Tunisia, Republic of
Prof Dr Mustapha Ferjani MD
Senior Colonel MC
Tunisian Armed Forces
1005 El Omrane, Tunis
Basis Task of the Military Medical Service
The Military Health Service is responsible for:
• assuring the medical welfare of operational forces,
• providing medical care services to military and civilian personnel
of the Ministry of National Defence and to their
• participating as main partner in the implementation of the
national disaster relief plan.
It contributes to the national effort to develop the Tunisian
• by participating in the teaching of medical and paramedical
officers in the medical faculties and their schools and
in training in university health departments (supervision;
continuous medical training, medical research),
• by developing certain fields of activity such as aeronautical
medicine, underwater and hyperbaric medicine, emergency
and catastrophe medicine ...,
• by dispensing preventative and curative medical care free
of charge to conscripted soldiers during their national service
and to the civilian population of certain remote zones
of the country, in particular the Saharan territories,
• and by being generous with the curative medical care to
the general population in accordance with agreements
made principally with the national health insurance service
The medical service to the armed forces is both preventative
and curative and includes treatment. This aim constitutes an
unwavering rule both in times of peace and in emergency
Certain actions, such as medical evacuations by helicopter
to assist severely injured victims of traffic accidents and in
particular Tunisian tourists and foreigners in the Saharan territories,
are conducted concomitant with the public health
services in the context of support to the national effort.
From the functional point of view, the Tunisian Health Service
is a joint forces service and its Director General is
directly answerable to the Minister of Defence.
This service is structured into a central design agency repre -
sented by the Directorate General of the Military Health Service
(DGS) and the operational establishments comprising
the medical units, the specialised centres and the training
The Central Directorate
The DGS is responsible for the design of programmes in the
different fields of military medicine, for the supervision of
their implementation and for evaluating them.
The Directorate is composed of:
• a medical supply and support directorate,
• a scientific, technical and training activities directorate,
• a control and evaluation division,
• an administrative and financial division.
The first directorate, supply and support, facilitates the collection,
treatment and analysis of medical information, the
support of forces in the field and in catastrophes and planning
for a better management of hospitals.
The second directorate deals with questions of hygiene and
prevention of disease in the army as well as medical checks
and fitness for selection. It coordinates the various units and
research laboratories, which form part of the military hospital
structure. It also designs the programmes and training
courses for the medical, paramedical and auxiliary officers in
the armed forces health service practice school (EASSA) and
in the School of Military Health (ESM) and decides on priorities
for training overseas.
The Executive Agencies
The executive agencies are constituted by:
Health/Medical Establishments formed by three hospitals,
one of which is a university hospital (Tunis) and the other
two are regional hospitals (Gabès, Bizerte); four specialized
regional polyclinics, a military dental medicine centre, three
family military dispensaries and eighty unit medical services;
and five medical recruitment centres.
(With the intention of making medical services accessible for
military personnel and their dependants, the health service
has created a significant number of first line medical service
units and dispensaries deployed throughout the country and
supported by the regional military hospitals of Gabès in the
south, of Tunis and Bizerte in the north of the country and
this in addition to an agreement drawn up with the Ministry
of Public Health to take charge of patients in these establishments.)
Specialised Centres (see Institutes)
Two Schools (see Training)
3 Military Hospitals (Tunis, Gàbes, Bizerte).
The main hospital in Tunis:
The Principal Military Hospital of Instruction of Tunis
The HMPIT is a Role 4 university hospital with 620 beds,
comprising practically all medico chirurgical specialities. It is
responsible for training and research and possesses a lead -
ing-edge technical support centre including a 64 Slice CT
scanner, 3-tesla MRi, coronary scanner, arterial scanner, PET
The HMPIT’ organ transplant team conducted the first cardiac
transplant in Tunisia in 1993, the first graft of both kidney
and pancreas in Africa in 1993 and created its tissue bank in
Military Blood Transfusion Centre (CMTS)
Centre for Aeronautical Medicine (CEMEDA)
The CEMEDA provides medical selection and periodic checkups
for military aircrew and for technical airline aircrew and
civilian air traffic controllers. It also vets certain categories of
personnel who are subject to specific fitness standards such
as divers, Special Forces personnel and combat swimmers
and also vets troops called up to serve in overseas operations.
The centre deals with the physiological training of
pilots especially in the areas of hypoxia, variations in pressure
and sensory illusions.
Military Hospital of Remada
Located in the extreme south of the country in a Saharan
environment. It's a Role 2 modular hospital. It is designed to
support deployed military personal and also civilian population
of the region. It contains more than 8 specialities including
surgery and intensive care. Medical and paramedical
staff of around 40 people take turns monthly and dispose of
technical platform with laboratory, radiology, pharmacy...
Military Centre of Hygiene and Environmental Protection
It is a specialized centre for military health. It started its activities
gradually in 2012 to conduct:
• Vaccination campaigns in military units.
• Monitoring and evaluation of the application of hygiene
rules in military units.
• The control of water intended for human consumption in
• Control of Air Pollution in the military units.
• Hospital hygiene in health care Units.
• Health education in the military units.
The Military Centre of Hygiene and Environmental Protection
performs epidemiological investigations in the military in the
event of appearance of a transmitted disease. It collaborated
with the authorities of the Ministry of Health for the welfare
and protection of the citizen.
Centre of Military Occupational Health and Professional
It was created in 2013. Its purpose is to prevent professional
risk, ensure the health and safety at work and the whole staff
of the armed forces. It is responsible of studying specific professional
hazards in military environment and implementation
of technical and medical preventive measures.
The achievements of this centre consist in elaboration and
implementation of a program to prevent a toxic risk in the
army, progressive establishment of periodic medical examinations
to the military and assistance for some training in
the management of professional risk.
Military Emergency and Medical Assistance Service
It was created in 2013. Its mission is to respond in collaboration
with medical facilities exclusively to non-hospital emergency
situations of individuals or collectively.
The Armed Forces Health Service Practice School
The Armed Forces Health Service Practice School (EASSA)
provides the specific post doctoral and joint forces military
theoretical and practical medical training of doctors, pharmacists,
dentists and veterinary surgeons. It prepares these
personnel for their future roles in the armed forces. It also
trains specialised nurses.
Many international scientific events are regularly organized
by EASSA under the aegis of the International Committee of
Military Medicine (ICMM) such as the ICMM Course for Health
Support in Saharan Environment. This course becomes an
annual meeting for medical officers coming from different
countries and the sixth session will be held in Tunis and
Tozeur in November 8-14, 2015. As others ICMM course, can
be cited Tunis Low of Armed Conflict and Medical Ethics
Course which is organized for the third time during October
2014 in collaboration with ICMM Centre of reference for education
on international humanitarian law and ethics (Swiss
Armed Forces) and the support of International Committee of
Red Cross (ICRC). Can also be mentioned the Military Health
Course on Methodology and Medical Writing and its third
session will be held during the period of March 30 to April, 3,
The School of Military Health
The School of Military Health (ESM), trains military nurses
(three years of study). In addition to the national nurse training
programme, the students benefit from a military training
as non-commissioned officers, as well as a military medical
training enabling them to carry out their role in hospitals and
specialized centres, or in various units of the Army, Navy or
The operational aspect of military medicine is provided by
field hospitals, either in their traditional or modular form or
in the form of mobile medical units (Shelters).
The Tunisian Army has modular mobile medical units
(resuscitation, surgery, laboratory) constructed by Tunisian
Large experience in conducting overseas missions and
peace-keeping operations under the aegis of the United
Nations Organisation (Somalia 1992-94, Cambodia 1992-
1993, Rwanda 1993-94, Congo Democratic Republic 1960 &
2000-2010) or the African Union (Burundi 1994) or else in
purely humanitarian missions undertaken for the relief of victims
of natural disasters like the missions undertaken in
Algeria after the earthquakes of 1980 and 2003, or to the
displaced populations and refugees in the Lebanon in 1982
and in Albania in 1999.
Despite this experience in carrying out humanitarian missions
abroad, Tunisian Armed Forces faced for the first time,
since 1958, a complex emergency situation on homeland in
February 2011. Libyan crisis started few days after the Jasmin
The Armed Forces have been assigned some new missions
other than the preservation of order and the border’s control.
These new missions comprised the administration of refugee
camps, the coordination of international humanitarian effort
and a contribution in providing health support to the refugees.
Tunisian Military health service (TMHS) had to cope
with these new challenges; not only to support the deployed
soldiers but also to provide health care to Tunisian migrant
workers and to the refugees fleeing the on-going violence in
Some difficulties were faced and most of them in connection
with Saharan environment specificities, refugee cultural and
religious diversity and camp status.
During the period of February 23 – July 31, 2011, TMHS has
provided more than 20,000 medical consultations with an
average of 128 consultations / day and more than 600 consultations
/ day in the beginning of the crises. 393 war-injured
patients were received at Dhehiba border point during
the period of April 27 to July 31, 2011. They were stabilized
by Tunisian Medical officers then transferred to infrastructure
public and private hospitals.
Medical evacuations by helicopter to assist severely injured
victims of traffic accidents and in particular Tunisian tourists
and foreigners in the Saharan territories, are conducted concomitant
with the public health services in the context of
support to the national effort.