Conflict of Interest: Senior Health Official leases public asset to his NGO
Upon publishing the Arabic version of this investigation on 31 Dec. 2024, the government took action to improve contract terms, yet fundamental issues remain.(*)
On 13 March 2024, Egypt’s Cabinet approved the direct transfer of the management, operation, and use of Maadi Mabarra Hospital to the Madinet Nasr Association for Development and Social Welfare. The association, previously known as the Rabaa Al-Adaweya Association, had its assets placed under state control in 2015 by the government committee tasked with seizing and managing the wealth of the Muslim Brotherhood group.
At the time of the Cabinet's decision, the association was chaired by Ahmed Saafan, Assistant Minister of Health for Hospital Affairs. Saafan also headed the Health Ministry’s curative care section—the very department responsible for overseeing all public hospitals.
A year prior to this handover, the Madinet Nasr Association submitted a proposal to run the hospital for a 10-year term. The offer included 6% of revenues to the state, with a minimum annual payment of 3 million pounds (around $600,000), alongside a pledge to invest 90 million ($1.8 million) into the hospital: 40 million in the first year and the remaining 50 spread across the remaining nine.
While Health Minister Khaled Abdel Ghaffar defended the move as a bid to turn a loss-making hospital into a profitable venture, an investigation by Al Manassa uncovers what appears to be a glaring conflict of interest involving Saafan. The inquiry also points to a breach of the legislation governing the handling of funds linked to terrorist-affiliated organisations.
Documents obtained by Al Manassa —including the association’s original offer, a memo from the state-run Curative Care Organization/CCO, and the hospital’s financial records— reveal that the arrangement stands to benefit both Saafan and the association. Meanwhile, the CCO and nearly half of the hospital’s workforce are left at a loss.
A new identity for Rabaa Al-Adaweya
Nestled along tree-lined road 6 of Maadi, near Sakanat El-Maadi metro station, the two-acre Maadi Mabarra Hospital complex (2,321 sqm built) represents a critical piece of Egypt's public healthcare infrastructure. Operated by the Curative Care Organization/CCO—a self-funded entity established in 1964 to provide middle-class Egyptians with affordable care—the facility delivers
comprehensive medical services.
It houses 116 beds and 13 specialized clinics serving around 60,000 people annually. Patients pay 80 pounds ($1.60) to see a specialist and 120 ($2.40) for a consultant. About 1,000 patients annually receive care at state expense. The hospital performs around 30 surgeries per day, totaling 11,000 procedures annually.
In its proposal to the Ministry of Health/MoH, the Madinet Nasr Association for Development and Social Welfare states it is registered with the Ministry of Social Solidarity under license No. 3990 of 1993. This is the same registration number previously held by the Rabaa Al-Adaweya Association, which once managed the Rabaa Al-Adaweya Medical Center— now known as Nasr City Specialized Hospital.
In 2015, the Committee for the Inventory and Management of Muslim Brotherhood Funds, chaired by First Assistant Minister of Justice Ezzat Khamis, ordered the seizure of all assets belonging to the Rabaa Al-Adaweya Medical Association.
The association oversaw three hospitals: the Rabaa Al-Adaweya Medical Center, along with its branches on Mostafa Al-Nahhas Street, and in the Third Settlement. The name change came after this state action.
Under Law No. 22 of 2018, which governs the management and disposal of funds belonging to terrorist entities, the state-appointed committee is mandated to assign expert administrators to manage these frozen assets. The committee also determines administrative expenses and the compensation of these custodians.
Before becoming head of the curative care section at the ministry, Ahmed Saafan was appointed by this same committee to serve as either chair or deputy chair of three NGOs whose assets had been seized for alleged Brotherhood ties: the Islamic Medical Association, which operates 30 hospitals and clinics across seven governorates; the Sharia Association in Heliopolis; and Ibn Al-Nafis in Tanta.
Since the Ministry of Social Solidarity’s database of NGOs does not contain information about the Madinet Nasr Association—either under its current or former name—Al Manassa submitted an official request for its board membership details. Although ministry staff initially expressed willingness to cooperate, one week later they declined providing any information.
However, a Facebook video posted by Nasr City Specialized Hospital in Feb. 2024 shows a lottery for a free Umrah trip, during which the names of some board members were mentioned. Al Manassa was able to verify the identities of three of them: Alaa Thabet, editor-in-chief of the state-owned Al Ahram newspaper; Major General Hamza Darwish, permanent undersecretary at the Ministry of Local Development and board member of the Egyptian Federation for Development and Social Protection, which works with various ministries including Youth and Sports and Social Solidarity; and Major General Ashraf Khairy, former assistant health minister for financial and administrative affairs.
Where did the 40 million come from?
On Dec. 24, 2023, Mohamed El-Tayeb, assistant minister of health for governance and technical affairs, sent a letter to Ahmed Farghali, chair of the CCO’s board, regarding procedural requirements for reviewing offers to manage Mabarra hospital. The letter stated that “in the event of awarding the contract to the Madinet Nasr Association, the matter must be presented to the Committee for the Inventory and Management of Funds of Terrorist Entities and Individuals.”
According to Law No. 22 of 2018 on seizure of terrorist funds, this committee’s prior approval is required before “any investment decisions” are made involving frozen entities. This approval must be obtained prior to taking any step, including submitting offers or undertaking commitments.
However, as seen in El-Tayeb’s letter—obtained by Al Manassa—the plan was to consult the committee only after awarding the contract to the Madinet Nasr Association. This suggests that the association submitted its offer and the Cabinet reviewed and approved it prior to the committee being informed.
A judicial source who spoke to Al Manassa anonymously said this violates the law. “The whole point of Law No. 22 of 2018 is to preserve the value of frozen assets in case a defendant is acquitted and entitled to recover them,” the source said. Unauthorized investment decisions could expose the state to future compensation claims.
Economic expert Wael El-Nahas echoed this concern. He pointed to the case of Safwan Thabet, the owner of Amoun Pharmaceutical, who regained full control of his assets after being acquitted. “Judicial custodians cannot make investment decisions without committee approval,” El-Nahas said. He also questioned the legality of the association’s 40 million-pound investment commitment in the first year of the contract. “Where did they get that money from?” he asked.
Conflict of interest by decree
Despite the absence of the seizure committee’s approval, Egypt’s Cabinet and MoH moved ahead. They based their decision on Article 76 of the 2018 Public Procurement Law, which allows the Cabinet to authorize a specific administrative body to directly contract with a natural or legal person if they submit an integrated and funded investment project, provided that this project achieves the state’s economic and developmental goals for the administrative body.
The decision was finalized before the passage of a new law in May 2024 regulating public-private partnerships for healthcare facilities. The law came into effect on June 24, 2024 following presidential ratification.
Nonetheless, the Cabinet’s decision appears to violate Law No. 106 of 2013, which prohibits public officials from entering into financial arrangements that constitute a conflict of interest.
At the time the contract was awarded, Saafan served as head of the MoH’s curative care section, which oversees all state-run hospitals. He was also chair of the NGO awarded the contract.
Article 11 of the conflict-of-interest law prohibits government officials from offering consultancy services, whether paid or unpaid.
Article 15 clarifies that even after a government official leaves their position, they are prohibited for six months from taking on roles or providing consultancy to entities that were under their supervision or related to their former work, investing in those fields, or exploiting information gained from their previous position.
In this case, Saafan simultaneously held both a position in the MoH and headed the association seeking to run the public hospital.
According to the law, a conflict of interest exists when a public official—or a close relative—has a material or moral interest that compromises their professional responsibilities or leads to unlawful gain for themselves or a relative.
Article 3 of the law stipulates that in the event of a absolute conflict of interest that results in immediate harm to the public interest or public office, the official must eliminate this conflict either by relinquishing the interest or leaving the position or public office. In cases of relative conflict of interest, they must disclose the conflict and take corrective steps to avoid harm to the public interest.
However, the law lacks a mechanism for how such disclosures should be made. It mandates the formation of an anti-corruption committee to assess these cases, but this committee has yet to be established by presidential decree.
The leasing arrangement clearly presents a conflict of interest, according to Hazem El-Feel, the former chair of the CCO board and former head of the curative care section at the MoH. “Senior public officials must be dedicated full-time to their roles,” he told Al Manassa. “Here we have a senior ministry official chairing an NGO that is negotiating with the very institution he helps manage.”
Former Doctors Syndicate board member Ahmed Hussein agreed, while adding that this constitutes an abuse of power.
“Saafan held an executive leadership role while approving a deal that benefits an entity he chairs,” Hussein said. He emphasized the importance of transparency and fairness when state hospitals are offered to the private sector.
A leading official at the CCO, speaking to Al Manassa anonymously, criticized the lack of oversight in the NGO’s offer. “There is no monitoring mechanism in place to ensure they meet their investment commitments,” he said. “All we have is a quarterly report submitted by the association’s chair—to himself—at the Health Ministry.”
This is despite the fact that the Maadi Mabarra Hospital is subject to numerous oversight bodies, starting from the head of the CCO and ending with the Ministry of Finance, the Central Auditing Organization, and the Central Agency for Organization and Administration.
Imaginary losses...
Article 76 of the Public Procurement Law allows for direct contracting only if the proposed project achieves national economic and developmental objectives.
In this case, Health Minister Abdel Ghaffar claimed the goal was to turn Maadi Mabarra Hospital from a loss-making entity into a profitable one.
During a site visit two weeks after the Cabinet’s decision, he said the hospital’s operating losses justified the transfer to the private sector.
The minister added that the CCO’s hospitals receive 60 million pounds ($1.2 million) annually from the national budget to cover salaries, in addition to community donations to fund medical supplies. The minister reiterated these figures subsequently in July 2024.
https://public.flourish.studio/visualisation/24357285/However, the CCO’s response to the NGO’s offer contradicts the minister.
A March 2023 memo to the Cabinet and MoH, seen by Al Manassa, stated that the hospital was already self-financed and did not burden the national budget, aside from its allocated share of the emergency care grant (50 million pounds across eight hospitals) as per PM decree 1063 of 2014.
According to the Finance Ministry’s 2022/2023 income statement, the CCO as a whole generated 646.2 million pounds (around $12.5 million) in pre-interest profits.
Similarly, according to the NGO’s proposal, between 2019 and 2022, the Maadi Mabarra Hospital earned 276 million pounds ($5.3 million) in revenue, averaging 61 million pounds ($1.2 million) annually, and posted a net profit of 31 million pounds ($0.6 million) between 2018 and 2022.
Moreover, MoH spokesperson Hossam Abdel Ghaffar announced in May 2024 that the government had allocated 10 plots of land in 10 governorates for healthcare partnership projects.
One such project involves Maadi Mabarra and France’s Gustave Roussy Institute for cancer research and treatment, to which the Cabinet granted permission to manage and operate the Dar El Salam Oncology Center (Hermel) in March 2024.
...and predicted losses
The CCO’s memo also noted that the offer did not provide any economic or financial advantage to the organization. The hospital was already generating profits, and in addition, the offer made no mention of accounting for depreciation of medical and non-medical equipment. Nor did it include a clause guaranteeing the return of the hospital after ten years without liabilities or debts accrued during the contract term.
The senior CCO official told Al Manassa that the organization and hospital currently invest about 20 million pounds annually to improve infrastructure and medical equipment. Given a 10% annual depreciation rate, he noted, the equipment would essentially be worthless after a decade.
The combined value of medical and non-medical equipment at Maadi Mabarra exceeds 1.5 billion pounds ($30 million), and total hospital assets are estimated at around 3 billion ($60 million), according to El-Feel.
Al Manassa was unable to obtain detailed records of past investments in the hospital, aside from those mentioned in the CCO’s memo to the Cabinet, which noted that the hospital’s current annual investment level exceeds the 9 million pounds ($0.18 million) promised by the association.
Press archives confirm that Maadi Mabarra has made significant capital investments over the past decade: in 2017, it opened and renovated five operating rooms and a recovery room at a cost of 3 million pounds; in 2019, it upgraded the same operating rooms for 5 million; and in 2020, it opened a pediatric intensive care unit with 11 beds and four rooms at a cost of 5 million.
https://public.flourish.studio/visualisation/24357386/Half the staff, no guarantees
According to the CCO’s financial statements, hospital workers receive less than 1% of the institution’s total net profits, which totaled 642 million pounds in 2023. Yet the Madinet Nasr Association’s offer only guarantees the retention of 50% of the hospital’s workforce, subject to performance evaluations.
The other half would be forced to relocate to other CCO hospitals. The organization’s legal department objected to this clause in its memo, stating that it would create new burdens, including severance pay and the cost of absorbing displaced workers.
Additionally, the CCO would not benefit from the rental income, which would go directly to the MoH, even though the Maadi Mabarra Hospital is one of the CCO’s best facilities.
The association’s offer also violates Article 19 of Law No. 153 of 2021, which governs public-private partnerships in infrastructure and public utilities. The law requires a fair distribution of risk, investment, and returns among all parties. The CCO’s legal department warned that it would be liable for any debts or liabilities incurred during the contract term.
How the CCO was drowned in debt
The CCO was established in 1964, building on hospitals nationalized by the Nasser regime in 1961. These included facilities previously owned by Greek and Italian missions, the Coptic Hospital, Agouza Hospital, and Gamal Hospital in Alexandria, according to Mohamed Hassan Khalil, chair of the Committee for Defense of the Right to Health.
Since then, the organization has operated as an independent economic entity, outside the government budget, using non-governmental accounting standards, according to El-Feel. He confirmed that the CCO generated profits and secured grants and loans, which allowed it to build the Nasser Institute and Al-Haram Specialist Hospital. It also owns Agouza, Hilal, Dar Al Shifa, and Al-Gomhouria hospitals.
He attributes the CCO’s current debts of 3.7 billion pounds ($74 million) to state loans used to build several hospitals that were later transferred to the MoH without the accompanying debt, leaving the organization to bear the financial burden alone.
He said successive heads of the CCO had repeatedly appealed to the Finance Ministry to assume these debts, since the transferred assets now belonged to the state.
Al Manassa tried to reach Assistant Minister Saafan for more than three months to request comment. He did not respond to phone calls or WhatsApp messages.
Likewise, CCO chair Mohamed Shweikar and his predecessor Ahmed Farghaly declined to comment, each referring Al Manassa to the MoH.
When contacted, Health Ministry spokesperson Hossam Abdel Ghaffar said “the deal is currently under review by the State Council, and there are no issues with the financial offer.”
As government agencies refuse to clarify the terms of the deal, former Doctors Syndicate board member Ahmed Hussein summarized the situation, “This is the loss of a public hospital that offers affordable, high-quality care at no cost to the state.”
(*) Weeks after publishing this investigation in Arabic on 31 Dec. 2024, the government moved to renegotiate the terms of its privatization deal for managing a public hospital under Cairo's Therapeutic Healthcare Institution. The exposé’s revelation of a direct conflict of interest involving the Assistant Health Minister led to substantial amendments in the contract aimed at bolstering oversight and protecting public resources.
Under the revised terms, guaranteed state revenue from the hospital lease rose sharply—more than tripling from 3 to 10 million pounds annually. The government’s share of profits was also raised from 6% to 8%. Meanwhile, the timeline for the promised 90 million pound investment in infrastructure was significantly compressed from 10 years to just two years, accelerating the pace of modernization. In a shift towards safeguarding public interest, the new agreement mandates that 40% of the hospital’s beds be allocated to low-income patients, ensuring the facility continues to serve a critical social function.
Despite these gains, however, the revised contract leaves the most troubling concern untouched. It fails to resolve the central conflict of interest stemming from the Assistant Minister’s dual roles. This lingering contradiction raises deeper questions about transparency, accountability, and the integrity of Egypt’s approach to managing state assets.