Tunisia is experiencing an irreversible demographic shift. With some 17% of its population now over 60 — a figure projected to reach nearly 20% by 2043 — the country is aging at a rate unmatched in North Africa. This transformation is happening amidst economic stagnation, institutional collapse, and political repression, creating a crisis that the state is structurally and financially unequipped to manage.

The numbers tell a haunting story. Tunisia’s total fertility rate has fallen to well below the replacement level. The working-age population, which once drove the country’s modest economic growth, is shrinking in relative terms, while the elderly expand. By 2043, nearly one in five Tunisians will be over 65. This inversion of the demographic pyramid coincides with a dependency ratio that has already worsened in just over a decade (or about half a generation). The economic implications are severe: fewer contributors to social security systems, greater pressure on public health infrastructure as well as safety nets, and a fiscal time bomb linked to pension obligations.

The situation is worsened by mass emigration. Nearly half of Tunisians, including three quarters of its youth, express a desire to leave. Moreover, between 2021 and 2025, some 6,000 doctors and 39,000 engineers emigrated, stripping the country of the very skills needed to sustain health systems and drive economic renewal. This brain drain is both a cause and consequence of Tunisia’s decline. Those who remain face an economy growing at just 2.8% annually, with GDP per capita not expected to recover to its 2019 level until 2034. Unemployment persists at 15.7%, and informality remains high, absorbing over a third of the labor force.

Pension and social security systems are already under severe strain. The National Social Security Fund and the National Retirement and Social Provision Fund are projected to run a combined deficit of €755 million by the end of 2025. As the ratio of workers to pensioners narrows, the state will be forced to choose between raising taxes, reducing benefits, or accelerating deficit spending — each option carrying significant social and political risks.

The health sector is equally vulnerable. Non-communicable diseases account for 87.7% of Tunisia’s disease burden and 86% of deaths. Yet the country has only two dedicated geriatric care facilities. There is no specialized geriatrics training program, and hospital infrastructures lack basic adaptations for elderly patients. Mental health and suicide among the isolated elderly remain taboo subjects, reflecting a broader societal failure to reckon with the human dimensions of aging.

These challenges are magnified by the current political environment. Since the presidential power grab in 2021, state institutions have been systematically weakened. Electoral integrity has collapsed, civil liberties have been curtailed, and dissent is criminalized through decree laws targeting “false information.” Public administration is in disarray, with officials frequently dismissed without explanation, creating operational paralysis in key ministries. Governance has been replaced by erratic decision-making and ideological purges.