Policy Brief: Tunisian COVID-19 Response

COVID-19 hit Tunisia at a time of political and economic unrest. In the years since the so-called Arab Spring in December 2010, protests and unemployment have continued to increase—creating a combustible mix that now is being compounded by the pandemic.

Like many nations, Tunisia is struggling to strike a balance between protecting people’s health and salvaging the economy. How has the Tunisian government responded to the pandemic? And how has it influenced the crisis?

This policy brief answers these questions by analysing the government’s preparedness and response before and during the impact of COVID-19 and the quality of its governance and coordination.

Unstable political and economic environment

The so called “Arab Spring”—a series of protests against authoritarian Arab regimes—started in Tunisia in December 2010. The first demonstration was sparked by the self-immolation of a 26-year-old street vendor, Mohamed Bouazizi, whose wares had been seized by government officials. Anti-government protests then spread across the country as citizens everywhere objected to high unemployment, poverty and political repression. The president at the time, Zine Al-Abidine Ben Ali, was forced to step down and flee to Saudi Arabia.

However, despite protesters’ initial victory, the political and economic situation in Tunisia has deteriorated in the following years. The government has struggled through numerous shuffles and reforms. The last presidential election took place in October 2019, when Kais Saied was elected. However, parliament remains fragmented between rival parties. Unable to address the country’s primary challenges, the divided parliament has caused a declining trust in government.

Domestic armed groups also emerged in Tunisia in the years since 2011, some of which are affiliated with Al Qaeda or the Islamic State. In addition, armed groups from the neighbouring countries of Libya, Algeria and Mali threaten peace and security, with terrorist attacks targeting local and foreign tourists.

The local economy also struggles due to the political unrest and corruption, the war in neighbouring Libya (where many Tunisians worked, until recently), and the threat of terrorism. Unemployment among young adults increased from 23% in 2010 to 30% in 2018. The pandemic exacerbated this trend, with unemployment increasing from 15% in the first quarter of 2020 to 18% in July. In March, Minister of Economy Hakim Ben Hamouda predicted a GDP loss of $660 million to $2.2 billion.

Amidst the turmoil, Prime Minister Elyas Fakhfakh resigned in July following a row with the Islamist Ennahda party. This led to a lack of coordination in governance.

COVID-19 in Tunisia

As of 17 November, there were 80,404 confirmed cases of COVID-19 in Tunisia (54,362 of which are reported as recovered) and 2,345 deaths.

The first case in Tunisia was detected on 2 March, a man who returned home from Italy. In April, evidence of community transmission was documented. In August, Tunisia was re-classified as experiencing only “sporadic cases” in some areas. That less-problematic status has fluctuated, however, with the country moving back and forth between disease stages. As of 20 October, five governorates were on “high alert” and 13 were on “very high alert,” according to the Tunisian Ministry of Health.

Tunisian Health System’s Preparedness, Response and Coordination

Early transmission

By the end of January, COVID-19 tests were available at all entry points into the country. However, travel from high-risk countries was not halted until 10 March. It was not until mid-March that stricter preventive measures were imposed, such as school closures and a 12-hour curfew. A full lockdown of the country, including the closing of its borders, started on 22 March, 20 days after the detection of the first case in Tunisia. An earlier response would have resulted in better containment of the virus.

The Ministry of Health, including the National Observatory of New and Emerging Diseases (Observatoire National Des Maladies Nouvelles Et Emergentes- ONMNE), provided regular updates and advice to the public on its website and social media pages. A national Covid-19 response strategy was adopted in March, but it was not shared with the public and it is unclear whether Tunisian authorities negotiated procurement for masks, other personal protective equipment and equipment such as ventilators.

A national Covid-19 response strategy was adopted in March, but it was not shared with the public 

The health system in Tunisia was already ill-equipped prior to the pandemic; with only 240 ICU beds in the country (equivalent to one bed per 100,000 people). This was due to a lack of prioritization of the health sector amidst the country’s economic struggles. In addition, all private hospitals in the country are located in coastal cities, leaving the majority of the population uncovered.

When the police finally implemented fine-enforced travel restrictions, clear information was not provided to the public in advance. Other issues that raised human rights concerns were the use of drones and robots for surveillance. In June, Prime Minister Fakhfakh revealed that the government was accessing personal data through mobile phones to monitor adherence to the lockdown. Many people were concerned about these violations of individual rights and privacy.

According to the Ministry of Health, donated diagnostic tests were distributed to only 60 hospitals across the country. Meanwhile, a COVID-19 emergency preparedness and response plan was developed by the U.N. High Commissioner for Refugees (UNHCR) for its vulnerable constituents—a large group in Tunisia. Implemented in April, some of its main challenges were import-and-export restrictions that limited its ability to contract with service providers, a lack of data and analysis on virus transmission, and delayed delivery of essential medical supplies.

The country-wide lockdown in Tunisia had the most significant negative impact on the tourism, trade and transportation sectors, which account for more than a quarter of all jobs in the country. This resulted in a loss of income for many workers, especially daily and other informal labourers (many of which are refugees and asylum seekers). 

Coordination and governance

A national monitoring committee was established in April by the Ministry of Health to manage and monitor prevention and response. The committee includes 11 representatives form government bodies and unions, including the ministries of health, economic union and finance. However, no clear roles were assigned and no follow-up plan was established.

The Tunisian government has enacted strict preventive measures, which were initially successful in preventing a larger outbreak. However, an earlier preparedness and response plan would have allowed better overall containment of the pandemic and management of the economic crisis.

- Rasha Kaloti

Health Policies Researcher at ImpACT

Despite the role of the ONMNE, there has been a lack of coordination between the different ministries. Ministries work separately and there is no emergency-information system. In addition, government bodies issue contradictory orders, leading to public confusion. For example, thousands of people were asked to go to post offices to file for financial aid, despite an earlier announcement of a curfew and physical-distancing measures. 

Announced in July, the financial aid program was created to support local businesses and the unemployed over the course of nine months (July 2020-March 2021). The delay in program initiation was most likely a result of disputes within the government. For example, there have been tensions within the president’s team of advisors, leading to the resignation of the national security adviser. This was followed by the 15 July decision of the prime minister to step down himself. The resulted was chaos.

Finally, there is poor coordination between the public and private sectors. The private sector is given a minimal role in the pandemic response, despite its dominance of health facilities. This poor coordination has caused inadequate supplies of masks and medicine. 

Conclusion

Tunisia is facing unprecedented political and economic challenges, and the COVID-19 pandemic has exacerbated them. The Tunisian government has enacted strict preventive measures, which were initially successful in preventing a larger outbreak. However, an earlier preparedness and response plan would have allowed better overall containment of the pandemic and management of the economic crisis.

More effective coordination between the various actors, including the various ministries, municipalities and the private sector, is essential in combating the pandemic and resolving the financial crisis in Tunisia. Regulations and policies must be coordinated and clearly shared with the public, along with a coherent, transparent system for resolving political disputes.

Vulnerable populations, including refugees and asylum seekers, must be protected and prioritised during crises. This can be achieved by facilitating UNHCR’S access to services, supplies and essential medications. Finally, a human rights approach must be adopted, with oppressive and invasive measures—such as unfettered access to personal information—halted immediately.

 

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