Al-Ahram Weekly Online   11 - 17 November 2004
Issue No. 716
Published in Cairo by AL-AHRAM established in 1875

Every breath you take

Every time you inhale these days, you are subjecting yourself to possible health risks. Jennifer Evans reports

Click to view caption
Government officials have denied that Cairo has been suffocated by fumes in recent weeks...

Black exhaust spews from rows of dominoed cars and microbuses idling on the oxymoronic "race home" for iftar, as the sun sets in an almost beautiful orange haze, buildings in the distance blurred into a watercolour-like painting. A dry cough explodes from a taxi driver as he lights his first cigarette of the day.

"Out of each 10 people you'll meet in Cairo this time of year, six or seven of them will have this sort of flu-like cough," says Dr Ashraf Hatem, professor of chest diseases at Cairo University Hospital, referring to the symptoms so many Cairenes suffer from during the period from late October through November.

"Usually it starts with a soreness or itching in the throat, pains in the eye, itching in the nose, low-grade fever, and sneezing," Hatem explains. "Then there is a cough, which may come in sporadic attacks that worsen in the evening and at dawn, when the pollution is worst. While these symptoms usually indicate a viral infection of the kind which is passed on so easily in heavily-populated areas like Cairo, the condition is increased significantly by air pollution and what we call the 'black cloud'."

The infamous 'black cloud' first appeared in 1999. Although its presence continues to be blamed on the burning of the waste from rice fields in rural areas just outside the capital, this is not the sole factor in its formation, according to Dr Mahmoud Amr, professor of environmental and occupational medicine at Cairo University and Director of Toxicology at Qasr Al-Aini Hospital. Offering an analogy, Dr Amr explains that even though the practice of burning rice husks has been going on since the time of the Pharaohs, there is a simple reason that it affects the environment so strongly at this particular time of year.

"Look, when does water boil?" Amr asks sarcastically. "At 99.9 degrees or 100? In November, when the burning of rice husks is added to the other pollution factors which are already very heavy, the atmosphere reaches its boiling point. And that is where we are at in November."

Amr explains that auto exhaust fumes from the city's estimated 2 million cars combined with emissions from the area's 20,000 metal smelters are the major man-made factors contributing to the toxic composition of the cloud. There are also natural factors which aggravate the problem, including high humidity, low wind speed and high temperatures.

"The path of the mild wind passes through Lower Egypt's smog and onto the southern Delta area where rice is cultivated, picking up the smoke from the agricultural waste. Because the wind is so mild, the mass of polluted air is then unable to push itself out of the lower-lying parts of the city. This creates what we call 'black winds'."

And while the government has repeatedly made statements to the effect that all is well, the impact of these phenomena on public health is problematic. Amr says the major toxicological components which hang over the city as if caught in a bowl are nitrous and sulphuric gases. These can cause a condition of the blood called "meta-hemoglobinemia".

"The capacity of the blood to carry oxygen to all parts of your body is decreased, if it is not made impossible," says Amr. "This leads to drowsiness, fatigue, laziness, and the feeling that you need an extra coffee."

"Nitrous and sulphuric acids hanging in the air will also solidify and may cause your stomach to ache. But after a while, adaptation occurs. Then, though you no longer feel this sort of nausea and sickness, the original reason for the symptoms remains present."

According to the WHO, the average Cairene has to ingest more than 20 times what are considered acceptable levels of air pollution. When this situation is combined with the 'black winds', it is not surprising that health problems begin to multiply. "All of our body's systems are affected by polluted air," says Amr. "Your liver, kidneys, blood. No system is immune."

The effect on children is of special concern, according to Hatem.

"Children are more vulnerable to these types of acute bronchitis -- what we call acute hyperactivity -- and are more prone to bronchial asthma, which in Egypt affects 12 per cent of the population. That is a very high percentage. The other risk group especially affected at this time of year are those over the age of 60, both men and women, and especially those that suffer from a chronic illness such as diabetes, coronary artery disease, or hypertension. But in actual fact, no one is immune."

Amr concurs. "To start with the head, neurological diseases causing aggressive behaviour are one consequence. As you move down to the lungs, you will find the air causing bronchitis, pneumonia, fibrosis of the lungs and even cancer, due to these acidic winds coming from the black cloud. These effects are exacerbated, of course, for those who smoke and those who live in proximity to smokers."

Extended time spent in heavily polluted areas will increase the deleterious effects of the black cloud on personal health. Mohamed Addlem Satah, a 39-year-old traffic policeman, has been working on Corniche Al-Nil for six hours a day for the last eight years. He says he's been sick with a cough many times, even though he only smokes occasionally, and worries about the effects of pollution. "I worry especially during the black cloud," he says, "but I'm getting used to it."

Yet despite increasing public concern and medical evidence, to date no public health warning has been issued by the Ministry of Health.

"Places such as Mohandessin, where there are a lot of high buildings with little space or green areas, are the worst," says Hatem. "I wouldn't want to stand in the middle of Cairo for an extended period of time, as the central part of the city is also bad. The better areas are 6th of October, Maadi and Nasr City, because there are lots of green areas, so there is more oxygen being produced."

Hatem advises his middle and upper class patients to go and live in the new cities like 6th of October, or 10th of Ramadan, which are much healthier for them as well as for their children. But he admits that there is no easy solution. "You can bring plants into the home, prevent dust accumulation and try to live in green areas, but it's not practical advice for everyone."

Ideally, the doctors say, changes must be made at all levels. "One of the most important things is to convince people about the importance of the air they breathe, starting from one's home and going outwards, to your dust-filled streets, your community then to your government," explains Amr.

He also challenges the idea of a band-aid solution to the effect of Cairo's population on its citizens.

"The cost of treating the health effects of pollution is very high. In a country with limited resources, eventually the health costs will outweigh other expenditures and will affect our standard of living as a whole. But what if we spent the same amount on environmental initiatives as we do on public health? Do you really think our citizens would still suffer from chronic and acute bronchial problems, leukaemia, liver disease, anaemia and the other medical consequences of our toxic air?"

"It's a simple choice," Amr sums up. "Either you stop breathing, or you adopt healthy breathing." Unless the whole city wakes up and does the latter, the former outcome will continue to be increasingly common.


Since the condition of the air will not show any significant improvement until later in the month when (and if) the rain begins and the winds improve, medical professionals suggest a number of proactive measures which you can take:

* Wear a mask, while this may invoke ridicule on the street, it is the most effective way to help your body filter the air before it passes into your precious lung tissue.

* When available, use closed circuit air- conditioning within your car which will recycle the air already inside, rather than pulling new air in from whatever part of town you happen to be passing through.

* Try to avoid being outdoors at dawn or dusk, when pollution levels are highest.

* Those already suffering from some form of bronchial-related condition, such as asthma, should take more of their inhalant medication to keep their airways open.

* Cut down on shisha , goza and cigarette smoking, which are especially popular during Ramadan.

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