When the novel coronavirus began wrecking havoc across the globe, I fished out my grandfather Tawfik Fakhoury’s medal for an outstanding role in the campaign to eradicate the malaria-bearing Gambia mosquito from the Kingdom of Egypt and the Sudan in 1945. An irrigation engineer, he had done his profession and family proud. But there had been thousands like him through the history of Egypt.

The Justinian plague that ravaged Byzantium in AD 452-541 – the first epidemic on record, which killed around 50 million or some 26 percent of the world’s population – is said to have originated in flea-bearing rats first infected here, although most cases of cholera, malaria and bubonic plague came to Egypt from outside. In AD 1348 under the the Mamelukes the European Black Death reached Cairo, killing 10-20 thousand per day, destroying harvests and livestock, and setting the healthcare system instituted by Sultan Qalawun (1279-1290) back. The Black Death was of course a true pandemic that recurred for centuries, and was still evident in North Africa well into the 19th century. With the dawn of the modern era  it had taught humanity about prevention, isolation, and quarantine.

By the time the Black Death reached Cairo, the heyday of Islamic medicine had long been over, hygienic and health practices as well as urban planning had deteriorated, and people tended to regard illness as a test from God, taking no precautions to isolate those infected with a contagious disease. As a result the 1348 plague, therefore, Cairo was practically emptied. The ruling class sought safety elsewhere in the country or abroad, while the Mameluke emirs and soldiers, together with the indigenous peasantry, died by the thousands – so much so that feudal privileges normally reserved for emirs were given to ordinary peasants. Agricultural and urban infrastructure collapsed. This was compounded by the fact that it hadn’t been ten years since the plague receded when it struck again, this time generating truly apocalyptic scenes with Cairo dwellers bearing their shrouds  and congregating on Fridays. 

The plague continued to spread following the Ottoman conquest of 1517, mitigated through Ottoman-instigated importation of European medicine. When the plague hit Istanbul in the mid-18th century, the Ottoman Sultan Mustafa III commissioned a translation of two of the Dutch reformer and physician Hermann Boerhaave’s books, but medical knowledge proved ineffective in the face of cultural parctices and the geographical position of the empire between Europe, Central Asia and the Indian subcontinent. It was ironically at the same time that the Andalusian physician Ibn Khatima put together guidelines for avoiding infection: clarifying and perfuming the air, avoiding southerly and seeking northerly winds during sleep, staying put and shallow breathing, staying calm and reading the Quran, avoiding meat that isn’t fresh and consuming full-grain bread, avoiding alcohol, maintaining a healthy bowel routine and avoiding constipation.

Fakhoury’s medal

As far back as ancient times, Egyptians are believed to have maintained hygienic routines for children and adults alike, considering the cleanliness of their bodies, clothes and living quarters clean an essential condition of life. According to Herodotus, indeed, cleanliness was to the ancient Egyptian a creed before it was a health precaution, and a precondition for stepping into consecrated spaces. The average ancient Egyptian practised hand washing before and after meals, shaving head as well as facial hair regularly to avoid vermin, and using ointments and aromatic oils to purify the skin. Even the simplest houses had to have adequate ventilation and were regularly swept. Such habits seem to have been lost under the Mamelukes and until the reign of Muhammad Ali Pasha (1805-1848), however. When the French campaign arrived in 1798, it was common for rubbish to accumulate, driving air pollution. 

There was no medical profession to speak of, and the people in charge lacked any means of preventing disease. Barbers, fortune-tellers and other quacks took advantage of the ignorance and helplessness of the peasantry. And so when the plague hit again in January 1799 – coming from Izmir via Istanbul and Alexandria – it killed up to 12 thousand people daily in Cairo alone. Dockers from Upper Egypt would contract the illness in Alexandria, then they would set off to their villages in the south for fear of dying away from home, spreading it all along the Nile Valley. The French immediately lost 99 troops, mostly from among their medical team, while Egyptians, as it seems, had developed some immunity. 

The plague hit again following Muhammad Ali’s rise to power in 1813, and as part of his modernising efforts the Pasha instituted a new medical system, largely for the benefit of the army, bringing over, among many others, the French doctor Antoine Barthelemy Clot, better known as Clot Bey (1793-1868) to establish the first school of modern medicine in Abu Zaabal in 1827. The Pasha’s efforts to counter the plague are beautifully fictionalised in Naguib Mahfouz’s The Harafish (1977). 

Under King Fouad (1917-1922), it was malaria that spread in Upper Egypt, prompting the establishment of malaria-fighting units in Qena and Aswan where the future King Farouk visited patients at their houses. Under King Farouk wealthy Upper Egyptians donated LE 100 thousand towards the building of a hospital for treating fevers and filling up infested groundwater wells. According to Ministry of Health Qena deputy Mamdouh Abul-Qasem, today, even though malaria was eradicated in the 1960s, these units continue to fumigate the swamps and monitor the spread of diseases. 

The history of this particular contagion in Upper Egypt dates back to AD 1500 at least, when an anonymous Italian traveller reported catching the disease there, describing the blinding of crocodiles as a way to hunt them. Malaria did not resurface in Upper Egypt until 1998, according to Abul-Qasem, when a number of Sudanese visitors to Aswan turned out to have the disease. The Aswan High Dam played an important role in keeping malaria out, what is more. As for cholera, which in popular culture remains the most widely celebrated infectious disease, its vaccine marks the bodies of older Egyptians like tattoos.   

*A version of this article appears in print in the  9 April, 2020 edition of Al-Ahram Weekly