“Our hospitals are ruins,” Amel Belhaj said as she visited her bedridden father in a Tunis hospital ward with mould-tainted walls and rusty radiators.
“On top of our illnesses, we have to cope with the misery of these places, the dirt, the behaviour of the staff,” she said.
The nearby toilets smelled strongly of urine and rubbish was strewn on the floor.
Her father, who occupied one of the ward’s 11 beds, refused to comment.
Developing the health sector has been a key priority for Tunisian governments since the country gained independence from France in 1956.
Today, the North African country’s 11 million people are served by some 166 hospitals and 2 100 health centres, according to official figures.
But public health services have deteriorated since the 1990s and are failing to meet modern demand, according to a report last year by the health section of the powerful UGTT union.
“If there is one public service that needs urgent reform, it is the health sector,” it said, bemoaning “social inequality” in treatment.
The sector suffers from corruption, regional inequalities in access to advanced equipment and “medical deserts” – entire regions suffering a scarcity of healthcare professionals.
The UGTT study said Tunisia risked backtracking on the advances it has made since independence from France in 1956.
“There are services we’re proud of and others that need particular attention,” said Kaouther Hedhili, a senior health ministry official who admitted the current state of the sector was a “major failure”.
She said Tunisia’s public services were saturated with staff following massive recruitment into menial and administrative jobs after the 2011 revolution.
Yet hospitals also lack qualified medical staff – across the country, the sector has a shortfall of almost 14 000 staff.
Hospitals are also burdened with some $207 million of debt, she said.
But senior health official Nabiha Borsali Falfoul said public criticism of the sector is often exaggerated.
“The hospitals are in great demand,” she said. “The staff are working beyond their means.”
Authorities also point out that general life expectancy in Tunisia has risen from 66 to 73 in just a decade, a sign the health service is doing its job.
One hospital official, who asked not to be identified, complained that private health operators were “demonising” the public sector.
Private clinics have mushroomed to serve wealthy clients and an influx of Libyan patients.
But because of their cost, most are out of reach for many Tunisians, who are forced to rely on public health services.
Chokri Hamouda, head of the emergency department at the Charles-Nicolle Hospital in Tunis, said a solution was urgently needed to tackle the lack of qualified medical staff.
It is imperative “to adapt the means available to the needs of the citizen”, he said.
“You can’t put a price on good health, but ensuring it does have a cost.”