Medicine was rudimentary and medical assistance was very poor. They were provided by empiricists (tolerated doctors), supervised by an amine, a kind of corporation head appointed by the Monarch.
In Tunis, only one facility reserved for Muslims, the Sadiki Hospital, housed the chronically and the mentally ill patients. In the interior, two infirmary-dispensaries operated, one in Sousse and the other in Sfax.
The lazarets installed in the main ports and in the Chikli and Zembra islands were intended for the isolation of the patients during epidemics. The Jews were not in a better position. Their assistance, was provided by charitable organizations, financed by donations and contributions from their members. The Italians and the Maltese had an infirmary located in the street of the Teinturiers, and the French were treated in a small hospital of eight beds, the Saint Louis hospital, in the street of Sidi Saber. In 1880, at the instigation of Cardinal Lavigerie, this hospital was transferred to a larger abandoned barracks in Sidi Ali Azzouz street. The princes and the wealthy classes of the population were treated by foreign doctors. According to Henri Dunant , the father of the International Committee of the Red Cross, twenty doctors, all foreigners, belonging to ten different nationalities, were practicing in the Tunisian capital in 1858.
 Dunant H. La Régence de Tunis, STD Tunis 1975, p.229-30.
Following the establishment of the protectorate in 1881, the administration developed the instruments of its policy. It made an urgent appeal to high-level French doctors to come to Tunisia, in order to mitigate the influence of Italian doctors and compensate for their numbers. It proceeded to reinforce quarantine measures and established a maritime sanitary police to prevent epidemics. In 1886, a military hospital was set up in the El Omrane district, with four annexes in Sfax, Gabès, Kef and Gafsa, independently of the Sidi Abdallah hospital, created in 1899, near Bizerte, for the French navy. The Official Gazette of the Republic of Tunisia in 1892 indicated that there were 106 doctors in the Regency, 47 of whom were qualified foreigners practicing in Tunis and large cities, and 59 physicians who were tolerated, most of them were Muslims, and who were spread throughout the territory. In 1894, a Jewish hospital was founded by Jewish doctors from Livorno.
In 1898, the French Civil Hospital replaced the Saint Louis Hospital. At the beginning, it had 190 beds. Initially reserved for the French, in 1925 it was opened to the Israelites.
The Italian colony could not be left out. In 1900, it built a large 200-bed hospital in Montfleury, which was funded by its citizens with the contribution of the Italian government.
In 1899, Dr Brunswick-Lebihan, an intern of the Paris hospitals, arrived in Tunisia. In 1902, he was promoted to the position of Director and Head of the Surgery Department of the Sadiki Hospital. A Talented trainer, he created a school for medical assistants and organized a medical service which was entrusted to Dr. René Broc, assisted by Dr. Hassine Bouhajeb, the second Tunisian physician to graduate from French faculties. A woman, Dr. Gordon, provided the female consultation.
On December 23, 1902, Charles Nicolle arrived in Tunis. He replaced Dr. Adrien Loir at the head of the Pasteur Institute.We won't dwell on the scientific work and research of Charles Nicolle. As it is knowing, he was awarded the Nobel Prize in Medicine in 1928 for his work on exanthematic typhus, in 1929 he was elected to the Academy of Sciences and in 1932 he was appointed to the Chair of Experimental Medicine at the Collège de France. It is worth mentioning the role played by Dr. Ernest Conseil, a close collaborator to Charles Nicolle. As a head of the Hygiene Office of the Municipality of Tunis in 1909, he distinguished himself in the fight against epidemics with an exemplary dedication, detecting the patients that he isolated in the lazaretto 'A quarintain facility'of La Rabta.
This lazaretto, was integrated into the Sadiki hospital in 1912, took the name of Hôpital des Contagieux in 1924, then the name of Hôpital Ernest Conseil in 1930.
It is also worth mentioning, among the illustrious names, Dr. Etienne Burnet, the 3rd director of the Pasteur Institute in 1936, who demonstrated the disparities between the various communities in terms of food and tuberculosis.
In 1927, the hospital for mental illnesses of La Manouba was established.
In the 30's, the major epidemics (plague, cholera, smallpox, ...) were practically under control.
In 1932, a force of nearly 200 roving nurses was formed in ordet to fight against malaria.
According to the daily newspaper Ezzohra, dated October 13, 1934, the number of doctors practicing in Tunisia increased to 340, including 203 in the capital. In 1939, the Ariana Preventorium was set up and opened its doors.
In 1944, the French civil hospital became under the name of Charles Nicolle Hospital and the Italian hospital was named hospital of the Liberation, before being renamed Habib Thameur Hospital after the Independence.
In 1945, and for the very first time, a Ministry of Social Services including the Department of Healthcare was headed by a Tunisian. A diversified paramedical staff were trained, maternal and child protection centers were set up in hospitals and medical-school centers were assigned to a team of medical inspectors.
in 1950 the Lamine I center devoted to the fight against tuberculosis and the Institute of Ophthalmology to the fight against trachoma. The same year, the dispensary infirmary of Kef was set up as a regional hospital with a preventorium.
Private medicine was thriving. The medical practices were concentrated in the large cities, according to the economic level of the people.
The hospital practitioners, who were poorly paid, devoted the best of their time to private practice while providing free care to the most vulnerables.
The following table, from J. Magnin, shows the number of doctors practicing in Tunisia in 1953 and 1958.
 nous donne l’effectif des médecins qui exerçaient en Tunisie en 1953 et en 1958.
|Tunisian Muslim||Tunisian Jewish||Frensh||Other||Total|
|1953||100 (18%)||56 ? (10%)||350 (63%)||47||553|
|1958||130 (29%)||67 ? (15%)||207 (46%)||38||442|
 Magnin J. Medicine of yesterday and medicine of today. . Review of the Institute of Arab Belles Lettres (IBLA), Tunis 1957, 80, pp. 393-416.
The ten-year perspectives 1962/1971 was set as an objective to empower the citizen in order to develop a healthy and dynamic society. Social investments had reached, in the sixties, more than 50% of the investments.
The government's planning defined the actions to be taken. Due to the shortage of medical personnel, they proceeded to hire on a contractual basis a large number of practitioners, mostly from Eastern European countries, and increased the number of training programs for doctors in France and abroad.
The four-year plan identified the following three main areas of focus in the area of health:
- The demographic balance and the intensification of prevention and social hygiene- Optimization of the hospital's performance by involving doctors to practice full time
- The creation of a medical education
By the end of the 80s, we have seen the rise of the pharmaceutical industry in Tunisia, as well as the development of the medical devices industry. Since the 2000s, Tunisia has become a preferred destination for healthcare abroad and has distinguished itself as a country of choice in the medical tourism sector.
All these factors have allowed Tunisia to have a leading position in Africa in the field of scientific research and publication, making it one of the best health systems on the continent.
This document was prepared from several sources:
Inaugural lecture given by Dr. Amor Chadli during the Franco-Tunisian Meeting of the National Academy of Medicine of France, Tunis, October 21, 2010
BIAT's Sectoral Analysis of the Pharmaceutical Sector
Data from the Tunisian Ministry of Health OMS
Data from the Tunisian Ministry of Health
Presentation of the CNIP: Figures of the Pharmaceutical Industry 2018