How Covid-19 tipped Tunisia into political turmoil

There was one number on the lips of the Tunisians whose anger and discontent spread onto the streets in recent weeks, sparking dramatic political upheaval.

It was 19,000; the number of Covid-19 related deaths among a population of 11.7 million over the last 18 months (a further 1,000 have since died).

After the nationwide protests – sparked by the pandemic but rooted in long standing economic and political tensions – the president, Kais Saied, declared that he would suspend parliament, remove MPs’ immunity from the law, and take over from the prime minister Hichem Mechichi.

The political crisis has raised concerns internationally about the future of Tunisia’s young democracy, often hailed as the only success story to emerge from the Arab Spring. The largest party in parliament before its dissolution, Ennadhha, has been among those who have branded the move a “coup”.

However, more broadly, some polls suggest as much as 87 per cent of the population support the president’s drastic action.

“Ghannouchi [the president of parliament, and leader of Ennahda] has lots of money and he doesn’t buy any oxygen for the country,” says Monia Jardezi, a 50 year old woman who came to protest outside parliament in support of Mr Saeid the day after the "coup".

The handling of the pandemic alone is not responsible for popular discontent, but Covid-19 has exposed the ineptitude of Tunisia’s political class, as well as a crumbling health sector that has been increasingly neglected since the 2010-11 revolution.

The weeks leading up to the events of July 25 saw Tunisia ravaged by the delta variant, sparking the worst wave of cases so far. Daily fatalities went above 200 in July, making it one of the highest per capita death rates in the world.

“People were piled one on top of the other in the corridors,” said Nebiha Falfoul-Borsali, the head of the Covid-19 ward at Habib Thameur hospital in Tunis. In other regions, demand was so high that people were dying outside the hospital.

So far, just eight per cent of the population have been double vaccinated. But according to Amnesty International, the rollout has lacked transparency, with “ineligible” ministers and government advisors pushing to the front of the queue alongside healthcare workers and the over-75s.

Further deliveries from the Covax vaccination scheme have been delayed due to global supply shortages as well as a lack of local political leadership.

Then, the week before the “coup”, a number of vaccine donations arrived from regional neighbours.

The government issued an open call inviting anyone over 18 to get their shots. However, no appointments were made, leading to huge crowds amassing outside the vaccine centres. Mr Mechichi, the then-prime minister, fired the minister of health in response – the fifth time change since the pandemic began.

Since 2011, successive Tunisian governments have been struggling to manage the economy and provide health services.

“We can think of the pandemic as the last drop,” says Intissar Fakir, director of the North Africa and Sahel Program at the Middle East Institute. The pandemic “magnified the power struggle between the president and parliament and the lack of a clear vision on where to take the country,” she added.

Dr Falfoul-Borsali says the system has struggled due to a lack of consistency.

“Health has suffered from the iterative changes of ministers. It is a reality but it is not a recent thing – it is since the revolution, every time there is a cabinet shuffle, the minister changes,” said Dr Falfoul-Borsali.

“We have never had a minister that has [enough time] to create a strategy and put it in place.”

As a result, the public health system has gone from bad to worse. Tunisia's pre-pandemic healthcare spending equates to around 7 per cent of GDP, compared to a global average of around 9 per cent.

“The public system is drowning, machines and equipment haven’t been replaced, a lot of staff have left – to move abroad, to retire or they died –and they haven’t been replaced,” said Tarek Bennaceur, the regional director of health of Tunis, adding that the recruitment freeze came as part of austerity measures required to access loans from the International Monetary Fund.

During the pandemic, extra staff were hired on contracts of three months to a year, and the state asked doctors and nurses to work on a voluntary basis.

Hospitals across Tunisia have dedicated so many resources to treat Covid-19 patients that the mortality rate of other illnesses has risen, according to Dr Falfoul-Borsali.

Meanwhile, oxygen is in short supply. When Youssef Sid, 70, started having breathing problems after testing positive for the virus last week, he called his doctor only to be told that there was no space at the two hospitals in his hometown Sousse.

“They are super busy, and between a 70 year old and a 30 year old, they take the younger. They make choices,” says Sid’s nephew Mohamed Akremi, who took to Facebook to ask for help.

Within five hours, he had found an oxygen concentrator from a volunteer organisation, but social media is also flooded with sellers. According to Mr Akremi, he was asked to pay 6,000 Tunisian dinars (£1,538) for 10 litres of oxygen, more than 15 times Tunisia’s minimum monthly wage. “People profit and raise the price,” he said.

Bayrem Kilani, a 35 year old artist in Tunis, is one of the organisers working to fill the gaps in the state’s Covid-19 response by creating a platform of 400 associations, including volunteer doctors, called the “Citizens Commission Against Covid-19”.

The commission distributes medical aid and runs communication campaigns about the vaccines.

“We created this commission because nothing was happening. This is not our job but they all disappeared – the state, the ministry of health, the prime minister, the president, they all did nothing,” said Mr Kilani.

Whether or not that will change under Mr Saied's stewardship remains to be seen. In the meantime, the president's Facebook page is peppered with updates about medical and vaccine donations from countries including the US, Germany and Italy.

Amid an uncertain future, Mr Saied will use these gifts to his advantage.

“There has been widespread disillusionment with the sacked prime minister’s handling of the Covid crisis and widespread corruption in the country,” said Eckhart Wortz, professor at the University of Hamburg, who studies vaccine diplomacy.

“As Kais’ [the president's] recent actions lack constitutional and democratic legitimacy, he will need every support he can get to frame himself as some kind of technocratic saviour.”

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