In Winning Hearts and Votes: Social Services and the Islamist Political Advantage, Steven Brooke closely analyzes the symbiotic relationship of the authoritarian Egyptian regime under Hosni Mubarak and NGO service providers, specifically the Muslim Brotherhood, which was able to mobilize its extensive social service network into political movement during elections in 2011 and 2012.
With a focus on three primary questions, (1) why do authoritarian regimes rely, sometimes quite heavily, on non-regime organizations to provide social services to citizens, (2) how do these opposition organizations use service provision to instigate political movement, and (3) within the context of these organizations, what is the relationship between provider and recipient, Brooke draws on historical data from the Islamic Medical Association (IMA) and qualitative research during the political rise and height of the Muslim Brotherhood in Egypt (4).
The IMA was “the largest and oldest of the Brotherhood’s organized social service initiatives” until its assumption and dismantle by the military regime led by Abdel Fattah El-Sisi in 2015 (Steven Brooke, The Muslim Brotherhood's Social Outreach after the Egyptian Coup, Brookings, 2015). Founded in 1977, the growth of the IMA over the decades is just one example of Egypt’s reliance on NGO actors to fill state rolls – something that Brooke shows has been historically common for authoritarian leaders, especially in the Middle East, during times of economic hardship in order to ensure higher levels social and perceived state stability.
While the Mubarak regime had an adversarial relationship with the Muslim Brotherhood, the IMA played a particular role in supplementing the government’s hospital and medical facilities in middle class neighborhoods with affordable, quality care, estimated at its peak to have treated millions of Egyptians each year (137).
This begins to answer the why and how posed in Brooke’s guiding questions. The IMA flourished in an environment where medical services were critically needed and survived by largely separating itself from political proselytization during the Mubarak years. New evidence presented by Brooke changes previously held ideas about the internal structuring of the IMA, showing that the majority of doctors and staff were paid employees, well compensated in the market, and the majority of patients paid for services rendered at IMA facilities rather than relying on charity or reduced prices (7).
Moreover, the focus on professionalism, character, and quality shown at IMA facilities was able to be enforced because its employees were accountable, and they avoided outright quid-pro-quo clientelism which Brooke argues can dissuade middle class voters who find it ethically compromising and a sign of weak governance (12). And, it is notable that the IMA forbade, and even disciplined employees, for politicking with patients.
Brooke highlights the advantages that this type of provision offers the Muslim Brotherhood in achieving Islamist political mobilization, particularly post-1990. Targeting a wealthier patient base presumes a higher level of voter autonomy because patients are not dependent on state services, and at a time when political competition was widening, the IMA was able to build significant social capital which transferred to candidates running on behalf of the Muslim Brotherhood, who were often leaders or affiliates of IMA hospitals (96). This all occured at a time when the regime relied more heavily on non-state actors for social services following the devastating Cairo earthquake, though through the early 2000s the state would continue to intermittently harass the IMA (52).
By 2011 and the ousting of Mubarak, campaigning began to overflow into Brotherhood social services which also expanded to provide medical caravans to poorer neighborhoods. This year also saw the Muslim Brotherhood able to compete openly in political elections, forming the Freedom and Justice Party, with their candidates winning the majority of parliament seats in the 2011 elections and Mohammed Morsi winning the 2012 popular presidential election. Analyzing votes for the second-round presidential election in 2012 for Cairo, Brooke shows a positive correlation between IMA facilities and votes for Mohammed Morsi (100).
The July 2013 removal of Morsi by the Egyptian military and the subsequent crackdown on Brotherhood activity in Egypt end this particular case study in the effects of social service provision on voter turnout. Brooke’s argument that targeting the middle class for reliable, affordable services was paramount to the Muslim Brotherhood’s political success is evidenced in the data presented.
While the “Islamist political advantage has been widely presumed rather than demonstrated,” Winning Hearts and Votes provides data coinciding with the Muslim Brotherhood’s rise in popularity (Melani Cammett and Pauline Jones Luong, “Is There an Islamist Political Advantage?” Annual Review of Political Science , vol. 17). Contributing spatial analysis and significant survey and archival data to the innerworkings of the Muslim Brotherhood’s social service arm, Brooke asserts their Islamist advantage can be primarily explained by the confluence of service provision to a politically mobile middle class during a time when elections were becoming increasingly competitive in these same areas.
Sarah Tomerlin is an independent scholar.
Date Of Review:
March 11, 2021
Steven Brooke is Assistant Professor in the Department of Political Science at the University of Louisville and Associate Fellow (Non-Resident) at the Middle East Initiative, Harvard Kennedy School.
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