The National Cancer Institute was in crisis long before the car bomb attack
 
 
22 killed and dozens injured in an explosion at the National Cancer Institute in downtown Cairo, Egypt on the evening of Sunday August 4, 2019. - Photograph: Mohamed El Raai
 

Cairo University President Mohamed al-Khosht announced on Sunday that the National Cancer Institute has resumed full operations two weeks after it was damaged in a deadly car bomb explosion that left 22 dead and dozens injured. The institute was shut down and its patients were transferred to other hospitals in the area immediately following the August 4 blast. Khosht said that in addition to the repairs, long-needed renovations are also underway to improve medical services at the facility.

Established in 1969 on the Nile Corniche road in central Cairo, the National Cancer Institute is a state-subsidized health facility that provides medical care for thousands of patients. With few alternatives, the damage from the blast left many worried about their prospects for treatment.

Yet the institute has been steadily deteriorating for years, with its medical services and research capabilities — and even some of its physical structures — in a state of disrepair long before the car bomb attack.

One half of the institute, the south building, has been out of use for nearly a decade. It was abandoned and had its walls torn down in 2010 after a report found its structural columns had dangerously weakened due to faulty construction. The institute is also drastically underfunded, operating on a budget four times smaller than what it requires, according to a former dean of the facility. Meanwhile, the number of patients seeking treatment more than doubled between 1999 and 2009 and continues to grow, putting further strain on the facility’s already limited resources. 

Over the past decade, complaints by patients over their treatment at the institute are widespread in newspaper accounts. Patients have complained about the quality of care, government red tape, equipment breakdowns, and for those who live outside the capital, the hassle of having to travel to Cairo for treatment.

This wasn’t always the case.

In 1999, the opposition newspaper Al-Araby published an article that tracked several stages in the history of the institute since its founding half a century ago as one of the county’s premier medical institutions and scientific research centers. The institute founded a cancer research center in 1971, and two years later, began to use more innovative iridium needles in treatment, and established a laboratory for cellular diagnostics. The institute also organized scientific conferences and published a scientific journal specializing in oncology. In 1988, the first bone marrow transplant in Egypt was performed at the institute for an acute leukemia patient. According to the former dean of the institute, Sherif Omar, the institute was able to meet the needs of its 120,000 patients.

Throughout most of the 1990s, news coverage of the institute was relatively positive, with commentary on its various treatment plans, and its role in helping organize scientific conferences on oncology. Yet news coverage over the past 20 years indicates that the institute has been steadily declining, with patient complaints becoming increasingly common.

An internal performance review in 2010 found that the institute treated approximately 200,000 patients per year between 2002 and 2010. They included approximately 20,000 new patients and 185,000 patients returning for periodic follow-up treatment each year. Around 10,000 patients received treatment each year in the institute’s department of internal medicine. The institute provided free treatment to 82% of the patients, while the remaining 18% were covered by private health insurance programs.

During this eight-year period, the institute received LE40 million in state funding annually, a sum that barely covered 30% of its expenses. Private donations ranged from LE35 million to LE40 million a year, leaving the institute to cover the rest of its expenses with the fees of non-subsidized patients, according to statements by the former dean of the institute, Alaa Haddad, in 2012. At the time, Haddad said the cost of treating a breast cancer patient was around LE120,000 per year, while the cost of treating a leukemia patient ranged from LE50,000 to LE100,000 per month.

Exacerbating the financial strain was the steep increase in the number of patients. Between 1999 and 2010, the number of patients seeking treatment at the institute nearly doubled, putting a severe strain on its limited resources. The situation was made even worse when structural defects were discovered in the institute’s south building, pushing an already precarious situation to a critical point.

In January 2010, a report by a technical committee assigned to examine the south building found significant erosion in the structure’s columns, despite the fact that the building had been constructed just 20 years earlier. On the committee’s recommendation, the south building was evacuated of all patients, staff and equipment — decimating much of the institute’s medical capacity. 

The number of beds available fell from 600 to 315, according to the 2010 performance review. The south building consisted of two floors with 10 outpatient clinics, one floor for follow-up clinics, two floors for marrow transplants, two floors for inpatient treatment, and six operating rooms. They all halted operations when the building was evacuated. 

In the ensuing years, the institute took several measures to deal with the crisis. The Ministry of Health allocated capacity in a First Settlement hospital to take on part of the institute’s operations; the hospital was later turned into a breast cancer treatment center. Meanwhile, some patients were moved to other hospitals such as the Dar al-Salam Cancer Center, (formerly known as Hermel). In 2015, a number of outpatient clinics were built with donated funds opposite the south building, in a park in the Sayeda Zeinab municipality. Meanwhile, the north building continued to operate at full capacity.

In 2010, a fundraising campaign was launched to build a new hospital named 500500 in Sheikh Zayed, which the general manager of the institute, Ihab Khalil, says will open in 2020. Khalil also says renovations for the National Cancer Institute’s south building will be completed two years later following a grant from Sultan bin Muhammad al-Qasimi, the emir of Sharjah in the United Arab Emirates.

The measures taken following the evacuation of the south building helped keep the institute afloat, yet they fell far short of solving deeper issues of capacity and providing quality care. 

Upon its completion, the operational capacity of the First Settlement hospital will be 68 beds in the inpatient departments, two operating rooms, five outpatient clinics and three intensive care beds, according to the National Cancer Institute website. As the institute’s capacity halved with the loss of the south building and the number of patients increased in recent years from 200,000 a year to around 250,000 a year, patient waiting times for screening, testing, treatment and surgery have also risen.

The other issue is that government funding for the institute is insufficient, and its dependence on grants and donations is not sustainable. 

Another former dean of the institute, Mohamed Latif, says the institute receives three times its capacity in patients and needs LE150 million added to its current budget of LE50 million. Yet it is highly unlikely the government will provide such an increase in funding, especially considering that real spending on health and education in the state budget has fallen for the third year in a row as the government pursues a harsh economic austerity program.

Even without the car bomb attack earlier this month, the National Cancer Institute would have remained in a precarious situation, operating under severe strain, to the detriment of its thousands of patients.

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Mostafa Mohie