The Egyptian government has severely undermined the rights to education and health care by failing to allocate sufficient spending, falling short of constitutional obligations and international benchmarks, Human Rights Watch said today. It is failing to ensure free primary education for every child and quality health care accessible to all.
Inadequate funding has contributed to severe shortages and high costs. Egypt has a shortage of hundreds of thousands of classrooms and teachers while the health care system suffers from low salaries, an inadequate doctor-to-population ratio, and a lack of 75,000 nurses. Families pay school fees and out-of-pocket costs, a majority of health care expenses are paid out of pocket, and doctors are personally paying for essential hospital supplies.
“The Egyptian government has failed for years to adequately ensure the rights of education and health for everyone, as demonstrated by its chronic underfunding,” said Amr Magdi, senior Middle East and North Africa researcher at Human Rights Watch. “The lack of adequate funding for health and education demonstrates the government’s deep indifference toward its citizens’ rights.”
Human Rights Watch analysis found that, over the past five years, education spending in Egypt has consistently decreased in inflation-adjusted terms and as a percentage of total government expenditure and Gross Domestic Product (GDP). Health care spending has mostly decreased in inflation-adjusted terms but fluctuated as a percentage of total expenditure and GDP.
In fiscal year 2025-26, which began July 1, 2025, the government proposed and parliament approved an education budget of 315 billion Egyptian pounds (about US$6.3 billion), equivalent to 1.5 percent of Egypt’s GDP and about 4.7 percent of government expenditure. Human Rights Watch analysis found that this is the lowest percentage of the budget allocated for education since at least 2019. In inflation-adjusted terms, Human Rights Watch found that spending on education decreased 10 percent from 2024/25 and is 39 percent lower than in 2013/14 or 2014/15, when President Abdel Fattah al-Sisi came to power.
Egypt’s 2014 Constitution requires the government to spend no less than 6 percent of GDP on education. Prevailing international benchmarks recommend 4 to 6 percent of GDP and at least 15 to 20 percent of public expenditure. Human Rights Watch's calculation for 2025-26 spending as a percent of GDP would place Egypt in the 12th percentile of all lower middle-income countries, spending less than 88 percent of similarly situated countries.
The current year’s health budget of 245 billion pounds (about $4.9 billion) is equivalent to just 1.1 percent of Egypt’s GPD and 3.6 percent of total government expenditure. Human Rights Watch found that the budgets from 2021/22 to 2025/26 fluctuated between 1 and 1.4 percent of GDP, never reaching even half the minimum 3 percent the constitution requires.
After adjusting for inflation, health spending in 2025/26 is only 2 percent higher than the prior year and remains 4 percent lower than in 2022/23. When taking population growth into account, per person spending is flat over the last three years.
Egypt’s health spending is also significantly below international benchmarks. The Abuja Declaration of 2001, which Egypt signed, included a pledge to allocate 15 percent of government expenditure to health. The World Health Organization (WHO) has estimatedthat providing universal health coverage, an important element of the right to health, generally requires governments to spend at least 5 to 6 percent of their GDP on health care, four to five times Egypt’s current allocation. Egypt adopted a landmark Universal Health Insurance Lawin 2018, which aims to achieve full coverage by 2030.
As in prior years, the government falsely claimed that its 2025/26 budget met constitutional spending minimums for health and education by including extraneous budget lines, such as debt servicing, in its calculations. In 2022, Egypt spent more than twice as much servicing its external public debt per capita than it spent on health care.
Human Rights Watch has previously found that Egypt’s declining funding is severely undermining education, raising significant human rights concerns. The government has acknowledged shortages of hundreds of thousands of teachers and classrooms. Public schools charge nominal fees, waived for some low income students, violating Egypt’s obligation under the constitution and international human rights law to provide free primary education.
In 2019, families with children in school spent an average of 10.4 percent of their income on school-related costs. Due to the poor quality of chronically underfunded public education, many higher-income parents pay for private lessons and tutoring, worsening wealth-based inequality.
Egypt's underfunded health care system similarly faces significant challenges and the country’s declining trends on several important health care indicators raise significant concerns for the right to health.
The health care system suffers chronic and severe shortages of resources. Doctors have reported paying out of pocket for essential hospital supplies like gloves and sutures. President Sisi in recent years acknowledged that salaries for doctors at public health care facilities, set by the government, are inadequate to retain qualified staff, citing a lack of resources.
Low public health care funding contributes to the growing number of nurses and doctors leaving the country, further undermining the availability of health care services. According to the Doctors’ Syndicate, 11,536 doctors resigned from working in the public sector between 2019 and March 2022. Approximately 7,000 Egyptian doctors emigrated to work abroad in 2023 alone.
Egypt’s doctor-to-population ratio was 6.71 for every 10,000 people in 2020, well below the WHO’s minimum recommendation of 10. An independent 2024 study of Egyptian doctors working abroad found that low remuneration, poor working conditions, and a lack of medical equipment and supplies pushed them to leave. Egypt also has a shortage of 75,000 nurses, according to the head of the Nursing Syndicate.
The WHO estimated that more than 57 percent of health care expenses in Egypt were paid out of pocket in 2023. Out-of-pocket costs worsen health care inequalities by creating barriers to accessing health care based on the ability to pay. In 2024, President Sisi ratified law 87 on health facilities, which allows private investors to manage and operate public hospitals, a form of privatization, without imposing regulations to ensure universal access to these hospitals, such as by setting price caps.
Human Rights Watch wrote to the Egyptian ministries of education and health on December 22, 2025, to share its findings but did not receive a response.
The rights to education and health care are enshrined in international law, including in the International Covenant on Economic, Social and Cultural Rights, the African Charter on Human and Peoples’ Rights, and the Convention on the Rights of the Child, all of which Egypt has ratified.
Egypt has an obligation to take deliberate, concrete, and targeted steps to the maximum of its available resources to fulfil economic, social, and cultural rights. Egypt should guarantee free primary education and should also ensure high-quality health care is universally accessible for all, regardless of one’s ability to pay.
Deliberate retrogressive measures, such as Egypt’s reduction in spending on key elements affecting the rights of education and health care, are presumptively a violation of its obligations unless fully justified. Under international law, Egypt also has an obligation to protect the right to health by ensuring that privatization in the health sector does not pose threats to the availability, accessibility, acceptability, and quality of health care.
“By systematically failing to meet constitutional spending requirements for education and health for many years, the government is neglecting the very sectors that would enable citizens to live with dignity and for the economy to thrive,” Magdi said. “This years-long failure shows that the government’s talk of social and economic rights is essentially lip service.”
Distributed by APO Group on behalf of Human Rights Watch (HRW).
