16.09.2011 Egypt

How is the democratic process in Egypt evolving?

Interview mit Alaa Shukrallah, AHED, PHM Egypt; Cairo

How is the democratic process in Egypt evolving in the moment, what are the key actors?

It can be said that Egypt is going through the second stage of the revolution which began on the 25th of January 2011. The first stage comprised the first 18 days ending by the toppling of Mubarak along with the major symbols of the ruling oligarchy, the most oppressive, exploited and corrupt characters’ of the state and the ruling elite. This target focused a long history of the anger and frustrations of several generations and different groups of people from different sorts of life and classes. It hence, gave unity among people from nearly all sectors of society, except those who were directly and strongly tied up with the ruling clique and its power structures at the different levels of the state organs and their elite monopolists partners amongst the business class. This unanimity amongst the population was represented in the millions of people that joined the revolution and were able to break the backbone of this clique and his most directly oppressive organ represented by the police and internal security.

The army had to make a choice between mass slaughters or to back down and remove the major symbols of the ruling clique. The latter as we know was the choice that was determined on the eve of Mubarak’s abdication.

However, due to the specific character and pathway of that revolution, including its vast size, its speed and the spontaneous character of this mass revolt, it could not develop at the time an alternative power structure to replace the old one. In addition, the long history of the lack in democracy and the lack of any real organized political parties, except the Moslem Brotherhood to a certain extent, played an important role in the creation of the vaccum of power among the revolution, a power which could replace the ruling elite and their system. In fact people and the different groups and classes that made the fabric of society and joined or supported the revolt were newly learning about themselves and each other during the process of the revolt.

As mentioned before, this stage can be said to have ended with Mubarak’s abdication on the eighteenth day after the revolution began followed by the abdication of the Ministry which was instituted during his last days.

However, with this victory and in the few months after the abdication, the pressure of the mass movement from below was able to achieve very important victories and gains for the revolutionary and democratic goals. Among these stand the weakening, the oppressive police and security apparatus which was strongly hit and the exposed for its criminal actions against people including the use of torture and police brutality and corruption, the breakdown of the corrupt and oppressive ruling party the NDPE and the dissolving of the local councils.

In addition, the new government that was formed council was formed; its prime minister came to Tahrir square to promise his allegiance to the goals of the revolution and his accountability to the people. “I

However, in my opinion aside from all these victories and democratic gains, the most salient victory for democracy and social justice in Egypt are the break of fear amongst the vast amount of population from all sorts of life and their belief that they have the power to change things. Within this frame work I would also strongly add the other lessons learnt by millions of Egyptians who took part in the revolution and in Tahrir square where the stories of human solidarity which during these days broke all the barriers between religion, gender and ethnic difference. Christians, moslems, ethnic and social groups as well as men and women fought hand in hand for a better more just society. I feel that such gains despite any future setbacks will not dissipate from the common memory of the people and will play a decisive role in the future. The same major slogans “for democracy, social justice and human dignity”became the banner under which not only the Egyptian people revoluted but a whole Arab revolution has adopted and erupted. The Arab Revolution has started and it will continue. I know it is difficult, I know there will be many setbacks, but it will continue; this I am positive of the triumph of democracy and social justice in the end. However, the duty of the left and democratic forces locally, regionally and internationally to address the challenges through successful strategies are immense.

The current stage of the revolution and its challenges:

The stage we entered during the past few months is the second stage, its the stage of developing new alternative visions for the future, continuation of the struggle forward along this vision and moving from spontaneity to organisation. At this stage the major tasks are to develop and in force new alternative programmes and building political parties, and mass organisations. However, what must be noted here is that while this is being achieved the old system is still intact. For despite everything we are still struggling within the same socio-economic system that existed pre-revolution. The revolutions gains are achieved through mass pressure from below which widening space and rights. .

Another vital aspect of the revolution, that after the first stage of unanimity directed against the major symbols of the old regime, the revolution camp begins to split and differences on visions and alternatives for the future come to the fore. Different forces that joined together the revolt at a certain moment after achieving the first goal i.e. the overthrow of the Symbols of the old regime begin to confirm and promote their own identities, alternative solutions for the future. Hence new camps and new alliances start to form. These alliances based on different perspectives, strategies, ideologies...etc rearrange accordingly their positions and try to push forward their own agendas.

Although this process is normal, it may and actually does constitute a great danger on the revolution and its future. It can weaken the revolution and makes the masses lose their momentum and of course it can also play in the hand of those forces that have an interest in halting the revolutionary process from continuing. These are the characteristics of this phase.

The first split that took place was between the “poitical Islamic” camp, and the “democratic and liberal” camp. And I think that there is a danger in that split. Although some of it may be normal, but I think that it is also played upon and exaggerated and that we should be very careful not to fall into that trap of making it an ideological fight between a “civil or state against an Islamic state , I think it is very dangerous, because the real essence of the question is: what is democracy?

The real struggle should be around how we define and articulate democracy and social justice in our alternative visions for the future and not that of false ideological fight between secular and religious understanding of the character of the state. Democracy should include all the basic human rights elements including non-discrimination, equity and direct participation of all citizens in the shaping of their society and their lives. In Demoracy in that sense is very interrelated to social justice i.e. the right of all people for equal opportunities to resources and the wealth of the nation. When the progressive and democratic forces move away from the dichotomy of civil or secular against the religious, etc, a wide front can be built and those who oppose these rights would be isolated and the goals of the revolution will move forward, however, if we get trapped in the liberal dichotomy of liberal against religious the movement and the revolution will lose and fall in the hands of the fundamentalists and the conservative elements of the state and the old regime.

We should and have to place the conflict as a programmatic one i.e. programmatic issues such as the position on discrimination, the your position on the Right to organize, the Right to strike, the right to participate , to have your voices heard, the Right of change. In addition to what type of political system we want to achieve and its relationship to achieving true social justice. In this context the position towards issues such as minimum a maximum wage, on social benefits, labour Rights, Right to Health and health care, on the Right to Education, etc all become essential components of the required alternative. They have been for long denied by the old system and are definatley not yet addressed by the new order instilled after the revolution. They have all been in fact, in my opinion, some of the basic factors that drove people to rebel and to revolt against the old regime and here I mean the old system, i.e. the prevalent socio-economic system.

And here we enter a very important dilemma. On aspect of this dilemma: is the in fact that this revolution cannot really fulfil the slogans and the hopes of the vast amount of people that suffered from impoverishment, lack of services and injustice, exploitation to an unprecedented level under the old system unless it addresses these policies in a radical and genuine manner.

And this system, i.e. this social-economic system is still prevalent under the new order and is continually promoted and supported by most international agencies and governments in the west which are supposedly protecting and pushing for democracy in our region.

How can you push for democracy if you are also pushing for a system which is socially unjust? Which violates the Right of people to education, to health care, to social security, to a decent human life in dignity.

This is an inherent contradiction that will take a long time to solve and that’s where in fact comes the question we have to see it as part of the struggle, the struggle cannot only take place and cannot really be victorious at the level of Egypt alone. It has to be also take place on the regional as well as the international ones. In fact, it is the dominant neoliberal policies that have played a very significant role not only in accentuating the crisis of the last regime but in developing the exploitative and oppressive system which the people of Egypt and the Arab region revolted against. Naturally it acquired its own course and its specific characteristics from the regional context.

Accordingly, we have to see that in that sense, we have a mixture of struggles on different levels, we have a struggle at the moment for democracy, but we cannot separate that from very the struggle on the social and economic levels i.e. those related to social justice among which I think four major issues come:

• minimum and maximum wage

• a package of social benefits that assures that all people have a decent minimum package, which with they can live on in dignity and

• Insuring the Right for all people to health care as well as insuring peoples equal rights to quality education.

These are among the major social issues in addition to the democratic issues such as the Right to organization and association, right to strike, Freedom of press, etc. and of course a more participatory type of democracy.

It is around such issues that the struggle of the coming phase especially that the elections should be taking place within a few months. Naturally, as mentioned, different political camps are beginning to form. The creation of the widest revolutionary fronts around a minimum program which interrelates democracy with socio-economic rights is the major task for the progressive and democratic forces if the revolution is to continue and succeed. What we have to do is try to create a net which insures the widest front of all forces that rebelled under the slogans of the revolution which were democracy, social justice and human dignity.

But to turn this into essential programmatic issues, both as I said democracy and social justice intertwined together and to lobby as biggest front as possible on these minimum issues. And I think in that sense we move away from that dichotomy of Islam versus civil or secular to the issue of Rights for all people. Rights of people to be protected against discrimination, Rights of people to a decent life and Rights of people to organize and Rights of people to participate etc. etc.

And I think in that sense we can win from both, the political Islamic forces and from the liberal forces that can see that this is the only way forward to democracy and not for other alternatives that are very bleak.

Polarization should move from the ideological and religious discourse to that of a programmatic one. That’s why I think the Left and democratic forces should lead in the direction of another road which can break this type of polarisation and create a wider camp on programmatic issues based on basic human rights, on the level of democracy and social justice.

This front you envision as some kind of party that would go for election?

It will be a coalition between different political parties that are being formed currently. However, if the elections will require being under the banner of one party, then we have to do it. It all depends very much on the new law of the parliamentary elections which is still not clearly defined.

But it very much depends, if its going to be a party list that’s gone to take, and you enter with different parties this will break the votes; and we have to ensure that there is a good representation, a sizable representation that is effective and protective of the democracy and social justice within the parliament, if the parliament is overtaken by the other forces which will be against the revolution and democracy, this will be a danger for the continuity of the next phase.

Back to the issue of Health: What does that direct to the Right to Health?

Are there already some policy changes, changes on the ground? Actors in the health field: doctors associations, doctors without rights, coalition for the Right to Health.

Indeed the issue of health, as you know, has been an important issue even in the period pre-Mubarak fall, it has been a mobilizing issue and it has been an important issue for all people and as you know, since about five years before the toppling of Mubarak, many organizations, among them AHED, was engaged in developing a coalition against the law that is called the health insurance law. This law was been developed during the last era of Mubarak’s Government and the rise of his son. It represented the most corrupt marriage between the state officials and some of the monopoly big business. Conflict of interest was inherent in the ministry. The government was known to be the strongest advocate of privitization of all previous public and state sectors only to be bought by themselves and their cliques for peanuts and sold for billions. The Privitization of health was amongst the major issues that this government pushed for led by the previous minister of health who was in the same time one of the biggest private investor in health care services.

And for us, this law represented an important feature of the neoliberal policies that existed during the Mubarak era. In the area of service provision this law came to legalize the inequity in health care services as a de facto and to organize this division by creating two types of health care systems, one for the poor and one for the rich. A basic minimum package for the poor” and other higher interventions under other expensive private insurance schemes. Even within the basic minimum package the patients had to pay a third of the costs of medications and all types of interventions. In cases of catastrophic health care conditions this could be totally out of the means of the majority of people in Egypt.

Naturally we saw in this an infringement on the Right of all people to health care. Health care services were to increasingly become commodities sold according to your means (financial resources) and not to your needs.

That if somebody needs a heart operation and this is not included in the package, they die, this is a criminal violation of the right to health, which is a basic human right.

So it became a major mobilizing force in fact and as you know the coalition reached to include something like 70 different types of organisations, all the political opposition parties that were existing during that time were in it, plus a vast amount of human rights and community organisations and NGOs, civil society organisations And this coalition was able to pressure and prevent the law from passing for the last five years until the regime was toppled.

Now – saying that – the toppling of the regime, and the process that took place within the revolution opened two new fronts in the area of health – the front of the health carers, or the health care workers (doctors and nurses struggle for better conditions of work). For the first time a wide spread movement amongst both doctors and nurses as well as other health care helpers for coalitions to put their working conditions on the agenda as a burning issue. Doctors and nurses were striking and demanding better conditions of work, better wages and more protection, particularly after the collapse of the police.

The other front is the front of social justice and the right of people to a decent quality health care system, which has been degraded and totally discredited during the past 30 years.

So these two fronts have opened simultaneously. On the other hand, we had a new government, and the new government in certain aspects reprsent as I said, one of the victories of the revolution. The prime minister for example went to Tahrir square in front of the masses, of the people that played the revolution and said I come to represent you and if I fail I will come back to you

So the government became more accountable to the people for the first time. As the revolution continued health care teams started joining the revolution, of course having to add, also it was very interesting, during the Tahrir phase the amount of doctors that joined the Tahrir to aid the victims of the security and police. This is a new force that has been added to the revolution –increasingly many doctors – started feeling themselves as part of the people and part of the revolution and not as an elite at all. The nurses actually were pioneering in forming their new independent union and many of them also took part in the revolution. The organization of progressive doctors and nurses has become an important avenue for the revolution and for the movement of the right to health.

Pressures from the doctors, from the health care professionals as well as political pressure from the different political forces again for change of the government led to another change just a couple of months ago and a new minister of health replaced the previous one which was accused of belonging to the same old regime that was toppled. The new Minister is known to be much closer to the people that have been struggling for the right to health, in fact the names of some of our colleagues and comrades were suggested for the minister of health, like Dr. Mohammed of AHED , who had several meetings with the Prime Minister. At the moment we have a good connection to the Minister of Health and that is also a new opportunity that never before existed for the movement.

So I think is this also an important entry point in the breakthrough of the corrupt and exploitative forces of the old regime.

Along side with this, the health care issue became a burning point on the agenda and a doctors’strike and a nurses’ strike continued throughout the last few months, we were actually

After a meeting took place between representatives of the strike of which two of them were our colleagues from the coalition for the Right to health to represent the doctor’s strike. They met with Prime Minister and he promised to improve the conditions of the doctors and health care workers and the funding of the hospitals. The strike was stopped to give a chance to the primeminister to fulfil the promises but unfortunately, nothing realy happened and now the strike is back again.

The dilemma of the new government which is governed by the old socio-economic policies and system

As I said before, there is an inherent dilemma that would face anybody who takes a position in government at the moment: on the one hand the new government feels and is held more accountable by the people, and some of them have even a strong relationship with the progressive forces that work for the right to health – but on the other hand, they are working within a system that is governed by an economic and social system which is both local as well as regional as well as international. And that’s where the real dilemma comes into it:

It is not just corruption and authoritarianism, it is the whole of the neoliberal agenda, for solving the problem of health care in the world and particularly in the Third World that is compounding, that is creating the problem of violating the people’s Right to Health. And in fact our struggle is and has to be against this whole neo-liberal agenda which under the “austerity measures” and market oriented policies have and are increasingly pushing for turning health care into a commodity in the market for those who can pay for and is increasingly also being monopolized by big business.

The dilemma of any new progressive minister of health or education,...etc , is how to face the result or the outcome of the policies that dominated that good part of the past 30 years which through moving away from the state responsibility for service provision and the move towards privatizing all sectors of life with clear bias big business have emptied the treasury of the government. So even if there is a progressive minister who is biased towards the Right to Health is unable to come out of this, in the end of the day, where should the resources for this come from? That needs another basis of a social-economic system that tries to get the resources through a new system of redistributing wealth on the national level, such as through putting a maximum wage and increasing taxation on the high income brackets and big business. This of course comes in contradiction with the neo-liberal policies which have dominated the thinking and policies, not only in Egypt, but also regionally and internationally and continue to do so.

That’s a question, that has to be also asked /answered regionally and internationally

How the European Union policy is affecting the current situation?

In fact this can lead us into looking at the EU policies and how it impacts on the current situation.

The EU has been very supportive of the democratic revolution in the Arab region, yet they have been also of course, unfortunately, as you know, the strongest allies of all these autocratic regimes before. However, if we put the past behind, we come then to the dilemma; where does the EU stands from the neoliberal policies; in fact, the EU is pushing the agenda of the neoliberal policies which is infringing on the people’s Right to Health, people’s Right to Education and what I call the social trap, which led to this revolution. And accordingly, this cannot be helping in solving the real grievances of the people and creating a true participatory democracy.

And I think it is time to realise and it is time that we address some of the essential underlying policies that have created this upheaval and will continue to create it.

If we really want to solve and achieve a truly democracy and justice in the region and in the world.

Role of PHM?

That’s of course, as you know, AHED is part of the PHM, so in that sense, the PHM is very involved in this process all around, however I must say in the past few years the PHMs activities on the regional level were limited to just few meetings with our colleagues and comrades in Palestine and in Lebanon, Morocco, but there were no active joint movement of either solidarity or joint actions...etc.

And I think this is something we have to strongly address in the next phase.

Suggested strategy for the next phase for the Right to health movement in Egypt

As in the health care system we feel that there are many of us that are active in the PHM and in AHED and in the Health Movement for the Right to Health to Egypt we feel we need three strategies, dimensions On the one hand to develop and push forward an alternative policy in the health care which is socially just and holistic and abides by the Right to Health for all people , equal right to health care for all ,

And of course on the other hands relating health to addressing the social determinants of health, which create most inequities on all levels and vulnerabilities to ill-health. And the Unequal vulnerability to ill-health which points to the issue of the spread of injustice and the policies that produces it and reproduces it.

The other level of the work at the moment which has taken and should take a new impeutus is the mobilization and movement of the rights of the health workers. This has taken a newer and stronger dimension since the revolution started. During the past few revolutionary months many doctors and nurses entered the struggle and took part in the revolution, not just as individuals but also as a specific group which are formulating their own struggle and demanding their rights and striking and entering the revolution.

Another very important level is working on the local community levels. The work on this level, the issue of the right to health care and health in general is both a basic human rights social issue and also a strong entry point that could work as a leverage to raising the issues of social justice as a whole. The status of health of the people is the mirror of their development and the social conditions they live and work in and under. Such work could and will assist people to organize themselves and identify the major conditions of ill health related to unequal power and wealth which are injustly divided. Finally, it is a very opportune time to move from advocacy around this issues on the local level to actually help people take actual control over their resources such as control over their health centres i.e developing alternative peoples health units in local communities. In a time of revolution this is possible.

And I think the opportunity for this now is much better and much more favourable than at any other time in the history of our struggle in Egypt for the Right to Health.

In realizing this at this moment we have to fight for reaching an understanding with the new Minister of Health (who is known to be a progressive man and is close to the coalition for the right to health care) such an opportunity has to be also utilized. Developing such models in areas where there are strong people’s movements in congruence with the health units that exist in these areas, where people can become in partnership with the health team in the public health units, the governmental health units, to try to place their priorities , their issues and their supervision on these directly.

And I think on all levels this is achievable but it means a lot of work , a lot of organisational work and of course other levels of lobbying and advocacy on the local community level as well as on the national level. We had an experience before, because on the local level now, local committees are being formed, they were formed during the revolution. And there are NGOs that are working there, progressive NGOs in certain areas.

How can we make this organisational movement which is currently taking place i.e of the tendancy of people to organize themselves, and discussing the social issues, how can we help putting the health issue both as an issue within the agenda of people’s Rights as well as an entry point to developing alternative social policies whether be it in Health or Education etc.

What is the role of the organized community? How can the organized community take over and participate more effectively and deciding how the resources are used and what are their priorities and how can they take over control of this?

I think that is another, a third challenge that should be tied to our local work in organizing and advocating for the revolution in general. And that’s where the organizsations such as AHED and other members of the PHM Egypt I think should be looking into both local as well as national together. And, as I said, the third point is the work in organizing a progressive movement among the health teams.

So the strategy should combine working on these three different levels which should continuously inform each other :

1. National Level advocacy for promotion of an alternative just quality health care for all people as a basic human right.

2. Assisting the organization of the health care team level

3. Assisting mobilization of local communities around health issues and social determinents of health and developing alternative Primary Health Care models on the community level with community control. (community ) level

That’s how a PHM, if we actually articulate this in the next months, and if we can adopt such policy, this can be implemented not only in Egypt but in the Region, such as Tunisia, and maybe now also in Lybia, where we see something great happening and in Yemen and in other areas with our colleages in the region.

And I think PHM internationally can have a key role to play and should play a much bigger role through its engagement as part of a wider process that is taking place in the Arab region

This is very exciting but also challenging , I believe that we can do that but again the challenges and the forces against it are great both locally, regionally and internationally . And that’s why we need all the solidarity on these three levels and the widest collaboration and joint work, because we are facing basically the same type of forces in Egypt or the region and internationally. And these are the forces that endangering the people’s right to living. But we have to do it – we have no alternative.

And that’s why we have to keep in close contact during the next months and as soon as I am back to Egypt I really intend to put a lot of energy into this, I mean of course I’m doing a lot of work directly in political work but I also want to try to put a good amount on relating this to health because I know we really have made a breakthrough and it can be very effectively again: putting this struggle on the issue of people’s Rights and not on what is seemingly on ideological or religious basis.

So you have contact to Libya?

Unfortunately, not as PHM Libya, there are some contacts, but very scattered we have to start to look for more, we never did, I don’t think we had ever representation of Libya in the regional PHM, but we have to look now through our different colleagues in the region and see who has contacts. I now have a chance to meet some Libyan revolutionaries in a training course in Tunisia maybe this will open a new venue..

You see that the PHM regional coordination is functioning or not?

There is no coordination, I mean we have to recreate it. To be frank, there is no regional PHM for a couple of years now, at least the last couple of years, we had one meeting, we need to get in touch with each other.

Of course during the past few month as you may realize in the region every body has been very busy with their direct tasks in supporting the revolution in their own countries and facing the huge challenges. There was no time for regional coordination and this is a dilemma if you are faced with such challenges at home you are happy with the revolution in the neighbouring countries but you can hardly do much about it.

However, the regional level is very important because we are facing not only local but also the same regional forces of reaction, Saudi Arabia is playing an extremely important role in helping the counter revolution in the Arab region so there are many of the Arab regimes that are frightened now.

So how can we create a wider front of democratic forces against this? This has to be on the agenda, it is today’s task, it has to be put on the agenda. Just like the issue of solidarity, solidarity is vital for us: the international solidarity was vital for us in the Arab revolution and it played a very important role at many junctions where there could have been other possibilities. Who knows, the what massacres could have taken place at different stages if it was not for international solidarity.

So these three levels have to continue, and I think that we should put more effort in it during the coming months:

The first is to restablish PHM on the local level with a wide mass base, and the second is to also restablish PHM at the regional level within the new revolutionary context, not only do we have three countries that revolutions have taken place and great success have been so far achieved, but the whole arab region from Morrocow to Bahrain is moving in a tsunami manner for “democracy, social justice and human dignity”. These were the slogans that all the revolutions in the region adopted and despite any set backs they will continue to motivate and move people in our region until a new and just and democratic system is established. However, the third level is the international level, it is a vital level and we hope that PHM internationally can once again play the role it was established to play in addressing jointly the neoliberal policies that is infringing on the right of people to health and hence to life. International action and international solidarity are badly needed and called for now more than ever. We are at a very critical junction, the counter revolutionary forces and working together locally, regionally and internationally, we also have to work together.

Alaa Shukrallah is Chairperson of AHED, Head of Training and Research Development Support Centre, Member of PHM 27.08.2011