RABAT, Morocco — “Medecin en deuil,” French for “Doctor in mourning,” is how physicians across Morocco describe themselves.
For months, they have been taking to the streets around the country in protest, wearing black — and that slogan — to symbolize death. But they are not out there alone. These days, medical students, clad in their white coats, are more likely found in the streets than in the classroom.
In a dramatic protest of the privatization of health care in Morocco, not one student took the Moroccan medical examinations on June 10, according to the National Commission for Medical Students. When the students did not show up, their parents did, in a demonstration of solidarity with their children.
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The dissatisfaction growing among doctors has culminated in widespread protests, strikes and the resignation of more than 1,000 doctors across the nation.
The demonstrations among students and doctors further threaten health care in Morocco, which has survival rates high enough to avoid the scrutiny of international organizations but observers say is disorganized and under-resourced on the ground.
The students have been peacefully protesting to protect public universities that are in perpetual competition with their better-funded, private counterparts, according to documents from the People’s Health Movement and the World Social Forum on Health and Social Security.
The doctors are protesting low wages — around $850 a month upon entry — and the quality of the hospitals where they are assigned to work, many of which lack medical supplies, have a shortage of staff and are located in areas without schools for their children and work for their spouses.
A few of the protests have ended in violence, with police using water cannons and dogs to disperse the protesters, according to documents.
Health Care Facing a ‘Crisis of Human Resources’
The head of government, Saad Eddine El Othmani, has responded to the doctors’ demands, noting that the public health care budget has increased 16% since 2016 and that there is a plan to reform the system by 2025.
There are 7.2 doctors for 10,000 residents in Morocco, one of the lowest ratios in North Africa. In Tunisia, the average is 12.7 doctors, and in neighboring Algeria, the average is more than 18. Overall, the number of medical professionals needs to increase by 175% to reach the World Health Organization’s 2035 goal of 34.5 skilled health professionals per 10,000 inhabitants, according to a WHO study.
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“You can go 20 kilometers from Rabat and find urban areas with no health care facilities,” says Dr. Imane Khachani, a private gynecologist in Morocco’s capital city of Rabat and former reproductive health adviser for the United Nations.
Dr. Amina Sahel, who recently retired as the director of Ambulatory Care Services at the Ministry of Health, has seen maternal health care change depending on the priorities of the minister of health. The current minister, Anas Doukkali, has a strategy to recruit doctors, Sahel says, but the capacity of medical schools could thwart his efforts.
“The thing that remains problematic, not only for maternal health but for everything, is the lack of personnel,” she says. “It’s truly a crisis of human resources.”
Further complicating Morocco’s health care landscape is an uneven distribution of doctors. Just two of the country’s 12 regions, Rabat and Casablanca, employ nearly half of all doctors for only a third of the population.
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Meanwhile, Morocco’s private health care sector is known for its high-quality facilities, care and technology.
“When you work in the private sector, you don’t have to follow political choices. People pay and they get what they pay for,” Khachani says. Her office, which offers complimentary refreshments at reception, is located in Hay Riad — the wealthier section of Rabat. The public sector, however, “does not have as much money as the needs require.”
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There are some bright spots. Morocco has managed to decrease maternal mortality by two-thirds in under three decades and is now on target with the United Nations’ 2030 Sustainable Development Goals.
Rabat’s public maternity hospital, Arrêt Maternité Les Orangers, is the only hospital in Morocco named a World Health Organization Collaborating Center, meaning it supports the mission of the U.N.’s international public health agency. The hospital is known for its comprehensive approach to care, considering “the person as a whole rather than just looking at the organ that’s not functioning,” says Khachani, who worked at Les Orangers prior to opening her private practice.
Maternite des Orangers, a multi-building maternity care complex just outside of the medina of Rabat, sees 8,000 births a year and employs nearly 30 OB-GYN specialists and medical residents.
Inside the doors of the hospital, medical residents mill around between their classes and shifts. At all hours of the day, family members sit just outside the white concrete walls of the hospital, waiting for the arrival of a newborn or the release of a mother. Guards flank the doors of the hospital and the gates of the complex, a normal precaution in Morocco.
The robust staff at Les Orangers is uncommon outside of the city.
Rural Areas Face a Lack of Resources, Staffing
In rural areas, “there’s a big infrastructural effort, but there are still hospitals that are under-equipped,” says Dr. Chafik Chraibi, an obstetrics professor at Les Orangers. “There are some that can only handle 20 births a day but do 40.”
And with no students taking medical exams, there could be significant new shortages in medical personnel if the students are forced to retake the year, given the numbers of doctors who have resigned.
On April 29, the tension among doctors came to a head. Hundreds of doctors, pharmacists, and dental surgeons marched from the Ministry of Health to Parliament in Rabat, chanting in unison.
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“Today or tomorrow, with no doubt I will get my rights,” they chanted. “I am Moroccan, I am patriotic. It’s impossible that I accept mistreatment.”
In some public hospitals, the shortage of doctors caused by the strike caused the suspension of surgeries.
“There aren’t enough people. There aren’t enough resources,” says a 45-year-old gynecologist who participated in the protests and asked to remain anonymous out of concern for his job.
The doctor, his thin face etched in worry, raised his voice over the chanting happening down the street. He works alongside two other OB-GYN specialists in a hospital in southern Morocco. The three of them deliver 8,000 babies every year — more than 20 each day.
Despite promises made by the government, the doctors remain unconvinced.
“For years we’ve been asking the minister (of health) to act,” says the gynecologist, standing on the outskirts of the crowd of protesters. “There isn’t a good job in our field.”
“Of course it affects the care for the mother and infant,” he adds.
Mary Bernard spent months in Morocco on an SIT Study Abroad program, and produced this story in association with The Round Earth Media program of the International Women’s Media Foundation. Selma Elhouate, who studied at the Connect Institute in Agadir, Morocco, contributed reporting.