pandemic, with more than 1,200 deaths and 30,000 cases confirmed at the beginning of August. The healthcare system has long been a mirror of the nation’s broader weaknesses, strengths, and tensions. Throughout Bouteflika’s tenure (1999-2019), it experienced a series of reforms, notably aimed at promoting new forms of management in public hospitals. Healthcare was caught between the imperative of maintaining an essential public service and efforts to liberalize the sector, and the founding principle of equality among citizens and the government’s desire to regulate public spending. Despite the economic crisis of the 1980s-1990s, the publicly funded healthcare system covers almost ninety percent of the population and ensures free coverage to patients suffering from chronic diseases. Between 1963 and 2012, the average density of healthcare workers per ten thousand citizens has increased steadily (from 0.4 to 12.1 for doctors, 3.3 to 19.5 for nurses and nursing auxiliaries, 0.24 to 2.2 for pharmacists).

To be sure, the Algerian system is among the best in Africa. Yet it remains far from the standards of wealthier countries. Health practitioners have long been confronted with dire challenges starting with the lack of proper equipment and aging facilities, the bureaucratic surveillance, and the isolation in medical deserts scattered across a huge national territory. The flaws of the system fueled anger and frustration among the population. As a result, acts of violence occasionally targeted health practitioners, who were put in the position of bumpers by successive governments. This resulted in recurring social movements in public hospitals, as nurses, physicians, or paramedics denounced their working conditions. In 2011, the newly founded autonomous collective of Algerian resident doctors led a series of actions to echo these grievances. Given the lack of response from public authorities, the physicians launched a historical strike movement in 2018, demanding better working conditions and reform of their civil service. These actions were met with the usual police repression and brutality. Consequently, the country has long suffered from the exile of its doctors, with more than twelve thousand working abroad in 2017, mostly in France.

Hygiene and medical-related issues also fueled the grievances that led to the Hirak. In the summer of 2018, hundreds of cholera cases caused by contaminated water used to wash watermelons shed light on the deteriorating condition of public health. The discontent expressed during the revolutionary mobilization was also linked to the corruption and mismanagement that led to the slow demise of the Algerian healthcare system. In the early days of the movement, an ailing Abdelaziz Bouteflika left the country to be treated in Switzerland. The departure of the president to a European hospital appeared to be another proof of the contempt of Algerian ruling elites for both the population and medical practitioners.

Throughout 2019, grassroots activists continued their efforts to create a model of horizontal citizenship and denounce pervasive injustices. The situation in public hospitals was one of the many emergencies they identified. The administration and the justice system responded with denial and repression. In August 2019, the member of an association supporting homeless people was briefly detained for recording a clip showing a destitute patient neglected by the staff at the Mustafa Pacha hospital in Algiers. She was arrested following a defamation suit filed by the hospital’s management. The same month, the mayor of the small town of Souk El Tenine, in Kabylia, threatened to resign if the wali (governor) did not honor the promise to rapidly build a small hospital. Overall, the Hirak did not change the dire situation of medical practitioners confronted with the shortcomings of the state and exposed to expressions of popular discontent. By the end of 2019, many considered that they had become the “scapegoats” of an healthcare system still managed in a chaotic fashion.

The pandemic reached Algeria in early March. From a political perspective, it represented an opportunity for the regime to crackdown on its despisers without risking a popular backlash in the streets. Some reacted in disbelief, and the usual conspiracy theories circulated, demonstrating the continuous weakening of official discourses. The desperate plea of a doctor from Zmirli hospital in tears, calling her fellow citizens to take the disease seriously, nonetheless circulated widely on social media. Most Hirak activists thus made the choice of responsibility and civility, following the strategy that they had adopted since the early days of the movement. They suspended their street actions before the newly elected president, Abdelmadjid Tebboune, announced a series of measures on 17 March 2020, which included closing the country’s borders and a ban on marches. Committed to continuing their movement by other means, activists demonstrated their solidarity with frontline medical workers. Students notably worked to produce protective gear for hospitals. More broadly, Algeria witnessed shows of gratitude and support for medical practitioners similar to those experienced in many countries throughout the world.

Yet, behind this unanimity, the widespread mistrust toward public authorities persisted. Some activists accused the government of underestimating COVID-related deaths and published their own statistics on social media. Anger soon resurfaced in public hospitals as patients released videos of the conditions of their isolation. The prison-like features of the facilities, their insalubrity, and the apparent lack of medical care prompted cries of outrage incriminating once again a failing Algerian state. In Boufarik, a patient treated for coronavirus escaped from the hospital and fled to Mostaganem, some three hundred kilometers west. More tragically, the tense situation in public hospitals and the shortcomings of the administration directly impacted frontline workers. In May, the death of a young doctor from Ras el-Oued sparked outrage. Wafa Boudissa was in her eighth month of pregnancy when she presented a medical certificate testifying to her pre-existing health conditions, but the hospital management forced her to continue working. In July, as the health situation seemed to worsen, several cases of violence targeting medical practitioners and at least two cases of doctors’ suicides were reported. In this context, hospitals once again saw expressions of discontent as frontline workers denounced the lack of protective gears and the disorganization of their services.

The situation of the healthcare system illustrates many features of Tebboune’s Algeria. The country’s constitution recognizes the right of all citizens to healthcare. In a way, the state certainly takes this mission seriously. Yet, the structural shortcomings of public authorities have left frontline workers exposed to the dangers of the pandemic and the mental distress that comes from being confronted with popular anger and desperation. Despite the mobilization of volunteer citizens, medical practitioners bear the brunt of the structural problems accumulated over time. When questioned about their mistakes, high-ranking officials refuse to be held accountable. In a surreal press conference, the minister of health denied any kind of responsibility for the disorganization of public hospitals, as he had only been appointed a few months before. Moreover, he argued that if Algerians wanted to live in a country like Denmark, it was up to them to act like in Denmark. More generally, the government reacted to the crisis with a voluntarism that does not hide its disorganization and the paternalism of high-ranking public servants. As always, when confronted with a challenge, the government reacts by mobilizing its security agencies. In Oran, police forces have been deployed massively to protect hospitals and prevent pictures to be taken. At the end of July, travel to and from twenty-nine wilayas were still forbidden. Additional checkpoints were put in place across the territory. Once again, rather than prioritizing a collaborative approach and acknowledging its limits, the Algerian state reacts by securitizing the problem. By resorting to coercion and authoritarian measures, the regime further fuels popular mistrust without mitigating the dire situation faced by medical practitioners in the country’s hospitals.
Aug 20, 2020 Lebanon
Muriam Haleh Davis By :
Muriam Haleh Davis

“This is the Voice of Algeria:” Radio Corona International Carries the Torch of the Hirak

[This article is part of a special bouquet on the interrelationship between the COVID-19 pandemic and social mobilization in the Middle East, North Africa, and the United States. Click here to view the entire listing of entries.]

One of the iconic moments of the Algerian Hirak occurred on 11 March 2019. The peaceful revolution had begun in February, and President Abdelaziz Bouteflika announced he would not be running for a fifth term. A young man who we now know to be Sofiane Bakir Turki responded to a reporter from Sky News Arabia on the streets of Algiers. She was not only asking the wrong questions (are you celebrating the departure of Bouteflika?) but also using the wrong language (Fusha). Her repeated interruptions asked him to speak in “Arabic.” His response was poignant: this is our Arabic, and we are not celebrating. They (i.e., all the members of the regime) should go, Yetnahaw ga3. This subsequently became the rallying cry for the movement. 

The narrative of Algerian history and politics in the official media often follows this script, seeming out of touch with the realities on the ground. Discussions focus on stale “memory wars” or insist on well-rehearsed lines of inquiry. The Hirak, which is a broad social movement and not an official political organization, engaged with Algerian history to denounce official narratives and create a “usable past” in order to construct a better future. Protestors also displayed the humor that is characteristic of Algerian political satire creating a rich lexicon of political contestation.

That was before COVID-19. As cases first emerged in Algeria at the end of February, the regime immediately seized on the pandemic to put an end to the Hirak and close down avenues for expression and dissent. Algerians were forced indoors and their creativity and channels of expression moved onto online platforms. The regime responded with a typical lack of imagination. The authorities blocked Maghreb Emergent and RadioMPost in April. In May, the much-loved satirical website “El-Manchar” ceased publishing due to the atmosphere of repression. As the regime has not only put pressure on media outlets, but also arrested an increasing number of Algerian journalists, activists, and citizens, the ground of protest has shifted, but the Hirak has not disappeared. 

In late March, a new media format emerged on the Algerian scene: pirate radio. Abdallah Benadouda, who has lived in the United States since 2014, began Radio Corona International (RCI), a podcast that is available on Soundcloud and has a Facebook page. With thousands of followers, the episodes are both cheeky and profound. Benadouda points to Radio Caroline, the British offshore radio station created in the 1960s to circumvent the monopoly BBC, as a model. He also insists that Radio Corona International does not claim to be the official radio of the Hirak, but rather tries to “carry the flame” until the movement can retake the streets. 

While radio is clearly a different manner of occupying public space, the choice of airing two episodes a week adopts the temporality of the Hirak, which featured bi-weekly protests in the country (on Tuesdays and Fridays) before the times of COVID. Fayçal Sahbi, an associate professor in the Department of Communication at the University of Oran, reports on music–covering the heroes (and heroines) of Rai in addition to other topics. According to him, the Hirak protests become a “kind of ritual for many, and a point of reference (repère) for some.” He continues: “Certain relationships and dynamics were possible thanks to the Hirak. The actors sought a public space that could be a refuge or alternative [in order] to continue this quest for a community of ideas and hope. RCI was one response to this need, even without intending to be."

Meryem Belkaïd, an assistant professor at Bowdoin College who contributes a chronique on cinema, notes that RCI is not the only such initiative. She also portrays the RCI as one way of continuing the revolutionary work of the Hirak. The format of a podcast offers more freedom than other outlets, she says: “It allows us to tackle about topics that other media can’t talk about if they wanted or won’t because they are close to the regime.” This resonates with Sahbi’s feeling that RCI’s episode on Meryoula (the “liberatory” or even “libertine” woman featured in Rai music), or the regime’s instrumentalization of Rai in the face of Islamism, would not have been possible in traditional Algerian media. 

In the episode that aired on 31 July, Belkaïd reflected on the Algerian documentary Fi Rassi Rond Point (A Roundabout in my Head) by Hasan Ferhani. The wonderful film recounts life in a slaughterhouse in Algiers and documents the feeling of physical and emotional entrapment of Algerians. The work testifies to a more general social condition as well as the political and spatial forced immobility of the population in the time of corona. It was also particularly fitting for the subject of the podcast, which was a special episode for Eid dedicated to the theme of sacrifice. 

***

The topic of sacrifice would likely have become a stale repetition of patriotic tropes in the hands of an official news outlet. But when adopted by RCI it becomes a charming and authentic tour of various subjects: personal anecdotes regarding the sacrifice of sheep, the history of Algerian football (focusing on the legendary player Hasan Lhmaz, nicknamed el-kebch or the ram), to René Girard (both the football coach and the theorist of sacrificial violence) and ending with a recounting of the story of Electra–told in Algerian Darija. The music spans from Umm Kalthum to the Algerian rapper, Diaz. As listeners send in their Eid wishes, they often say a word of support for the détenus d’opinion–those who have been jailed for their political opinions. A special mention is often expressed for Khaled Drareni, the journalist who was sentenced to three years in prison on 10 August on the pretexts of “inciting an armed gathering” and “endangering national unity.” 

Yet it would be misguided to present the Algerian media landscape as a bleak space dominated by ENTV that features state propaganda. Since the 1990s, the possibility of accessing non-state-run media outlets–including cable TV–contributed to the rejection of official discourses. Moreover, as these channels came into Algerian living rooms, they fashioned new subjectivities and engendered new forms of resistance.[1]

The connection between the media field inside and outside Algeria has another layer of complexity. Given that some of the contributors to Radio Corona International live in the diaspora, I asked Belkaïd if this split had influenced the reception of the podcast. She responded that the Hirak has exposed how “many things have shifted in the country” and said that rather than asking themselves questions about who has the right the act, the diaspora has “a responsibility to act, since our colleagues and fellow citizens are jailed or risk prison.” The alleged split between Algerians in the interior and exterior of the country is another division [2], she pointed out, that the regime has exploited for its own purposes–much like its crackdown of protestors carrying the Amazigh flag during protests.

The voices of Radio Corona International often mix references in multiple languages–Berber, Fusha, Darija, French, English. According to Sahbi, this occurred in a natural way: the founder Abdallah Benadouda used to work for Francophone Channel 3 and so it was more natural for him to animate the first episodes in French. “But it was a ‘reclaimed’ French, Algerianized,” Fayçal notes. “The public was mostly Francophone, which made things easier. But the more we continued, the more we felt the need to open ourselves to the question of language to not give the impression that we were ‘sectarian.’ At the beginning, the only chronique in Arabic was a parody that explained a single word used in a speech of Gaïd Salah. Since that time, we have [aried] around three or four episodes in Arabic (also Algerianized), and the mixture works pretty well I think.” 

It is true that when listening to RCI, one feels that they listening to a conversation rather than consuming a piece of packaged media. “One of the many reasons I believe the Hirak is a revolutionary movement,” Belkaïd explains, “is because it allows us to be who we are, to be reconciled with all the facets of our identities.” Indeed, the content of the podcast is incredibly varied.  Medhi Dahak analyzes the past and present of Algerian football, Salah Badis reflects on literature, and Sihem Abbas covers psychiatry. Some episodes feature an intra-generational conversation, for example when Mehdi Dahak spoke to his father, Bachir Dahak about the latter’s book entitled Les Algériens: le rire et la politique de 1962 à nos jours (“The Algerians: Laughter and Politique from 1962 to Today”). Another episode with Asma Benazouz featured a conversation about the Dark Decade, reflecting the need to transmit a painful history in the context of the official government policy that has insisted on “turning the page.”[3] 

All of these topics echo the deep-seated desire to recount one’s own history rather than have it recounted by someone else. To define oneself rather than being defined. Radio Corona International speaks to a refusal of the passive tense; a refusal that is communicated in many languages. As Belkaïd concludes, “There is no conscious policy other than being who we are and speak our truth.” Frantz Fanon once remarked that radio had the power to create national communities and that listening is not only a form of consumption, but rather an act of constitution. While Radio Corona calls itself the “radio of the end of the world,” it reminds us that another world is indeed still possible.

____

[1] Ratiba Hadj-Moussa, The Public Sphere and Satellite Television in North Africa: Gender, Identity, Critique  (Cambridge Scholars Publishing, 2018). 

[2] Algerian immigration to France began in the early twentieth century and increased during the First World War. This created a diaspora with immigrant subjectivities even as nationalist figures like Messali Hadj (as well as the FLN’s chapter in France, known as the FLN) were central to Algerian independence. During the war itself fighters were divided between those stationed inside the country, and those stationed outside, leading to a rivalry that was only temporarily resolved at the 1956 Soumamm Charter, which stressed the primacy of the internal struggle despite the eventual hegemony established by the “army of the borders” (stationed in Tunisia and Morocco) led by the Second Algerian President, Houari Boumediène. During the early years of independence the notion of hizb frança (“party of France”) emerged, which is a pejorative term used to denote those who are French-speaking and potentially put the political interests of the former colonial power before those of the Algerian nation.

[3] The “Dark Decade” refers to the violent conflict that occurred in Algeria in the 1990s that some have referred to as a civil war. Bouteflika’s policy of national reconciliation attempted to bring closure to these events by offering amnesty to those who committed violence. This also prevented a credible account of the state’s involvement and families who had membered “disappeared” continue to seek justice for these crimes.