Overwhelmed doctors, low vaccination rates and desperate locals: The pandemic is exacerbating Tunisia's growing political instability.
When Tunisian schoolteacher Rime Hamdi lost her sense of taste and smell, and her temperature began to rise, she knew her concerns about catching COVID-19 had been realized.
But instead of going to a hospital, the 46-year-old from the city of Beja, one of the first areas in the North African nation to be hard hit by this wave of infections, stayed at home to try and deal with the disease herself. It was terrifying, she told DW.
"And my fear only increased after my husband and children got infected," she recounted. "We knew that the situation was difficult in the [local] hospital and that there were no vacant beds. So we stayed at home."
Hamdi and her teenaged children recovered, she said, but they were eventually forced to bring her 51-year-old husband, Salim, to a private hospital in Tunis when he had trouble breathing. The local public hospitals had no space and not enough oxygen, Hamdi explained. Thankfully, Salim recovered.
Staying home to die
Hamdi is not the only Tunisian taking matters into their own hands in the face of a devastating surge in COVID-19 infections. They are well aware that their public health system is now unable to cope with the combination of rapidly spreading infections, a disorganized response by the authorities and a mostly unvaccinated population. Even some of those who are very ill prefer to stay home because at least then they can be with their loved ones when they die.
Tunisia had initially coped relatively well with the pandemic in the earlier part of 2020, bringing case numbers to almost zero last summer. But over the past two months, infection rates have risen as have the number of deaths. Official numbers show that, as of July 21, the country was seeing over 5,341 infections and 152 deaths per day. That equals a weekly infection rate of 319 per 100,000 people.
Local health authorities have also said the real toll is probably higher than this, estimating that as much as a third of the 12 million-strong population has already caught the virus. Officially, there have been over 17,000 deaths in Tunisia caused by COVID-19, but the true number may be closer to 21,000.
At the same time, less than 8% of the population is fully vaccinated and the vaccination rollout is moving slowly and, in some cases, chaotically.
Attacks on medical staff
Tunisian Health Minister Faouzi Mehdi organized a vaccination drive during this month's Eid al-Adha holiday, opening centers to all Tunisians over 18. But a lack of preparation meant there were long queues and eventually violence as vaccine supplies ran out. Medical staff were attacked, people in line scuffled and clinic windows were broken.
Prime Minister Hichem Mechichi fired Mehdi on Tuesday, saying that it was criminal to have people gather in this way during the pandemic. Mechichi also said he was putting the Tunisian military in charge of further pandemic efforts.
Meanwhile, Tunisian social media are seething with videos showing things like senior doctors crying with helplessness as they are forced to choose who can be treated, overcrowded hospital rooms where the sick lie next to the dead and aggressive relatives trying to beat up medical staff they think are responsible for the crisis.
Over the past few days, numbers of infections and deaths have been dropping slightly. But public hospitals are already full. In some, clinicians have either run out of oxygen, essential for COVID-19 patients who are having trouble breathing, or they have had to ration it.
The crisis has also seen the emergence of a black market in oxygen cylinders and respirators as Tunisians try to help themselves. Prices to rent these or buy oxygen have tripled. There are numerous Facebook posts by desperate Tunisians asking where they can get access to these.
"Unfortunately many people are profiting from renting out these machines," said Lotfi Hmida, a local from the southeastern town of Medenine, who started an initiative to help supply breathing equipment after his mother died. "The average rent of the machines can reach as much as 500 dinars (about €153; $180)."
Since December last year, Hmida and other local volunteers have been trying to put a stop to the profiteering by using social media requests to distribute the 18 machines they have access to in a more equitable way
Beyond the everyday horrors of this surge in Tunisian infections, it is also possible that the health crisis could do further long-lasting damage to the country's already unsteady economic and political situation.
Although Tunisia is often touted as the poster child of 2011's Arab Spring, the North African country is still working on a democratic transition after popular protests saw the end of a dictatorial regime. Tunisia has had 10 governments over the past decade since then and, as Tarek Megerisi, a senior policy fellow at the European Council on Foreign Relations wrote in a June report, its political system is "gummed-up."
"We are paying the price for the government's accumulated mistakes and mismanagement. The vaccines are long overdue," said Khalifa al-Harbawi, a civil servant who was taking a break in a cafe in the Bardo area of Tunis, just a few kilometers (miles) away from Charles Nicolle Hospital, where patients have been forced to share oxygen and staff have been assaulted. "The conflict between the two heads of the executive branch of the country will lead us into the abyss."
"A lot of international aid has arrived but there's no transparency," said Walid bin Khaled, who was working in his electronics store in the capital's Bab al-Khadra neighborhood. "We need vaccines urgently, but it is not clear what was actually provided. There's an information crisis, too, and this generates rumors and increases suspicions."
Tunisia is almost bankrupt. Public debt — what the country owes international lenders — was thought to be at around 87% last year. At the same time, according to World Bank figures, its national output (GDP) contracted 8.8% in 2020, while unemployment rose to almost 18% over the first three months of this year. And the pandemic lockdown just keeps making things worse because the country is heavily reliant on tourism.
On the brink
The COVID-19 surge can be seen as a potential "last straw" for Tunisia, Megerisi told DW.
"The chaotic response and the severity of the crisis will cause many to lose faith in the government, and the focus will be on the prime minister — despite the entire political class having undermined Tunisia's COVID-19 response over the past few months," Megerisi said. He argued that the pandemic is only going to aggravate the country's political stalemate.
"Worse still, today's crisis will only shrink the space and goodwill that Mechichi has to deal with tomorrow's structural, economic crisis — and that isn't going to go away," he said.