*Dr. Kassim Omran

The last two decades have been a steep slope in the history of public health in Bahrain since the establishment of health services in the country. Health services have deteriorated due to a number of issues, including the lack of administrative accompaniment to health developments on the policy level, the disruption of the required health projects or failure to complete them, in addition to the unexpected population increase due to unfair naturalization policies that have doubled the demand for health services, at a time the allocated budget for the public health sector has failed to meet health needs.

We can identify the most important milestones in the history of public health during these two decades:

1.       The arrests of medical cadres after February 2011, which marked an unprecedented turn not only at the local level but at the international level. This act was deplored by international organizations before it constituted a stain in the history of health in Bahrain. The medical cadres including doctors, nurses and paramedics have been targeted not only through the repressive tactics followed by the security parties, but also by fuelling and inciting patients from official state media outlets. This targeting has been integrated with the abhorrent use of the security situation in health practice, which has been numerous in its forms and apostasy. No matter how the regime tries to justify its repressive actions against medical cadres, it will not find a national or professional party who is convinced by its actions other than those whose interests and career gains have met with its ill goals of subjecting the professional sectors and medical ones to their own control, even if it contradicts the professional values and the principles governing this humanitarian profession, among its mission to treat the injured and its mission to kill and hurt them. This may have been explained by the dissolution of the "Bahrain Medical Society" administratively and the appointment of a board of directors by the Ministry that distorts this sector from the ethics, independence and neutrality of the profession and its interference in the paths of dependency.

2.       An outbreak of despair, low morale and a deteriorating working environment for employees and public health workers represented in the Ministry of Health. This was reflected in an increase in early retirement of physicians since March 2011 on one hand and the early retirement program suggested by the ministry of health, on the other hand, noting that a large number of people working in this sector submitted for the early retirement.

3.       Over the past two decades, a number of official symbols have emerged at the head of the health sector. These have left a negative imprint on the health track and its development. Regrettably, this course was full of ministers and undersecretaries who were not professional and only implemented extraneous policies to health practices and their history, except for the minister of [former health minister] Dr. Nada Hafaz, who starred in the early years of the third millennium.  After her era, ministers and undersecretaries appeared to the scene and their administrations were full with corruption, mismanagement, weak decision and guidance waiting. This deterioration and regression culminated in the appointment of Fatima Al-Balushi as Minister of Health to exercise the roles of oppression, discrimination, exclusion and completion of the sectarian engineering scheme of the Ministry, which was initiated by its former undersecretary.

4.       Numerous breaches of morality in medical practice and so-called "medical neutrality" through blatant interference in the reports of death certificates for the injured in security incidents and misrepresentation of the causes of death. Therefore, the observer can only allude to this crude touch to "the medical neutrality" of the emergency medical teams and the breach of their jobs and independent and impartial professional in the treating the injured, regardless of the background of their injuries. This occurred during the events of February 2011 and was strengthened in the following years where the rules of response to emergency distress calls were changed and transferred from the Ministry of Health to that of Interior to be an integral and harmonious part of the procedures of the security apparatuses and to subject their response exclusively to the rules of security classification of patients and the injured, rather than the rules of medical neutrality and its principles which govern the  medical and ambulatory practices.

5.       At the administrative level, we have seen the reorganization of the health sector through the formation of the Supreme Council of Health and its executive authority, suggesting the expansion of the dominance of members of the ruling family in various sectors of the state. One of the most important strategic transformations of the Council is the transformation of the health insurance system, which is so far worrying and insecure. The regime believes that the survival of the state as a health care provider is an economic burden, which wants to direct its share of the budget to other aims and to benefit from it in the system of honorees versus loyalty. As a result, the idea that the citizen will be blessed with a health insurance card, which will make him free to choose the physician and medical institution to obtain and choose the health care that he requires, has been marketed accordingly. Despite the seriousness of this leap, there has been no transparency so far in the transformation process and no comprehensive national project has been presented that raises the process of transformation and trades in its motivations, its future, how to finance it, how to maintain the health gains, the likelihood of failure and guarantees of its continuation. All that the people know about the transformation project came on the pages of the regime media by the President of the Supreme Council of Health [Sheikh Mohammed bin Abdullah Al Khalifa], which is a modern title of the ruling family's dominance of the health sector, and who seemed as an emerging dynamic field of trade where the gains are shared between the officials in the state.

As days pass, citizens will discover that the promises made by the President of the Supreme Council of Health are only illusions that will evaporate with a steady contraction in the solvency of coverage and the financial balance of the supposed health insurance card, and the officials then evade responsibility for this dangerous decision. Health regulation and the reformulation of health policies are not an error in themselves, but the problem lies in the intentions behind operational shifts and in their taking the means to increase the effectiveness of discrimination and negative use within the map of the system classifications of citizens. This turn will gradually transform health care from a "right" to "privilege" enjoyed by only some people.

6.       The militarization of health institutions and the transformation of an executive service stronghold in the country into a security stronghold. Although the loyalty and followers of the ministry's appointees have been achieved in recent years, this is no longer sufficient to the ambition of the New Testament to militarize the state ministries through the graduates and retirees of the military institution. All of that is in order to tighten the grip and ensure the implementation of supreme decisions without hesitation or accountability. The opportunity was awaited after the events of February 2011, when a military administration was appointed at the Al-Salmaniya complex through which things can be controlled.

7.       At the area of training, the two decades have seen a further decline. After the approval of the local training program for physicians in various secondary specialties and primary care which was approved in the period of [former health] Minister Dr. Ali Fakhro, and instead of developing it, this program began to erode and the task of medical training for doctors, nurses and technicians was assigned to training programs (by grants from the Tamkeen program) from outside the country and to all its graduates training in Bahrain.

8.       The ministry disavowed its duty as a primary employer for new doctors and nurses graduates of medical and nursing colleges from inside and outside Bahrain and adopted new employment bases that can only be understood by deliberately excluding a group of compatriots aspiring to provide their services in this important sector.

The exclusion procedure draws attention as its duration does not depend on the disruption of a batch or two batches of these graduates but also on a change in the mentality of this group by abandoning the thought of entering this important service area. Despite the need for urgent health services of new graduates of trained doctors or nurses to cover the continuous erosion of health cadres due to retirement, or to meet the increasing demand for health services as a result of the population growth in the country, unemployment and the blockage of professional and functional horizon have become daily suffering for graduates and their families who have incurred a lot of financial burdens in order to find a decent job for their children.

It is disturbing that this unemployment comes not over the background of the backdrop of a national surplus in medical staff or as a result of a lack of opportunities and medical vacancies, on the contrary, it comes as a result of foreigners employment which is still ongoing in various fields and at all levels. This halt in the recruitment process and increasing unemployment rates among doctors, nurses and health professionals is a dedication to the discriminatory employment situation of Shia citizens, whose employment in military, paramilitary and security institutions has been banned for a long time and this abhorrent policy has expanded to Health institutions such as Hamad University Hospital, which was built under the umbrella of the Ministry of Health, but were later taken over by the military institution, which is full today of foreigners while shiites remain prevented from.

*Bahraini doctor residing in the US