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Wednesday, 12 August 2020

Plague, cholera, and Spanish Flu

As measures continue to fight the spread of the coronavirus in Egypt, how did the country cope with other disease pandemics in the distant and not so distant past, asks Mina Adel Gayed

Mina Adel Gayed, Tuesday 2 Jun 2020
CL Auguste
Egyptians boarding boats on the Nile during a cholera epidemic, drawn by CL Auguste (1841-1905)
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Today, all of humanity is suffering the health and economic repercussions of the global Covid-19 pandemic. We are obsessed with infection, discombobulated about changing our routines, and anxious about staying at home indefinitely until someone discovers a cure or vaccine to save us and give us back the lives we knew before.

They say that to understand the present and predict the future, we must look at the past and realise that humanity has endured and overcome many other catastrophes, with life eventually returning to normal or even better. This is the best advice we can give each other today at this difficult moment in human history.

In the past, Egypt has faced catastrophic epidemics of plague, cholera, and Spanish Flu, with writings by historians and newspaper reports from the time giving insights into how the country experienced them. They are reminders of the struggle Egyptians have long had with epidemics, and they can help us to understand how we can protect ourselves from repeating the mistakes of the past and inspire us to overcome today’s difficult moment.



PLAGUE: The plague never came in increments, but always in the form of a pandemic, striking one country after another every few years, sometimes leaving tens of millions of victims in its wake.

The incubation period for the plague was short, and symptoms would appear within hours or days of infection, including blisters and abscesses on the body as the disease spread through the bloodstream and nervous system. Soon, the body would be poisoned, and the infected person would feel excruciating pain until death within hours or days.

The mediaeval Egyptian historian Al-Maqrizi (1364-1442 CE) describes a plague epidemic in Egypt by writing that it “did not distinguish between one region and another. It swept all regions of the world, in the east, west, north, and south. It afflicted all human beings and others, even the fish in the sea, the birds in the sky, and the beasts on the land.”

Cairo “became deserted and desolate. No one walked in the streets. A man could walk between Bab Zuweila and Bab Al-Nasr without seeing a single soul because of the large number of dead and those attending to them [inside the houses]. The dust was high in the streets, people’s faces were hidden, the air was full of wailing, in every house there were cries, on every street there were many dead. Because the coffins were so many, they collided and the dead mingled.

“They say 20,000 died in one day, and during the months of Shaaban and Ramadan there were 900,000 funerals in Cairo alone. They ran out of coffins, so the corpses were carried on planks of wood, and two or three bodies were put in one coffin and on one plank.”

Al-Maqrizi goes on to explain how there were shortages of certain professions, such as Quran reciters, pall bearers, and grave diggers because there were so many of the dead. When it was time to harvest the crops, there was no one left to do the work. They could not cultivate the land either, so it was abandoned.

Sameh Al-Zahhar, an Egyptian historian and expert on the Islamic and Coptic heritage, told Al-Ahram Weekly that the plague or “Black Death” was an epidemic that spread in Egypt with few attempts made to stop it. Most historians agree that the plague reached Egypt in 1348 CE, and according to Al-Zahhar, it first appeared in Alexandria, causing 100 deaths every day. The death toll then rose to 200 deaths, then 700, and then nearly 20,000 deaths a day across the country. Within two months, 900,000 people were dead, according to the historians Al-Dhahabi and Al-Maqrizi, who lost his young daughter to the plague.

The late Egyptian journalist Salah Eissa tells us more about the plague’s journey through Egypt in his book Hawamesh Al-Maqrizi (On the Margins of Al-Maqrizi), where he writes that at the time the Egyptians suffered cruel kings, the threat of death, and the evils of the plague. The plague began in the Islamic month of Ragab and increased in Shaaban and then exploded to catastrophic proportions in Ramadan 903 Hijri (1497 AD) before partially subsiding by the end of the fasting month. At the time, Egypt was under the rule of the Sultan Abul-Nasr Abul-Sadat Mohamed bin Al-Ashraf Qaitbay.

In 917 Hijri (1511 AD) the plague came back to Egypt, and people suffered fuel shortages due to a scarcity of firewood, which brought the kitchens of the ruling princes to a standstill. In the following months, matters became worse as the plague spread across the country. Plague, poverty, and hunger “surrounded the people”, as the mediaeval historian Ibn Iyas put it, but the sultan gave orders to increase revenues by taking a portion of a dead person’s assets if they died of the plague to offset rising prices and famine.

Later in 1878, the level of the River Nile dropped, causing a severe shortage of various crops. There was also another terrible outbreak of plague. This caused the cotton market to fall sharply, and unprecedented famine spread in the south. Desperate mothers roamed from village to village with their children in their arms begging for food. More than 10,000 people died of starvation in the summer of that year, but the government of the khedive Ismail forced farmers to pay their taxes despite the miserable conditions because he had failed to convince the country’s foreign creditors to wait on collecting their debts.

Starving farmers were forced to sell their crops at half price or less before they were harvested and then to buy them back to feed themselves. Entire districts were abandoned, with many people leaving the places where they had been born for good.



CHOLERA: In the summer of 1902, a cholera pandemic reached Egypt, quickly spreading and destroying towns and villages and wiping out entire families.

Schools and Quran schools were shuttered, and doctors and medical staff were deployed across the country with supplies and tents to quarantine the sick. Panic filled the hearts and souls of the people, and life became unbearable. Each family talked about what had happened to other families and awaited their turn in the calamity.

The symptoms of cholera include nausea, vomiting, achy legs, intermittent moaning, distressed bodily functions, and often finally death. People ate garlic and quarantined the sick to guard against infection, as was described by famous writer Taha Hussein in his autobiography Al-Ayyam (The Days), where he describes the unbearable loss of his brother, a bright medical student, who died of cholera at a young age.

Unlike the mediaeval plague that Al-Zahhar described as “a pandemic with no attempt to end it”, there were many efforts to end the cholera epidemics. In 1831, Clot Bey, the founder of the modern medical school in Egypt, tried to treat an outbreak of the disease, though to little avail as 3,000 died every day until the epidemic subsided. One year later, in 1832, health clinics were opened in Damietta and Arish, but thousands still died of cholera until late in the century. According to Al-Zahhar, the epidemic in the 1830s spread during the moulid (religious festival) of Sheikh Abul-Maati in Damietta and killed 15,000 residents of Port Said, Manzala, Matariya and Daqahliya. It is estimated that 36,000 died of the disease in the Delta region.

Later in the century, the German physician Robert Koch discovered the cholera microbe and quarantine camps were built and hospitals overwhelmed with people getting tested. Protocols were changed at fever hospitals and isolation centres. Ahmed Abdel-Hamid Hussein, a researcher in social and political history, told the Weekly that due to the lack of health services in rural areas and limited awareness, many rural people still resorted to the local barber to treat cholera.

Sometimes, there was recklessness, especially at the beginning of an outbreak. A good example is the epidemic that hit Egypt in 1902 and infected the village of Mosha in Assiut. The mayor of the village hid the disease in those returning from pilgrimage to Mecca, and eventually it spread to Cairo.

Abdel-Hamid said a traditional concoction called the “Qena cure” was widely used to treat the condition at the time. But rural people were also treated in isolation camps and quarantine. The water used for irrigation and daily chores was routinely disinfected. Food coming from infected areas was treated as contraband, and ice and beverage factories were padlocked along with some eating places considered to be hotbeds of infection. Public transport was strictly regulated and pilgrimages suspended.

Cholera outbreak in Cairo
People leaving Boulak during cholera outbreak in Cairo, 1883


SPANISH FLU: This “mother of all pandemics” killed 40 to 50 million people around the world between 1918 and 1920, according to World Health Organisation (WHO) figures and the US Centre for Disease Control and Prevention.

Strangely, there are few historical sources that mention the Spanish Flu pandemic in Egypt, even though it spread like wildfire, and there are scare references in the journals of those who lived through it. One such reference is a document inviting the early feminist figure Hoda Shaarawi and her colleagues to attend the International Women’s Conference after World War I, with Shaarawi and others turning down the invitation because of the spread of Spanish Flu. The lack of any substantial documentation of the pandemic could be because the focus at the time was on a tectonic moment in Egypt’s modern history, namely the 1919 Revolution.

The pandemic was dubbed Spanish Flu not because it originated in Spain, as has been commonly believed, but because it was the Spanish press that first began reporting on the outbreak in the spring of 1918. However, there was coverage of the pandemic in the Egyptian newspapers of the time, as revealed by an article by Karima Hassan in Al-Masry Al-Youm in June 2009, which gathers much of what was written about the Spanish Flu in the newspapers Al-Muqattam and Al-Ahram.

Their coverage was vivid and helped unveil information about an otherwise poorly documented outbreak, including that the government was preoccupied with the pandemic which had reached Fayoum and spread to Alexandria. Most infections in Cairo were clustered in the districts of Abdine, Al-Khalifa, Darb Al-Ahmar, and Boulaq.

The press also reported that the municipality of Alexandria took admirable measures to combat the Spanish Flu, and the health department gave people useful tips, such as the importance of good ventilation and the fumigation of crowded public areas. The Spanish Flu spread ferociously in the villages of Kafr Al-Dawwar and Malawi in Minya, and the health department of the time distributed instructions on how to protect against the influenza, stressing that it was a highly contagious disease transmitted by inhaling contaminated particles in the air from the respiratory tract of an infected person, especially when they talked, coughed, or sneezed. Anyone who was infected had to self-quarantine at home in a room separate from the rest of the household, and remaining rooms had to be well and continuously ventilated.

The press coverage at the time also reported that the ministry of the interior had sent directives to schools to submit daily reports on the names and numbers of pupils absent due to illness, in order to gauge how many had the Spanish Flu. If there was a spike in infections, then measures were taken such as suspending classes. Most children were not allowed to go to school and Quran schools out of fears of infection, and celebrations of the moulid al-nabi (the Prophet’s Birthday) in the capital and countryside were banned due to the pandemic.

In Faraskour, the press reported that 44 souls had been taken in one day, and in Al-Mahalla Al-Kubra and its surroundings the flu “has spread like locusts” with many deaths being recorded, especially among the poor. The press noted that some cabinet ministers and heads of government bodies were thinking of bringing back retired staff, since many employees were at home with fever.

Looking back at how Egypt endured some of the world’s most infamous pandemics in the past and then looking at the situation now, we know that we are luckier because today we have better healthcare and most of the population is better informed and educated. The government today has been focused and invested since day one to protect the health of all Egyptians from the Covid-19 pandemic.

Looking back at history and listening to health experts, we can understand that we can help others and ourselves by sheltering in place and staying at home as much as we can, so we can stop the spread of Covid-19 in its tracks.

*A version of this article appears in print in the 4 June, 2020 edition of Al-Ahram Weekly

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