ROULAND Betty, JARRAYA Mounir, FLEURET Sébastien

DU TOURISME MEDICAL A LA MISE EN PLACE D’UN ESPACE DE SOINS TRANSNATIONAL. L’EXEMPLE DES PATIENTS LIBYENS A SFAX (TUNISIE)

25/10/2016

Résumé

Cet article s’intéresse au triptyque « santé-tourisme-territoire » en examinant conjointement les logiques du développement des services sanitaires privés dans la ville tunisienne de Sfax et les modes de recours aux soins des patients libyens depuis la révolution arabe de 2011. Phénomène fondé sur des logiques de voisinage (réouverture de la frontière, libre circulation, suppression des visas, etc.) qui débuta dans les années 1990, le tourisme médical manifeste un fort dynamisme sur le paysage urbain sfaxien depuis 2011 et cela en dépit de l’instabilité géopolitique régionale. Sujet encore peu étudié, la méthodologie exploratoire proposée combine une enquête qualitative conduite auprès des patients libyens (n=205) dans quatre cliniques privées de la ville ainsi que des entretiens semi-directifs menés auprès des professionnels de santé. D’un côté, le chaos en Libye ainsi que la proximité géographique de Sfax poussent les professionnels du (para)médical à investir dans ce secteur considérant le « marché libyen » instable mais porteur. D’un autre côté, les résultats indiquent l’augmentation et la diversification des profils des patients (réseaux, ressources, besoins). Le conflit en Libye accroît en effet la vulnérabilité des populations vis-à-vis de l’accès aux soins. Les reconfigurations spatiales locales en termes d’aménagements (à caractère médical, résidentiel, commercial) et régionales en termes de circulations (patients, transports, systèmes assurantiels, etc.) expriment l’émergence d’un espace de soins transnational. Le contexte géopolitique ainsi que l’appauvrissement des patients libyens nous amène à reconsidérer le tourisme médical au profit de nouvelles formes de mobilités à caractère « médicales » et interroge la durabilité du secteur d’activité à Sfax.

Texte intégral : rouland_jarraya_fleuret_rfst_2016_tms

Abstract

FROM MEDICAL TOURISM TOWARD A SPACE FOR TRANSNATIONAL CARE : THE CASE OF LIBYAN PATIENTS IN SFAX (TUNISIA)

This paper focuses on the triptych “health-tourism-territory” analyzing the logics of the development of private health services in the Tunisian city of Sfax and the modes of utilization of care by Libyan patients since the Arab revolutions in 2011. This phenomenon is based on geographical proximity and started during the 1990s, whereby a combination of multidimensional factors promoted the growth of an original sector, making Tunisia a leading destination for medical tourists:

– An United Nations embargo on Libya provoked the first medical tourist flows,

– Opening of the borders and free movements with the abolition of visas,

– Availability of medical staff in Sfax, due to an existing University Hospital,

– High quality and affordable health services,

– Infrastructures such as direct flights to Tripoli – also used by Tunisian doctors practicing in Libya.

Despite the geopolitical instability in the region since 2011, medical tourism has had an important impact on the urban landscape of Sfax, most notably in form of a new economic opportunity for a city that has been marginalized as regards the development of tourism infrastructure.

This paper provides a detailed analysis of the recent changes of a phenomenon understudied through a geographical lens, addressing in particular its local impacts and the magnitude of urban reconfigurations since the Arab revolutions.

Facing a lack of data and an instable geopolitical situation, with armed conflict in Libya, the methodology combines a qualitative survey amongst Libyan patients (n=205) in four private clinics in the city of Sfax as well as semi-structured interviews conducted with medical staff. In addition, we completed the study with an analysis in situ of the urban morphology around the private clinics where transformation and reconfiguration processes take place through new investment dynamics (new commercial and residential areas) with high impact on the land and real estate market.

On the one hand, the findings show that the chaos in Libya as well as the geographic proximity to Sfax push the (para)medical staff to invest in the private health sector considering “the Libyan market instable but as an expanding niche market”. The number of private polyclinics raised from three to 12 between 1998 and 2011 while other clinics are ongoing projects.

On the other hand, the findings point to the growth and the diversification of patients’ profiles (networks, recourses, needs of care, etc.). The war in Libya is increasing the vulnerability of the population regarding the accessibility of care in Libya. Spatial reconfigurations, such as new city planning (medical, residential, commercial) and regional circulation flows (patients, transports, assurances systems, etc.), are the expression of an emerging transnational space of care. The political context as well as the impoverishment of the patients leads us to reconsider the definition of “medical tourism” in this context and to question the sustainability of the related investments in Sfax, given its dependence on Libyan patients.

Map : Polyclinics in Sfax

mapsfax

Keywords: Sfax – Libyan patients – Private Health services – Medical Tourism – Transnational space – Local Development– Globalization.

Full Text : rouland_jarraya_fleuret_rfst_2016_tms