Egypt and U.S. Health Assistance

Few countries have been as successful as Egypt in parlaying its strategic position into an economic asset. At the nexus of two continents, astride the Suez Canal, and with one-quarter of the Arab world’s entire population, Egypt has made itself an object of interest, and often an object of concern, among the world’s great powers for more than a half-century. Since the 1975 disengagement of Egyptian and Israeli forces from the Sinai Peninsula, Egypt has drawn more than $70 billion in U.S. assistance, affecting a wide swath of Egyptian political and economic life. Other assistance has poured in as well, from European countries, from international financial institutions, and in recent years, from other Arab states. Whatever its difficulties at any given time, outsiders have consistently considered Egypt a prize worth winning, and they have contributed funds to make it so.

The U.S. economic assistance program in Egypt—a more than 30-year effort—is unusual in the annals of U.S. development assistance for several reasons. Most importantly, politics successfully insulated the multibillion-dollar effort from challenge for decades. Intimately tied to Arab-Israeli peacemaking, and tied as well to substantial U.S. military assistance to both Egypt and Israel, many in Egypt and the United States came to consider the program as untouchable. Over the years, far smaller U.S. Agency for International Development (USAID) programs were wrapped up or refocused to comport with shifting U.S. global priorities and conditions on the ground, but the USAID program in Egypt continued unabated, almost as if it were an entitlement.

The health sector is a valuable prism through which to examine these phenomena shaping the overall U.S.-Egypt economic aid relationship. Over more than three decades, the United States invested more than $1 billion in health projects in Egypt, and the period of U.S. assistance corresponded to a period of dramatic improvements in Egyptians’ health. Bilharzia was largely eliminated from the rural population, the rate of infant and child death from diarrheal diseases plummeted, and population growth flattened considerably. USAID efforts played a significant role in supporting each of these trends.