Today, Saturday, Independent Arabia published a report revealing that Tunisia’s private healthcare sector is awaiting the resolution of longstanding outstanding debts with the Libyan side. These debts, which have remained unsettled for over 13 years, stem from the treatment of Libyan patients and wounded individuals who sought medical care in Tunisian clinics following Libya’s security crises and conflicts after the fall of the Gaddafi regime, as well as the influx of patients in subsequent years.
The newspaper highlighted that Tunisian clinics have been unable to recover their dues despite repeated promises from the Libyan side. The latest commitment came when a Libyan delegation, led by Ahmed Militan, head of the Authority for the Support and Development of Medical Services, reaffirmed to Tunisian Health Minister Mustafa Al-Farjani their pledge to resolve the issue of unpaid debts to Tunisian healthcare institutions. Meanwhile, Basheera Rahim, Director General of Health Services Export and Investment Support at the Tunisian Ministry of Health, confirmed that Libyan officials expressed readiness to settle the outstanding debts. An agreement was reached to close this file and settle the payments as soon as possible, with a joint task force—including representatives from the health ministries of both countries—set to be formed in the coming days to address these challenges.
60 Affected Clinics
Abu Bakr Zakhama, head of Tunisia’s National Chamber of Private Clinics, an independent body, revealed that Libya owes over $112 million in unpaid debts to 60 private Tunisian clinics that have treated Libyan patients.
He explained that the Libyan side has struggled to pay off these accumulated debts, as successive governments have failed to fulfill their promises to resolve them since 2011. He emphasized that these outstanding payments pose a significant financial burden on Tunisia’s healthcare sector. Despite multiple commitments, the issue remains unresolved more than a decade later. This has severely impacted the cash flow of private clinics, limiting their ability to provide high-quality services, especially since Libyans make up about 70% of foreign patients receiving treatment in Tunisia.
Zakhama also noted that the Tunisian healthcare sector provides approximately 1.5 million medical consultations annually for Libyan patients, making it crucial to address the issue swiftly to ensure service continuity and quality. Although an audit committee was formed in 2018 to assess the debts, it concluded its work in 2023 without achieving a resolution.
He added that most Libyan patients bear the full cost of treatment at Tunisian private clinics. These clinics also accept cases covered by Libyan institutions that provide comprehensive health insurance, which is supposed to handle payments later.
Disputed Invoices
According to the report, Tunisian clinic owners and representatives of healthcare institutions described the issue of unpaid Libyan patient bills as “complicated.” In an interview with Independent Arabia, Sahbi Ben Ayad, owner of a private clinic, explained that Tunisian healthcare institutions had to navigate dealings with multiple Libyan committees representing patients, especially in the absence of a unified government before 2017. Each committee was approached separately to negotiate invoices and payment, in addition to handling medical coverage letters from the Libyan consulate and embassy.
Further complicating matters, insurance companies that were supposed to settle bills were dealt with individually, as were intermediary firms assigned by the Libyan side to act as liaisons between clinics and the embassy.
Ben Ayad noted that aside from a few reputable insurance companies that honored their commitments, most other parties failed to pay. This was especially the case for the treatment of Libyan patients and wounded individuals between 2011 and 2017.
He added that the situation improved somewhat after 2017, particularly in 2020, due to Libya’s relative political stability and the ability to coordinate with the Government of National Unity. However, some debts remain unsettled, particularly those linked to intermediary firms acting between the embassy, consulate, clinics, and Libyan insurance companies.
Ben Ayad estimated that total debts had surpassed 400 million Tunisian dinars (around $131.2 million), based on the exchange rate at the time (1.6 dinars per US dollar). Currently, the exchange rate exceeds three dinars per dollar.
Meanwhile, Tarek Obeid, a representative of another private clinic, said he is still awaiting payment for invoices processed under the same system, whether during the committee period or afterward, under the Government of National Unity. He explained that clinics received patients under Libyan coverage schemes, but they only managed to collect a small fraction of their dues. Although insurance companies and intermediaries initially cooperated, they later reneged on their commitments, leaving Tunisian institutions with nothing but unfulfilled promises.
Obeid mentioned that some clinics have resorted to lodging complaints with the Tunisian judiciary due to the financial strain, particularly smaller clinics that have suffered from reduced income and stalled investments. The ongoing treatment of Libyan patients has further complicated matters.
Tunisia has over 120 private clinics, with Libyan patients making up the majority of foreign visitors, followed by Algerians and Mauritanians.
Despite concerns over unpaid debts, Tunisia’s private clinics association has previously denied rumors of refusing to admit Libyan patients, reaffirming its commitment to providing services without discrimination.
