Tunisia has been engulfed in shock and anger since news broke of the deaths of 15 newborn babies in a major public hospital in the capital of Tunis between March 6 and 8. The scandal resulted in the resignation of health minister Abderraouf Cherif and an investigation into the deaths, and has also launched a discussion about the country's failing public hospitals. Many Tunisians began posting photos of dirty and crumbling facilities on a Facebook page called #BalanceTonHôpital, or “Call out your hospital”. The images, many unbearable to look at, include broken doors, dirty operating rooms, filthy toilets, and stillborns left for hours in the same room as newborns.

Thirteen of the 15 babies who died at the Rabta hospital in Tunis contracted an infection through an intravenous nutrient drip, according to a statement released on March 15 by the team investigating the tragedy. The cause of death for the two other newborns is still unknown.

The deaths sparked sharp criticism of the country's hospital management.

Jed Henchiri, a general practitioner, is the president of the Tunisian Organisation of Young Doctors (Organisation Tunisienne des Jeunes Médecins), which launched the #BalanceTonHôpital page on March 9.

For the past few months, we’ve been publishing photos showing the unsanitary conditions in Tunisian hospitals on our organisation's Facebook page. After the scandal over the death of the babies, we decided to launch a Facebook page called #BalanceTonHôpital so that we could collect these images in one place. We wanted as many people to see them as possible.

We received dozens of messages, most of them sent by doctors, nurses and hospital interns. Family members of patients also reached out.

The images documented the terrible conditions in public hospitals, especially the lack of equipment.

In the case of babies who are born premature, for example, a study from 2015 showed that 75 percent of hospitals don’t have sterile rooms to mix intravenous nutrient drips. Doctors sometimes have to mix the drips next to the patients’ beds, thus exposing the contents to all kinds of germs and bacteria.

In the Rabta maternity ward, there was a sterile room, but there was clearly a problem with the sterilisation process that led to the death of the babies.

In Tunisia, when you open a shop to sell tobacco products, the authorities have strict regulations and building codes. But that isn’t the case for hospitals! There should be strict codes for hospitals regulating what each department needs in order to function properly. For example, there should be a document that details the number of midwives and pediatricians needed on staff, and the type of equipment a hospital must have in order to be certified.
 

Photos taken in December 2018 of the entrance to the kidney transplant centre at the Hedi Chaker de Sfax hospital.


Photos taken in January 2019 of two patients forced to share a bed at the hematology emergency room at the Aziza Othmena hospital in Tunis.


Undated photos taken at the Charles Nicole hospital.

Undated photos taken at the Gabès regional hospital.


One Facebook user wrote, "When the elevator is broken and you need an emergency brain scan for your patient."

A photo taken in August 2018 at the Ras Jbel hospital.

The public health system grew rapidly after the country's independence in 1956, and Tunisia now has 166 hospitals and 2,100 health centres. In the mid '90s, however, in an effort to keep doctors from flocking to the private sector, the government launched a program that allowed them to work part-time in a private clinic to supplement their public hospital salaries.

“But there is no regulation, which means that many people have cheated the system,” says Henchiri. “Some doctors have abandoned their hospital posts to work full-time in the private sector.”