[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.