Between Piety and Politics: Social Services and the Muslim Brotherhood

In Ezbet-el-Haggana, a slum on the outskirts of Cairo, residents struggle daily to survive. Staggering unemployment, inflated food prices and problems securing housing make life here both difficult and uncertain.

I was in Haggana in the summer of 2009, conducting research on how social issues, such as unemployment and gender inequality, impact public health in slums. In conversations with residents, I quickly learned that their biggest problem was the inadequacy of basic social services. Many homes lack running water, and power shortages occur frequently during the night. There is no police presence to protect residents and they are chronically fearful for the safety of their families, especially at night. One man told me, "The youth know that there are no repercussions for what they do." The roads are unpaved and lined with trash, although residents pay a monthly sum to the local government authority for their garbage to be collected. There is only one government medical clinic in the area, with a single doctor. One young mother complained that she waited two hours for the government doctor to see her sick baby, but he left the clinic before seeing the child. "Doctors don't have hearts," she said.

The outlook of the residents was infused with a sense of hopelessness. They told me that the government doesn't care about them because they are poor, and they voiced their deepest fears that life will never get better for them as a result. But while the former Mubarak government seemed to have forgotten these people, Islamic organizations around Egypt -- particularly the Muslim Brotherhood -- have not.

Social service provision has been a core activity for the Muslim Brotherhood since the early 1930s, predating the group's political mobilization. The Brotherhood has long viewed social outreach as a way to demonstrate its ideological commitment to alleviating poverty, reducing inequality and increasing social responsibility.

For decades, the Brotherhood's relationship with the Egyptian government has been tumultuous. Though the group was officially banned in 1954, following an assassination attempt on President Gamal Abdel Nasser, the government feared an uprising if the Brotherhood's social service scheme crumbled. In fact, U.S. State Department records show that the Nasser government ultimately funded and staffed the Brotherhood's social services network because so many Egyptians relied on it. Presidents Anwar Sadat and Hosni Mubarak both struggled to balance limiting the Brotherhood's political activities while allowing its social outreach efforts to continue. This complicated political dynamic has allowed the Muslim Brotherhood to continue providing services while being forced underground. As such, it is difficult to track the group's complex network of organizations, which sometimes operate under different names. Despite a lack of precise data, it is widely known that the group operates hospitals, schools and programs to support widows and orphans across Egypt. And over the years, as Egypt's public service scheme has deteriorated, the Muslim Brotherhood has played an increasingly central role as an alternative provider of services.

The Brotherhood's medical services are recognized to be of higher quality and lower cost than those available through the public system. Where government clinics may only have one or two doctors, Brotherhood clinics are well staffed with dozens of volunteer physicians, which keeps costs low and improves the quality of patient care. And while government medical facilities often lack even basic medical supplies, the Brotherhood uses charitable donations to outfit its clinics with the latest medical equipment. A 2006 report from the Integrated Regional Information Networks, a humanitarian news agency, quotes a prominent Brotherhood member as saying, "A woman would usually pay at least U.S. $875 to give birth in a private clinic, compared to just U.S. $175 in one of our hospitals," and notes that Brotherhood-run clinics are open to all Egyptian citizens, regardless of their political or religious affiliation.

In her book Dreams and Shadows: The Future of the Middle East, Robin Wright describes her 2006 visit to a three-story Brotherhood hospital in Talbeye, a slum near the Pyramids. The clinic's patients could visit "gynecologists, pediatricians, cardiologist, ophthalmologists, general surgeons, dentists and others," and Wright noted the following sign on the wall: "The idea of the organization is to get closer to God through medical work. The organization facilitates the means of diagnosis for every patient who needs it, regardless of his financial ability, social status, or medical condition, without discrimination because of color, gender or faith."

The Brotherhood's response to the devastating 1992 earthquake in Cairo is a key example of the group's effectiveness. It quickly mobilized to help the victims, providing them with food and blankets and setting up makeshift medical clinics and tents for shelter -- developing a reputation for humility in the process. The skills the Brotherhood has developed over the years were again put to use during the revolution in Cairo's Tahrir Square, where the group ran security checkpoints, served hot tea, distributed blankets, printed posters and ran an emergency health clinic.

When I was in Haggana, one elderly woman I spoke with offered a piercing view of the political dynamic between the poor and the powerful under Mubarak's regime. "How can we respect our government if our government doesn't respect us?" she asked. By providing social services to the poorest Egyptians, the Muslim Brotherhood perhaps offers the poor a modicum of the respect this woman seeks. Whether its motives are pious or political, the Muslim Brotherhood has demonstrated it will step in where the government is absent. In so doing, the Brotherhood has succeeded in establishing a base of support among Egyptians who either admire its mission or rely on its services. As Egypt's new democracy takes shape and the Brotherhood begins to take a more active political role, it remains to be seen whether that support on the ground will translate into success in the polls.

Nadine Farag conducted research on the politics of social welfare in Egypt while completing a master's degree at the Harvard School of Public Health.