Islamic social welfare organizations in Cairo:

Islamization from below?

Clark, Janine A . Arab Studies Quarterly ; London  Vol. 17, Iss. 4,  (Fall 1995): 11.

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ABSTRACT (ABSTRACT)
Islamic organizations are integral to associational life in Egypt, forming a vibrant component of all areas of social
action and enjoying the support of large numbers of citizens. Islamic social welfare organizations are discussed.

FULL TEXT
ISLAMIC ORGANIZATIONS HAVE BECOME INTEGRAL to associational life in Egypt. Islamic medical clinics,
schools, banks, day-care centers, supermarkets and clubs form a vibrant component of all areas of social action,
and enjoy the support of large numbers of citizens. While these social-welfare associations are the least well-
known features of Islamic activism, they are becoming essential to the provision of services for the poor and even
sometimes the middle classes in Egypt. Islamic medical clinics are one of the most successful of the Islamic
activities. Located in the basements of mosques or attached to them, they provide an intermediate form of health
care between the expensive private hospitals and the government's often inadequate services. With their quality
care and low fees, they are representative of Islamic grassroots social-welfare activities.

The data in this article is part of an on-going research effort involving in-depth interviews with the doctors, nurses
and directors of Islamic clinics selected randomly throughout Cairo.(1) Neighboring shopkeepers who are
themselves former patients are also being interviewed in order to obtain both the patients' and the surrounding
community's perspective on the clinics.

The existence of Islamic clinics raises certain questions. Are Islamic clinics undermining the state's legitimacy by
successfully providing health services which the state has failed to provide? Are these clinics tied to radical
Islamic groups? Are they the tools by which the Islamic movement seeks to carve out social space within which
political mobilization, autonomous of the government, can be organized?

Contrary to the views expressed in much of the prevailing literature, this paper argues that Islamic clinics are
neither a reflection of nor a primary cause of a growth in political Islam. Preliminary research shows that they are
locally organized charitable associations deriving from a strong Islamic tradition which emphasizes individual
charity, and from a perceived need to supplement the overloaded and inadequate government clinics. These clinics
demonstrate the good intentions, community awareness, and religious devotion of their sponsors, who tend to be
independent local elites. In sum, these clinics and their sponsors, while part of an Islamic religious tradition, tend
to be apolitical.

Researchers typically argue that Islamic social-welfare associations are authoritarian, politically and
organizationally tied to violent Islamic fringe groups, and engaging in a grassroots battle against the state. With
respect to Islamic social-welfare associations in Egypt, the literature is replete with assumptions concerning their
authoritarian nature. Not only does the literature state that the clinics are extremely autocratic in their internal

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decision-making structures,(2) but it also argues that the criteria for Egyptians to use the facilities of the social-
welfare associations is personal and particularistic. Adherence to Islam (including codes of social and family
morality), patronage and clientship, communal membership and loyalty, and even political allegiance supposedly
form the pre-requisites of "membership" in these clinics, daycares, supermarkets and the like.(3) Furthermore,
Islamic associations purportedly are the instrument by which the Islamist current controls and directs the masses.
Treating the masses as objects of religious reform and control,(4) the literature portrays these associations as
fronts for "missionarism" on behalf of Islamist ideology, and as crucial outposts in the battle against the state for
the minds, souls and institutions of Egyptian civil society.(5) At a minimum, the mere successful provision of
services is seen as propaganda which increases the number of adherents to the Islamic movement both in the
streets and at the ballot box.(6)

These assumptions are "confirmed" by the fact that many studies make little or no distinction between extremist
and anti-social Islamic groups on the one hand and apolitical, social Islam on the other. Incidents of censorship,
intimidation and assassination generally become the sole object of study.(7) Those studies which make this
important distinction tend to minimize the revival of religiosity amongst Egyptians, and treat social Islam as part
and parcel of a larger political movement or call to Islam. While cases do exist in which clinics have become
footholds for radical Islamic groups, to equate social Islam with political Islam is an oversimplification.(8)

ISLAMIC CLINICS IN CAIRO: A BRIEF HISTORY AND DESCRIPTION

The appearance of the first non-governmental associations (NGOs) in Egypt began toward the end of the
Nineteenth Century and can be traced to the development of urban society and its social problems.(9) Some of the
earliest examples are the Greek associations of Alexandria and Cairo established in 1821 and 1856 respectively,
and the Geographic Society created in 1875. The first Islamic association, the Association of Islamic Benevolence,
dates to 1878, and the first Coptic association was established in 1891.(10) Originally, Egypt's civil associations
were primarily hospitals and schools established by religious or ethnic communities. By the beginning of the 20th
Century, associations without any particular community coloring were being created.(11)

Historically, Cairo has possessed the greatest number of associations. Beginning with only 20 associations
established before 1900, the city experienced rapid growth in the number of associations in the latter part of and
after the Second World War, as well as during the late 1950s. By 1960 there were over 1,000 associations in Cairo,
comprising 35% of the total in Egypt.(12)

These associations developed out of the social and economic needs of the people. They were also born out of
politics.(13) The creation of the first Islamic associations was also motivated by a desire to not let foreigners
interfere in the social and cultural affairs of the country.(14) Islamic clinics, for example, were to a large degree a
response to foreign missionary activities in health care. A surge of associational activity is found on the eve of
World War I and at the onset of the 1919 Revolution that resulted in nominal Egyptian independence from the
British. An official source notes an augmentation of the number of associations, and an increase in the
associations' control over the fundamental needs which the Egyptian state was neglecting -- notably the religious,
educational, social, health and welfare needs of the people.(15) Similarly, in 1947, a study conducted by Heyworth-
Dunne on 135 religious, political-religious, social, cooperative, vocational, and charitable associations attributes
the growth of associational activity to three reasons. The first was the weakening of colonialism following World
War II; the second was the feeling among Muslims that they must reject the Western powers that had come close
to destroying the world; and the third was the drop in the standard of living after the war and the insensitivity of the
ruling classes to the needs of the poor.(16)

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Today, many of the services offered by civil associations remain fundamental for Egyptian society -- in particular,
nurseries, pharmacies and clinics, schools, and centers for professional training. In certain cities and villages,
entire quarters depend on the associations' services. Most notable among them are the health services which, as
is discussed below, are generally superior to those of the public sector.(17) Of these associations, the majority are
Islamic.

Very little data is available on the exact number of Islamic associations in Egypt today. The Egyptian Central
Agency for Public Mobilization and Statistics provides official data on social affairs. However, its annual report
groups all categories of associations -- cultural, scientific and religious -- together. The most recent reports do not
even mention religious activities in the nomenclature.(18) In addition, nearly half of the registered associations are
not actually functioning.(19) There is also considerable evidence of numerous unregistered associations.(20)
Statistics on Islamic associations are therefore unreliable.

Bearing this in mind, Islamic NGOs registered with the Ministry of Social Affairs (MOSA) are estimated to
outnumber secular ones and comprise 8,000 out of a total of 14,000 in Egypt.(21) Islamic clinics are deemed to
number from 1,000 to 2,000 nation-wide and between 300 to 350 in Cairo.(22) Generally the clinics are located
within the poor, crowded areas of central Cairo as well as the newer outlying areas of the city where the costs of
establishing a clinic are cheaper.(23) Ranging in size from clinics with two doctors and one nurse to those with
200 doctors and 200 nurses and clerks, most Islamic clinics have a staff of about 10 doctors. Other than the
smallest of clinics -- essentially dispensaries -- the services offered by the clinics can be quite extensive and often
include surgery, cardiology, ophthalmology, detoxification programs, gynaecology, dentistry, x-ray facilities and
laboratories.

As all other non-governmental associations, Islamic clinics are governed by Law 32, issued in 1964, which formally
places all judicial decision-making rights concerning civic associations in the hands of MOSA. The Ministry can
oppose any candidate for the administrative council of an association. It can nominate representatives from
MOSA, up to fifty percent, for an unlimited time period to the council, and it can dissolve and nominate new
councils.(24) More importantly, the authorization and dissolution of associations are determined by MOSA. MOSA
has, for example, dissolved some associations that it suspected of being arenas for activities of Islamic
militants.(25) In the case of dissolution, MOSA also has the right to confiscate the associations' goods.(26)
Violating the provisions of the law can also incur penalties, as well as prison terms for up to six months.(27)

In terms of organisational structures, Law 32 specifies that all associations must have a general assembly which
meets regularly and elects a board of administration or board of directors. Each board must also have regular
meetings and all its decisions must be taken by majority vote. The associations, however, establish the conditions
for membership in the general assembly and a board may appoint a manager either from among or outside of its
membership. In terms of determining the authoritarian and/or Islamic "nature" of the clinics, therefore, the key
issues are who has membership in the general assembly -- and therefore the right to vote -- and whether or not an
Islamic code of conduct is being enforced by the boards of administration.

WHY ARE ISLAMIC MEDICAL CLINICS SUCCESSFUL?

To a large degree, the success and spread of Islamic clinics can be attributed to the good, cheap and accessible
health care they provide for patients. The Ministry of Health offers free or cheap health service. In addition, Egypt
now has a variety of private and semi-private medical facilities it can offer its population. In total, in 1985, 7.2% of
the hospital beds in Egypt were in the private sector and 63.8% belonged to the Ministry of Health.(28) However, it
is the 715 private sector hospitals and clinics, and the 12,455 practitioners who receive over 60% of the total health

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expenses by the Egyptian people.(29) From a total of LE478 million (approximately $159 million U.S.) which is
spent on health services by Egyptian patients and clients, LE340 million (approximately $113 million U.S.) is spent
in the private sector.(30) Even if one accounts for the fact that much of the public care is cheap or free, the private
sector still accounts for more than one-half of the expenses of individuals in this domain.(31)

The reasons for this preference for the private sector are numerous. Public facilities suffer from old and used
equipment, poor hygiene conditions, a shortage of medicine, and a lack of technical and, particularly, nursing staff.
Most crucial of all is the unreliability of the doctors and their lack of motivation due to their pitiful salaries and
bureaucratic responsibilities.(32) Despite some examples to the contrary, the bad reputation of the government
services drives patients to seek semi-private and private alternatives.

One such alternative has been the establishment of two semi-private insurance organizations with services and
hospitals for their clients.(33) Despite these efforts, however, only seven percent of the population was covered by
an insurance plan in 1982.(34) This is essentially due to the fact that the criteria for beneficiaries, based upon job
type and salary revenue, is ill-adapted for Egypt's economy. Independent workers, small businesspersons, and
seasonal workers are excluded from coverage.(35) In addition, the insurance system has not alleviated the
maldistribution problem: The highest concentration of beneficiaries is in Alexandria and the greatest number of
health centers lie in Alexandria, Cairo and Giza.(36) Finally, these facilities also suffer from a lack of adequate
financing and, consequently, equipment.(37)

In addition to the insurance hospitals, certain ministries also have their own network of health care.(38) The
Ministry of Education owns and controls 21 hospitals and education institutions. The Ministry of the Interior and
Defence, and the Ministry of Transportation also have centers of health care and hospitals reserved for their
personnel.(39) These hospitals compete, however, with the insurance hospitals for the same limited clientele.

Within the private sector, Egypt possesses a wide variety of doctors in private practice, private pharmacies, clinics,
polyclinics, and private investment hospitals. The majority of these facilities are targeted for Egypt's small affluent
class. In the private investment hospitals a room can cost between LE55/day ($18.00 US) and LE530/day ($176.00
U.S.).(40) Their fees are so high in fact that they often operate at only thirty percent capacity rate. Even if more
Egyptians could afford their services, the reputations of the investment hospitals have been marred by managerial
and ethical irregularities.(41) Due to the large salaries they pay, these hospitals are now also facing budgetary
constraints which are affecting their ability to buy and maintain hospital equipment.(42) The result is that they do
not even meet the health care needs of the rich -- investment hospitals have not lessened the large number of
curative trips the affluent take abroad.(43)

Private hospitals have therefore not solved the lack of good and affordable medical care for Egyptian patients. For
the vast majority of Egyptians there remains only one alternative: the philanthropic and religious medical clinics.
The most numerous of these are the Islamic medical clinics. The Islamic clinics' success lies in the state's failure.
As stated above, they are seen as an intermediate form between the expensive "investment medical care" and the
government's inadequate services. From the perspective of the patients, they pay less than in private hospitals and
clinics, and do not suffer the line-ups and rudeness of doctors in the government's employ. This popularity due to
the courteous treatment within Islamic clinics is further increased by their convenient locations.

The success of the clinics is, of course, also due to the fact that they alleviate the unemployment problem
amongst doctors. Despite its recent expansion of medical facilities, Egypt is still not able to provide sufficient
facilities either for its patients or for its doctors. Amidst thousands of unnecessary deaths, Egypt suffers not only
from a large and increasing number of doctors but from a surplus of doctors. Without sufficient facilities within

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which to practise medicine, only twenty-five percent of Egypt's doctors have a medical position.(44) While, on the
one hand, dwindling state funds are unable to provide the facilities for doctors, on the other, the doctors
themselves usually cannot afford to open their own practices. In addition to the expense of equipment and
supplies, rental rates in the central areas of cities and towns are too high for the majority of doctors. Doctors are
only paid approximately LE40 to 60 a month (approximately $17 to 20 U.S.) in state-run hospitals and clinics.(45)
Furthermore, the number of private clinics is already too great in relation to the size of the population which is able
to afford such services.(46) Doctors who open clinics in the cheaper peripheral areas of towns and newly created
towns also find that in these areas as well, the establishment of private practices is rapidly out-stripping the
number of potential patients with the means to pay. Private clinics must compete with religious clinics which cater
to those who cannot afford services.

From the perspective of the doctors, therefore, the bottom line is that Islamic clinics "...offer inexpensive medical
services and provide employment to...medical school graduates."(47) The director of the medical center of the
Mustafa Mahmud Mosque captured this sentiment well when he stated:

We used to dream while we were still medical students that we would be an army in the service and protection of
the
Egyptian

people, because physicians cannot live in isolation from society. But after graduation we found out that the world
of medicine is governed by the law of the sea. The large fish eat the small fish, and thousands of young physicians
cannot establish clinics. They can find no place to work but the medical centers of religious associations. These
organizations

receive large donations;

such centers

are therefore the only hope left to the sick and to young doctors who can work in a spirit not found in any other
place, provide good service, and practice within

correct spiritual framework.(48)

Doctors thus often seek employment in Islamic clinics for purely economic and professional reasons.

ARE THE CLINICS PROVIDING THE BUILDING BLOCKS FOR A FUTURE ISLAMIC STATE?

The Organizational Structure Of the Clinics

In most cases the idea of establishing a clinic originates from the neighborhood; community members approach
the mosque about establishing a clinic. In a minority of cases, an already established association or society
decides to add another project to its activities, that of building a clinic. In these latter cases, however, the societies
are also generally made up of members from the neighborhood.

The establishment and the functioning of the clinics also relies heavily upon donations from the community and
upon zakat (an Islamic form of tithe) from the mosque. For an overwhelming number of clinics, funding is primarily
local. Community members make donations -- everything from cement, iron pillars, windows, electrical wiring, and
money to physical labor -- in order to facilitate the building of the clinic.

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In larger and/or older clinics, the societies are also able to appeal farther afield for donations. Some of the clinics,
for example, are able to ask for donations from wealthy former members of the neighborhood who have moved to
more affluent areas of the city or who have migrated to the Gulf. The case of the well-known Mustafa Mahmud
clinic is an exception. The funding for its medical center derives primarily from abroad.(49) Mustafa Mahmud's
fame and vast networks throughout the Arab World (due to his television show entitled "Faith and Science")
enables him to regularly appeal to the religious community at large in Egypt and abroad for donations for the clinic.

However, while community members participate greatly in the founding of the clinics, community membership in
the general assemblies of the clinics' associations is rarely actively encouraged. The majority of the members in
the associations tend to be from the community; this involvement, however, is due to their own personal initiative.
As a consequence, membership is essentially limited to the wealthier, more educated members of the
neighborhood. In other words, membership is confined to those with the time and ability to do charity work.

Although fees are required for membership in the associations, the major obstacle to greater community
participation does not appear to be the fee but rather a lack of encouragement the clinics do not have a formal
policy of participation or inclusion. Association members and others from the neighborhood often gather in the
medical director's office to discuss neighborhood events and issues concerning the clinic, and in the course of
these discussions community concerns are raised. However, while associations are on the whole made up of
people from the neighborhood, the poor, who are the very people the clinics are serving, are not formally nor
directly represented and do not take part in the management nor the negotiation of the management of their
interests.

The bulk of doctors are also not members of their general assemblies nor consequently of their boards of
directors. While, on the one hand, the doctors feel that they are too busy for such extra responsibilities, on the
other hand, the boards regard doctors as employees and not necessarily as joint participants.

As the right to vote in Islamic clinics is dependent upon membership in the general assembly, the majority of
doctors, nurses, technical directors and patients are unable to use voting as a method of either choosing the head
of the board or of popular control. As stated above, while consultation with these people is widely practised it is
not binding and the solicited advice need not be heeded. Hence, once the general assembly has elected members
to the board, only the board exerts any formal control over decisions.

However, while doctors and nurses are not included in the formal decision-making process, much decision-making
in the clinics is less formal and more participatory than the structure of the clinics would imply. As a result of both
the smallness of the clinics, as well as the desire to serve the poor and make the clinic as successful as possible,
decisions in the clinics, such as the hiring of new staff or the purchase of new equipment, generally involve a large
degree of consultation with staff not on the boards.

In fact, when doctors, directors and nurses were asked whether doctors participate more or less in decision-
making in an Islamic clinic as compared to non-Islamic clinics, the majority stated that they definitely participate
more in decision-making in Islamic clinics. Doctors have a fair degree of daily decision-making authority and are
regularly consulted on issues. In addition, doctors and nurses are able to approach board members on a daily
basis as they pray regularly together in the mosque. Furthermore, technical directors are easily found and
approached as they are present each evening working in their capacity as doctors. patients often approach the
technical directors with questions and suggestions, and doctors are able to do the same.

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To summarize, through regular consultation the majority of the clinics operate in a highly participatory and
consultative manner. Doctors are regularly consulted by directors on their opinions and patients have open
avenues to the directors (in some cases on an informal basis before or after prayer) to give suggestions. The
common goal of ensuring the success of the clinic in terms of helping the poor results in most cases in an
informal consultative system. However, while an increased emphasis upon participation and consultation is clearly
evident in the Islamic clinics, it is not as yet formally established in the organisational structure.

Required Islamic Duties or Modes of Conduct Within the Clinics

When doctors and nurses were asked whether, upon being hired, they had received specific instructions
concerning Islamic modes of conduct and behavior while working at the clinic, only a small minority responded
affirmatively. In these cases, female doctors and nurses were told that they must be veiled. One unique exception
is provided by a clinic in the district of Sayida Zeinab, where a weekly Friday seminar is conducted and doctors are
encouraged, but not obliged, to present papers dealing specifically with Islam and medicine.

Similarly, a minority of clinics specify certain religious-ideological beliefs or other criteria, such as membership in
the association and/or residence in the immediate community, as conditions for membership into their general
assemblies. The majority of clinics have no ideological criteria other than a willingness to do charity work in the
service of the poor. Other than the few clinics in which women must veil, a similar lack of religious criteria applies
to the doctors and nurses whom the directors hire.

None of the clinics had a formal policy against hiring non-Muslims. Despite this, none had Christian doctors on
staff. Some clinics indicated a willingness to have Christians on staff. While clinics may have ideological criteria
for their association members, this does not apply to the doctors they hire. Certainly the majority of the Islamic
clinics indicated that they want the best doctors they can get -- Muslim, Christian or otherwise. In addition, all of
the clinics receive Christian patients. Up to 35% of the cases treated in some Islamic clinics are Christian.(50)
None of the people in Islamic clinics interviewed stated any policy against employing female doctors; female
doctors were witnessed at work in the vast majority of clinics. Furthermore, women are not limited to the role of
gynaecologists or to treating women only. Female doctors practise all fields of medicine and male gynaecologists
are also present in the clinics. In fact, at the time of the interview, the largest and most famous clinic, Mustafa
Mahmoud, had no female gynaecologist on staff, a service most patients expect and demand from an Islamic
clinic.

When doctors, directors and nurses were asked if they felt that the clinic they were working in was Islamic, the
various criteria the respondents mentioned as determining an Islamic clinic actually reflected a strong tendency
toward economic or charity criteria. The majority stated economic concerns related to helping the poor such as
reasonable prices, charity, low wages, serving the district, helping poor Muslims and the fact the clinics are
maintained on donations. This is consistent with the emphasis upon charity and social justice within Islam but
does not necessarily reflect a political ideology based on Islam.

Others mentioned that participants within Islamic clinics follow an Islamic code of behavior such as prayer.
Islamic dress, the veil, male doctors not examining female patients, "observance" and upholding of Islamic morals.
Still others mentioned the cooperation, solidarity and family-like relations amongst the doctors of the clinic.
Finally, a small minority felt there was no difference at all between clinics, but rather that an Islamic clinic was the
same as any other clinic.

Likewise, when asked if they felt any Islamic principles were being followed in the clinics they were working in,

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most stated that Islamic principles were reflected in the fact that the clinic charged low fees or gave low pay, that
the goal of a clinic was not material success or that the clinic helped the poor or was a form of social work. Others
gave moral or behaviorial reasons such as sympathy, hospitality, honesty, mercy, and performing one's job as best
one can. Once again, the majority of answers reflected a principle of charity. Clearly, there was no evidence of a
well-formulated concept of an Islamic model in terms of organizational structure. The Islamic "element" remains
primarily in the realm of sentiment and charity work.

Finally, when asked about the difference between an Islamic clinic and a non-religious clinic (private or public),
doctors, directors and nurses responded with economic reasons such as the reduced fees. Some even stated that
there was no difference at all. Regardless of how the question was posed, the majority of doctors, nurses and
directors saw the clinics in terms of the health care they provided and not in terms of any religious significance.

Clearly, the clinics cannot be labelled as authoritarian nor can they be said to be Islamic beyond the fact that they
provide a charity service and are located within or beside a mosque. The primary concern of the clinics is not
ideological, but to provide the best possible health care for the Egyptian poor and, sometimes, middle class. The
question remains, however, as to what their political demands and also their indirect political consequences are.

WHAT TYPE OF POLICY CHANGES DO THE DOCTORS, NURSES AND DIRECTORS IN ISLAMIC CLINICS SEEK?

The majority of directors, doctors and nurses working in Cairo's Islamic clinics feel that the relationship between
the Islamic clinics and the government should be one of increased cooperation. Primarily, this cooperation should
be in the form of monetary funding or loans for buying equipment, the elimination of taxes for the clinics, as well as
increased government supervision in order to increase or maintain the medical standards of the clinics.

Similarly, when former patients were questioned about their perception of the relations between the government
and the clinics, the majority stated that they thought the government should help the clinics financially. Less than
one-quarter disagreed.

Research conducted by al-Wafd newspaper confirms this desire for greater cooperation. Al-Wafd reports, for
example, that doctors would like the establishment of a system in which the Doctors' Syndicate is the third side in
a ratified work contract between Islamic associations and the doctors. They further would like some sort of
network or association established which would enable the clinics to better coordinate their activities and
resources.(51)

On the whole, the doctors, directors and nurses working in clinics do not object to government supervision over the
clinics with respect to medical practice and the objectives of the clinics' expenditures. Rather, as al-Wafd found,
they would like the cessation of government control over the association and interference in the administration.
This appears to be based on the doctors' fear that the situation in the clinics will become like that of the
government hospitals: over-bureaucratized and inefficient.(52)

This cooperative attitude toward the government is further confirmed by doctors, directors and nurses generally
negative reactions to the statement that Islamic clinics could be interpreted as a symbol of protest against the
government. Rather, most argued that the clinics lighten the government's burden; that they should get more
government support in terms of equipment and medicines as they are clearly contributing to a solution of the
country's socio-economic problems; and that the clinics were merely a form of status for the church or mosque.

This state-supportive nature of the clinics was also revealed when directors and doctors described the

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philosophical or inspirational roots of their endeavors. While they spoke of the grassroots welfare activities of
Hassan al-Banna and the early Muslim Brotherhood, directors and doctors also mentioned the first private
volunteer medical care organization established in 1909 by Princess Ayn al-Hayat Ahmad. With the generous
donations that the women of the royal family made from their private incomes, the Mabarra Muhammad Ali (the
Muhammad Ali Benevolent Society) founded a dispensary in one of the poor quarters in the city and over the years
developed a network of hospitals and outpatient clinics.(53) As the director of an association in the district of
Sayida Zeinab stated:

... our centers are derived from the old system. For example, long ago there was something called the mabarra,
those mabarras were really ideal examples for offering services to the really poor people ... so these clinics like
ours have been established to revive the mabarras' services...

This director clearly equates his clinic with that of purely philanthropic, secular work. The clinic is seen as an
extension of this service, not as a political rival to the state.

On the whole, therefore, doctors, directors, nurses and shopkeepers alike seem to view Islamic clinics specifically
in terms of the medical services they offer. The clinics and their work within them are once again seen as
complementary extensions of or partners with the government health services. Their demands on the government
reflect a cooperative and not an antagonistic stance toward the state. Certainly, there is no evidence of a "battle"
being waged against the state at the grassroots level.

IS THE PROVISION OF WELFARE SERVICES WITHIN ISLAMIC CLINICS LENDING SUPPORT TO RADICAL ISLAMIC
GROUPS AND THE GOAL OF AN ISLAMIC STATE?

When physicians and nurses were interviewed as to why they chose to work at an Islamic clinic, none mentioned
any Islamic or religious reason other than charity or helping the poor. A small number of responses included the
good medical experience they would be receiving and others explained that it was simply a means to earn a living.
Finally, some stated it was because of proximity to home or the fact that they had begun working at a clinic while
still in training and consequently decided to continue working at the same clinic upon graduation.

When specifically asked if Islam had influenced their decision to work in the clinics, the majority of doctors and
nurses stated that it was unimportant that the clinic was an Islamic one. A substantial minority stated that it was
important that the clinic be an Islamic clinic but in each case this was explained in terms of aiding the poor.

Iman Hammady's study of religious medical clinics in Cairo confirms this diversity of personal reasons, which do
not reflect any specific religious motivation, for working in the clinics. She finds that aside from the relatively good
secondary income that they receive (most doctors work full-time in a hospital during the day), the majority of
interviewees expressed their positive opinion of the different medical centers in question due to the good team
work and the friendly atmosphere that prevails among all staff members.(54) Others reported that they preferred
the clinic due to the convenient schedules and the convenient location of settings.(55) The majority of nurses,
according to Hammady, preferred their center due to its good schedule(56) and because they lived nearby the
clinic.(57)

In this study, when doctors and technical directors were asked if working at the clinic had changed their political
and/or religious beliefs, the vast majority responded that they had gained medical experience but that their
political and religious views had remained the same.

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Clearly, doctors working within the clinics do not join the clinics out of religious convictions and are not affected in
terms of their religious and political beliefs due to working in the clinics. It would seem that these doctors are not
good candidates for actively encouraging Islamic observance, either directly or indirectly through example, let
alone participation in organized Islamic groups. This is additionally supported by the fact that only a minority of
the doctors, directors and nurses interviewed supported the slogan "Islam is the solution". Other responses
included those which were even antagonistic: "When they explain the slogan, then I will be able to give an opinion.
But I feel that these are the right words being used for the wrong purposes." Another doctor exclaimed: "Empty
people say that. Unfortunately those are the words of empty people. It is a slogan some parties need, just slogans
repeated by some parties with no objectives." Another called for the separation of religion and politics, stating that
Islam should not interfere in everything.

Most revealing were the communities' attitudes toward those working in the clinics. The majority of shopkeepers
were friends with the members and doctors or acquainted with them, had family members who were association
members or were in the past themselves members. They clearly saw the clinic as something from within the
community, as being established and run by people similar to themselves and not in terms of something which
had been brought to them or as an example of what Islam can do. When speaking about the Islamic movement in
Egypt, for example, shopkeepers made clear, both directly and indirectly, the distinction between "us" and "them":
between the Islamic "movement", which is beyond the community and active at a different and "higher" level within
society, and the grassroots community-based clinics.

Shopkeepers were furthermore often critical of individual members they personally knew in the associations or of
the clinic themselves. Some even expressed their preference for private clinics or for a different Islamic clinic.
Hence, the clinics are not seen as a model of what Islam can do; rather, they are judged in terms of the
performance of a particular group of individuals. The clinics are therefore not gaining adherents to Islam but to a
particular clinic alone.

This is confirmed by Hammady who states that patients are attracted to religious settings due to the good quality
of medical services that they receive at reasonable rates.(58) Other elements such as fair treatment, discipline and
an atmosphere of trust are also mentioned.(59) More specifically, al-Ahram confirms that it is primarily the
reputation of individual doctors and the personal care the patient receives from the doctors that attract patients to
the Islamic clinics.(60) As Hammady discovered at the Mustafa Mahmoud clinic, patients are drawn by the name
of a doctor, not necessarily the reputation of a hospital or clinic in terms of facilities or luxury.(61) Conversely,
doctors' absenteeism, one of the biggest problems in the government hospitals, is what drives patients away.(62)

It cannot be forgotten that Islamic clinics are judged by the same criteria as non-Islamic clinics. Islamic clinics are
in competition with each other and with private and government clinics. They not only gain patients but also lose
them. For example, approximately one-quarter of the shopkeepers were very critical of the clinic in their
neighborhood. For example, one said: "One of my employees was misdiagnosed; they are just beginners there. And
I'd like to know what they do with the donations they receive. The fee has become expensive and they have
become commercial." Another shopkeeper complained: "Since the founder died the fees have increased a lot, so I
prefer to go to a private clinic instead of the hospital here." Similarly: "The people in charge of the clinic do not try
to enlighten the community in terms of sanitary issues. They work like government officials, just sitting in their
offices. ... They work like a government party. ..."

In fact, Islamic clinics sometimes appear to be judged more harshly than their non-Islamic counterparts. Since the
clinics depend on the community and are built with the objective of serving the community, community members
expect the fees to be very low and the clinic to be community oriented. Despite the examination fees of merely one

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to three Egyptian pounds, some shopkeepers still complained that the fees were too high and that the clinic had
become too commercial.

In addition to the remarkable lack of religious propaganda within Islamic clinics, it would seem, therefore, that the
individuals working in them are simply not those who are actively or subtly proselytizing. Shopkeepers,
representing the opinions of both the patients and the community at large, also do not display attitudes which
would reflect an increased popularity or support for the Islamic movement due to the benefits the clinics are
providing. Shopkeepers view the clinics solely in terms of health care and in terms of the quality of work the
particular group of community members is providing. Depending on their reputation, clinics, not Islamic groups,
gain and lose support.

CONCLUSIONS

Preliminary interviews reveal that political mobilization is not occurring within the clinics or their associations. The
clinics remain socio-economic reactions to the dire situation in which most Egyptians find themselves. From the
perspective of the patrons, Islamic clinics are successful because they provide good, accessible, personal and
inexpensive services. From the perspective of those who work in the clinics, and young doctors in particular, they
provide good experience and a supplementary income. This expresses itself in the form of Islamic, as opposed to
secular philanthropic, clinics due to the general atmosphere of religious revivalism in Egypt, and Islam's emphasis
upon individual acts of charity. The realm of ideological discussion seems, for the time being, distinct from that of
the practice of providing services.

The services within Islamic clinics are not propagated by the doctors nor consciously seen by patients as an
example of what an Islamic state could do and the present government cannot. Data from the clinics clearly
supports the argument that the state actually benefits from Islamic health services since the clinics lend
legitimacy to the social system and contribute toward social stability. The state, after all, permits the clinics to
operate and in doing so lends an air of tolerance. By maintaining an indispensable component of the social welfare
package in Egypt, social Islam and its associated groups not only gain legitimacy in, but also affirm the legitimacy
of, the social system.(63) In this sense, Islamist medicine can be considered, as Soheir Morsy states, a vehicle for
power sharing.(64)

An alternative scenario which could be understood from the success of the clinics is, of course, that their very
success mirrors the failure of the state. In this case, the clinics could be seen as delegitimizing the state by
asserting themselves as a parallel and alternative model to the state. The functional success could in the long run
extend to the political arena by seriously threatening the legitimacy of the government and of the secular political
order.

This scenario, however, does not appear to be presently taking place. One reason is that the provision of medical
care and the establishment of dispensaries, clinics and hospitals by mosques is not a new phenomenon. Islamic
clinics have been operating since the beginning of this century and have come to be seen as a natural function of
the religious institution (much in the same way North American Christians do not find anything unusual with the
Salvation Army or church-based food banks). Medical care within a mosque is seen as natural and not something
which is politically radical and associated with the Islamic groups of the last twenty or so years. Secondly, the
state does provide free medical care. While the wait is long and the care impersonal, Egyptians are not being
denied services. Hence, Egyptians on the whole do not see a particular political significance to the clinics.

Furthermore, the usefulness of Law 32 for silencing critical voices and for inhibiting the development of NGOs,

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secular and religious, which may contest government policies also cannot be underestimated.(65) Unless the
government changes Law 32, it will continue to control the establishment, expansion, functioning and
administration of Islamic associations. The existence of Law 32 challenges the notion of Islamic clinics as
autonomous spheres of political action, and circumscribes the ability of bodies other than the government to use
the associations as political tools.

While more field work remains to be done, this research indicates that Islamic social-welfare associations should
be regarded in terms of the positive impact they are making on Egyptian society. The success of Islamic clinics in
providing services does not necessarily translate into a political or ideological threat. Rather, their success
indicates the tremendous potential they have to contribute toward Egypt's economic and social development.

NOTES

1. The data in this article is derived from interviews in a total of ten Islamic clinics located in the following districts
of Cairo: Abbasiyya; Boulac; al-Haram; Masr Jadida; Medinat Nasr; Mohandiseen; Olali; Old Cairo; Sayida Zeinab;
Zaytoon.

2. Karim Haggag, "Civil Society in the Arab World," Civil Society 6 (June 1992): 13.

3. Sami Zubaida, "Islam, the State and Democracy," Middle East Report 179 (November-December 1992): 9.

4. Ibid., 9-10.

5. Alain Roussillon, "Entre al-Jihad et al-Rayyan: Phenomologie de l'islamisme egyptien," Modernisation et

nouvelles formes de mobilisation sociale (Cairo: Dossiers de CEDEJ), p. 45. See also Zubaida, "Islam, the State and
Democracy," 9; Mustafa Kamel al-Sayyid, "A Civil Society in Egypt?," Middle East Journal 47, 2 (Spring 1993): 239.

6. Augustus Richard Norton, "Introduction," in Civil Society in the Middle East Volume 1, ed. Augustus Richard
Norton (Leiden, New York, Koln: E.J. Brill, 1995), p. 23.

7. Looking specifically at Egypt, a small body of excellent scholarship on Islamic social activities does stand out.
For example, Morroe Berger's 1970 survey of charity organisations with an Islamic reference, Sarah Ben Nefissa-
Paris' research on the growth of Islamic associations as well as on voluntary zakat associations and their relation
to Islamic banks, and Alain Roussillon's research on Islamic investment banks are all notable. See Morroe Berger,
Islam In Egypt Today (Great Britain: Cambridge University Press, 1970): Sarah Ben Nefissa-Paris, "Le mouvement
associatif egyptien et l'islam," Maghreb-Machrek 135 (January-March 1992): 19-36; Idem, "Zakat official et zakat
non officielle aujourd'hui en Egypt," Egypte/Monde Arabe 7, no. 3 (1991): 105-120; Alain Roussillon, Societes
islamiques de placement de fonds et ouverture economique (Cairo: CEDEJ, 1988). In addition, dealing specifically
with Islamic medical clinics is some excellent research by Soheir Morsy and Iman Hammady. Soheir Morsy,
"Islamic Clinics in Egypt: The Cultural Elaboration of Biomedical Hegemony," Medical Anthropology Quarterly 2, no.
4 (December 1988): 355-369; Iman Roushdy Hammady, "Religious Medical Clinics in Cairo," Master's thesis, no
885, American University of Cairo, 1990.

8. See for example, Mary Anne Weaver, "The Novelist and the Sheikh," The New Yorker, 30 January 1995, 60-61;
Amos Elon, "One Foot on the Moon," The New York Review, 6 April 1995, 32; Mustapha Kamel al-Sayyid, "A Civil
Society in Egypt?" Middle East Journal 47, 2 (Spring 1993): 233.

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9. Berger, Islam in Egypt, 90.

10. Sarah Ben Nefissa-Paris, "L'etat egyptien et le monde associatif a travers les textes juridiques," Egypte/Monde
Arabe 8 (4ieme trimester, 1991): 108.

11. Ibid., 109.

12. Berger, Islam in Egypt, 92.

13. Ben Nefissa-Paris, "L'etat egyptien," 122.

14. Ibid., 109.

15. Ibid., 110.

16. Berger, Islam in Egypt, 93.

17. Ben Nefissa-Paris, "Le mouvement associatif," 34

18. Ibid., 22.

19. Ibid., 34.

20. Denis Sullivan, Private Voluntary Organizations in Egypt (University of Florida Press, 1994), p. 13.

21. Saad Eddin Ibrahim, "The Changing Face of Islamic Activism," Civil Society 4, 41 (May 1995): 5.

22. Soheir Morsy, Islamic Clinics in Egypt, 356. Morsy quotes this figure from a newspaper article in Al-Jumhuriya
Weekly Edition. The newspaper's sources are unknown.

23. Sylvie Chiffoleau, "Le desengagement de l'Etat et les transformations du systeme de sante," Maghreb Machrek
127 (January, February, March 1990): 97.

24. Ben Nefissa-Paris, "Le mouvement associatif," 21.

25. Mustapha Kamil Al-Sayyid, "A Civil Society in Egypt?," a paper presented at the conference on Civil Society in
the Middle East by the Ibn Khaldun Center and the International Peace Academy, Cairo, May 28-30, 1992, 16; Idem,
"A Civil Society in Egypt?," in Civil Society in the Middle East Volume 1, p. 282.

26. Ben Nefissa-Paris, "Le mouvement associatif," 21.

27. Excerpts from a report published by the Middle East and North Africa Program of the Lawyers for Human
Rights and the Egyptian Organization for Human Rights, December 1991, "Restricting the Human Rights Movement
in Egypt: Legal Restrictions on Independent NonGovernmental Organizations," Civil Society 5 (May 1992): 6-7.

28. Chiffoleau, "Le desengagement," 87.

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29. Ibid., 88.

30. Ibid.

31. Ibid.

32. Ibid.

33. Ibid., 87.

34. Ibid., 91. It is estimated that coverage will reach a maximum of fifty or sixty percent by approximately 1995.

35. Ibid.

36. Ibid.

37. Ibid.

38. The Doctor's Syndicate also recently opened a new hospital in Cairo.

39. Ibid., 87.

40. Ibid., 94.

41. Ibid., 94-95.

42. Ibid., 95.

43. Ibid.

44. Roussillon, "Entre al-Jihad et al-Rayyan," 51.

45. Chiffoleau, "Le disengagement," 97. This is compared to the large salaries doctors in private hospitals receive,
they can reach up to LE5000 (over $1500) per month. Ibid., 95.

46. Ibid., 97.

47. Morsy, "Islamic Clinics in Egypt," 362. This statement was made by a previous secretary of the Physicians
Syndicate and director of seven clinics associated with an Islamic association.

48. Ibid. The director was speaking at a meeting of the Physicians Syndicate which was dealing with Islamist
medical care as an alternative to private and investment hospitals.

49. The Mustafa Mahmoud Society is one of the largest and most widely known Islamic associations in Egypt. It
was founded in 1975 by Dr. Mustafa Mahmud, a highly successful Islamic "entrepreneur": scientist, television
personality, author of over sixty books, cardiologist, and founder of the above mentioned charitable organization.
Sullivan, Private Voluntary Organizations in Egypt, 70. Located in the middle- to upper-class district of

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Mohandiseen, the clinic and hospital cater to both rich and poor. In these respects, the Society and its facilities are
unique.

50. Al-Ahram, 4 April 1990. In some Christian clinics the percentage of Muslim patients may be as high as 70%.

51. Al-Wafd, 12 April 1987.

52. Ibid.

53. Nancy Elizabeth Gallagher, Egypt's Other Wars: Epidemics and the Politics of Public Health (Syracuse, New
York: Syracuse University Press, 1990 and Cairo: The American University in Cairo, 1993), p. 10.

54. Hammady, "Religious Medical Clinics in Cairo," 102.

55. Ibid., 103.

56. Ibid., 106.

57. Ibid., 108.

58. Ibid., 151.

59. Ibid., 166.

60. Al-Ahram, 22 May 1988.

61. Hammady, "Religious Medical Clinics in Cairo", 161-162. As Hammady solely visited Islamic clinic with
inpatient facilities she was able to interview patients as they convalesced over lengthy periods in the hospital.

62. Al-Ahram, 22 May 1988.

63. Morsy, "Islamic Clinics in Egypt," 360.

64. Ibid., 355.

65. "Restricting Human Rights Movement," 8.

Janine A. Clark is an assistant professor in the Department of Political Science at the University of New
Hampshire, Durham.

DETAILS

Subject: Social services; Organizations; Islam; Health care; Clinics

Location: Egypt

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 Publication title: Arab Studies Quarterly; London

Volume: 17

Issue: 4

Pages: 11

Number of pages: 6

Publication year: 1995

Publication date: Fall 1995

Publisher: Pluto Journals

Place of publication: London

Country of publication: United Kingdom, London

Publication subject: Arab/Middle Eastern, Ethnic Interests

ISSN: 02713519

Source type: Scholarly Journals

Language of publication: English

Document type: Feature

Accession number: 02713517

ProQuest document ID: 220600526

Document URL: https://search.proquest.com/docview/220600526?accountid=62689

Copyright: Copyright Association of Arab-American University Graduates, Inc. Fall 1995

Last updated: 2017-11-09

Database: Arts &Humanities Database

Database copyright  2018 ProQuest LLC. All rights reserved.

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