Outcry in Algeria over doctor deaths after gruelling on-call shifts

Two resident doctors in Algeria have died in quick succession in what colleagues say are emblematic of the chronic overwork, understaffing and inadequate conditions inside the country's public hospitals — deaths that have reignited a long-running dispute between the medical community and the authorities. ADVERTISEMENT ADVERTISEMENT Dr Aymen Badis, a resident neurosurgeon at the Frantz Fanon Hospital in Blida, died of a heart attack after completing a 24-hour on-call shift. Days later, a resident anaesthesiologist died while working at the Mohamed Lamine Debaghine University Hospital in Bab El Oued, a neighbourhood of Algiers. Colleagues posted on social media attributing her death to exhaustion and intense working conditions. Algeria's health ministry denied she was on an overnight shift at the time of her death. The denial drew further condemnation from within the medical community, who said it sidestepped the underlying issue of accumulated professional pressure. The National Union of General Public Health Practitioners issued two statements in response to the recent deaths, both published by the Algerian news outlet Awras. In the first, the union said the death of Dr Badis following what it described as "an exhausting shift" required "a serious and immediate response" on the ground. It said silence in the face of "this human haemorrhage" was no longer acceptable. In the second, it called on the health ministry to conduct a comprehensive review of the on-call shift system, saying years of policies that had failed to prioritise working conditions for doctors and nurses had led to "the exhaustion of healthcare staff and the transformation of the life-saving profession into a hazardous environment." Incidents that sparked anger The two cases are not isolated. Algeria has recorded several similar deaths in recent months, each triggering a wave of protests and demands for reform that, according to union representatives, have produced little change since doctors first staged a major walkout in 2018. Back then, some 13,000 residents took part in a prolonged strike over pay, working hours and the civil service system that obliges specialist doctors to take postings in under-resourced areas. According to testimonies and union reports, some doctors perform up to 10 on-call shifts per month in departments suffering from staff shortages but are paid for only six. Resident doctors — who carry a large share of the daily workload — receive salaries many describe as disproportionate to both their responsibilities and the years of training the profession demands. Night shift allowances are low, essential equipment breaks down and is slow to be repaired, and overcrowding is common in emergency departments, staff say. The government's response to more recent protests has been less than conciliatory. Human Rights Watch documented that in January 2025, authorities arrested Charaf Eddine Talhaoui, a leader of the Tlemcen Medical School resident doctors' association, for his participation in a protest movement that began in November 2024. A Tlemcen court convicted him of "spreading fake news," "undermining public order" and "undermining national interest" and sentenced him to 18 months in prison. His sentence was reduced on appeal in March 2025 to a year in prison, including a nine-month suspended sentence, and he was released in May 2025. A health sector under constant pressure Medical representatives are calling for a revision of an executive decree from 2013 that regulates on-call duty, increases on-call allowances, and sets a legal cap on shift length. The National Union of Public Health Practitioners argues that the minimum salary for a doctor should not be less than 140,000 Algerian dinars per month. The institutional problems are compounded by geography. Major hospitals and specialist centres are concentrated in large cities. Inland provinces face acute shortages of specialist doctors and equipment. Diagnostic machines such as MRI scanners and X-ray units break down and wait months for repair, as administrative procurement procedures slow the purchase of spare parts or modern replacements. President Abdelmadjid Tebboune said in a television interview that Algeria has the best health system in Africa. Yet Tebboune's claim that Algeria has Africa's best health system is difficult to square with the data. WHO figures show Algeria has 17 doctors per 10,000 inhabitants, which is the highest ratio on the continent among countries with large populations — higher than South Africa (7.9), Egypt (7.5) and Morocco (7.3) — but Mauritius records 27 per 10,000 and Seychelles 22, both ahead of Algeria. The average for Africa is 2.6 doctors per 10,000 people. Algeria's ratio remains well below France's 40 per 10,000, the country where a growing share of its medical graduates now practise. Emigration grows year on year That gap is partly a consequence of emigration. Algeria is now the largest single source of doctors holding qualifications outside the EU who practise in France — the country known in French administrative terminology as PADHUE physicians. According to figures from the French Medical Council, as of 1 January 2025 there were 19,154 such doctors registered in France, of whom 38.8% held Algerian qualifications. Tunisians were second at 15.1%, followed by Syrians (8.6%), Moroccans (7.4%) and Lebanese (4%). The historical and linguistic proximity between France and Algeria, and the compatibility of the two countries' medical training systems, makes the transition relatively straightforward. Yet Algerian physicians working in France under PADHUE status face a lengthy, financially punishing recognition process. One Algerian doctor working in France told a domestic media outlet she earns around €1,400 net per month — roughly the French minimum wage — while a specialist doctor with a French degree earns at least four times that. She said she works every day of the week and relies on overtime to cover expenses, receiving 25 days of annual leave. French President Emmanuel Macron has criticised the recognition system for slowing the integration of experienced foreign doctors his country badly needs, while French hospitals have become increasingly dependent on foreign physicians to fill gaps in under-served specialisations and regions. The union says emigration is not driven by pay alone. A number of doctors working in Algeria's private sector, where income is higher, have also chosen to leave, citing limited professional development opportunities, hospital overcrowding, and a rise in assaults on medical staff on duty as additional factors.