State Commissioners Authority Recommends Annulment of Minister of Health’s Decision Increasing Fees for Mental Health and Addiction Treatment Services

The Egyptian Center for Economic and Social Rights (ECESR) announced that the State Commissioners Authority has filed its report before the Administrative Court in Case No. 86235 of Judicial Year 79, initiated by the Center in coordination with the “Our Destiny is One” campaign. The case challenges the Minister of Health’s decision issuing the new financial regulations governing the Service Improvement Fund in mental health hospitals, insofar as it fails to provide for free treatment for indigent patients in emergency and life-threatening cases, subject only to the facility’s capacity.

The report concluded by recommending that the Court declare the claim admissible and, on the merits, annul Ministerial Decree No. 220 of 2025 to the extent that it omits the provision of free treatment for those unable to pay in cases of emergency and life-threatening conditions, within the limits of institutional capacity, and to order the administrative authority to bear the costs.

The report is grounded in the principle that successive Egyptian constitutions have consistently recognized the right to health as a fundamental human right, in alignment with international human rights instruments, foremost among them the International Covenant on Economic, Social and Cultural Rights (1966). It emphasized that the constitutional legislator, cognizant of the multifaceted nature of the right to health, has mandated the development of an equitable and effective healthcare system, including fair geographic distribution of services, improvement of medical personnel conditions, and the provision of adequate and sustainable funding.

At the same time, the report underscored the principle of social solidarity as a cornerstone for ensuring equitable access to healthcare services for all segments of society, such that financial incapacity does not constitute a barrier to the enjoyment of the right to health, whether physical or mental. In this regard, the Constitution establishes two principal safeguards. First, it obliges the State to implement a comprehensive health insurance system covering all citizens and all diseases, while exempting those unable to pay based on their income levels. Second, it enshrines a stricter rule rising to the level of criminalization, namely the prohibition of refusal to provide medical treatment in emergency or life-threatening situations. Notably, this prohibition is absolute, without exception or delegation to the ordinary legislator to circumscribe its scope.

Accordingly, the report found that the contested regulation is vitiated by illegality, as it fails to comply with the constitutional obligation to provide treatment in life-threatening cases and leaves open the possibility of restricting access to care for indigent patients in emergencies on financial grounds. While Article 7 of the regulation provides for free treatment in emergency cases and defines such cases as critical conditions requiring urgent intervention to save life or prevent deterioration, it fails to expressly include life-threatening conditions as a distinct category, as mandated under Article 18 of the Constitution.

The report further clarified that emergency cases generally refer to sudden conditions requiring immediate intervention to avert imminent harm, whereas life-threatening conditions encompass a broader category of situations posing a serious risk to the life of the patient or others—particularly relevant in the context of severe mental illness. Consequently, refusal to admit or treat patients unable to afford care in such circumstances constitutes a violation of both the constitutional right to health and the explicit constitutional prohibition against withholding treatment.

Moreover, the report noted that the current wording of the regulation unduly restricts psychiatrists’ ability to properly apply constitutional standards, particularly with respect to involuntary admission under Article 13 of Mental Health Law No. 71 of 2009. This provision permits compulsory admission where there are clear indications of severe mental illness necessitating institutional care, including cases involving imminent deterioration or a serious and immediate threat to the safety, health, or life of the patient or others. The regulation, however, may effectively preclude such admissions for indigent patients, thereby creating a conflict with both statutory law and constitutional provisions.

The report reaffirmed that the right to health is an inherent constitutional right, and that financial incapacity must not impede access to treatment in emergency or life-threatening situations. It stressed that the only permissible limitation in such cases is the facility’s capacity, not the patient’s financial means. Accordingly, it recommended annulment of the Ministerial Decree to the extent that it fails to ensure free treatment for indigent patients in these circumstances.

The report also rejected reliance on alternative mechanisms such as health insurance coverage or state-funded treatment schemes, noting that the universal health insurance system has not yet been fully implemented nationwide, and that treatment at the State’s expense remains constrained by the volume of applications. Therefore, access to healthcare in constitutionally protected situations must not be conditioned on financial ability.

Malek Adly, Director of ECESR, stated that the lawsuit was filed in August 2025 on behalf of guardians of patients, mental health professionals, and concerned stakeholders against the Minister of Health, the Secretary-General of the General Secretariat for Mental Health and Addiction Treatment, the Chairperson of the National Council for Mental Health, and the Director of Abbassia Mental Health Hospital. The claim seeks suspension and annulment of the contested decision, including the newly introduced pricing schedules, reinstatement of the previously applicable fee structure, and the removal of unjust financial burdens imposed on patients and their caregivers.

He further explained that the regulation has resulted in a disproportionate increase in the cost of public mental health services, effectively excluding large segments of patients from access to care. Monthly inpatient costs, which previously ranged between EGP 150 and EGP 6,000, have increased to between EGP 4,500 and EGP 11,500 for accommodation alone.

Khaled El-Gamal, counsel for the Center, stated that the Administrative Court referred the urgent aspect of the case to the State Commissioners Authority in October 2025 and subsequently reserved the case for the preparation of a legal opinion, which has now been submitted recommending annulment of the contested decision.

He added that the report relied on constitutional provisions guaranteeing the right to health and obligating the State to allocate no less than 3% of gross domestic product to healthcare, as well as on Mental Health Law No. 71 of 2009.

For its part, the “Our Destiny is One” campaign welcomed the report, reiterating its rejection of Ministry of Health policies that have rendered healthcare services a “luxury” accessible only to those with sufficient financial means.

Dr. Ahmed Hussein, the campaign’s coordinator and one of the claimants, referred to recent social tragedies in which mental illness was a contributing factor, underscoring the risks associated with the commodification and pricing of healthcare services, particularly in the fields of mental health and addiction treatment. He called upon the government to translate its stated commitments into concrete action by revising the contested regulation and expanding free access to mental health and addiction services in compliance with constitutional guarantees.