Rising poverty, overcrowded public transport, and sprawling slums threaten to reverse the gains made in eradicating tuberculosis (TB) in Egypt, experts say.
In recent days, the government has released new figures showing a significant decrease in mortality caused by TB. But medical experts warn the government will never be able to stamp out the disease through a narrow medical approach. Rather, it must tackle the socio-economic problems at the disease’s root if it is to avoid a dramatic increase in infections.
“Our slums, our transport, and the poor economic conditions of millions of Egyptians make many people prone to the disease,” Mahmud Amr, a chest disease expert from Cairo University, told IRIN. “TB will continue to shatter the lives of thousands of people as long as no progress is made in these areas.”
The political instability that followed the overthrow of former Egyptian President Hosni Mubarak in February 2011 sent Egypt’s economy into a downward spiral.
In 2011, 25.2 percent of Egyptians became poor, up from 21.6 percent in 2009, according to the state-run Central Agency for Public Mobilization and Statistics (CAPMAS). More than half of these poor people lived in Upper Egypt, it added.
“Although most tuberculosis patients are poor, poverty itself is not the problem,” said Ahmed Attia, head of local NGO Egyptian Society for Fighting Tuberculosis. “The problem lies with the living conditions this poverty brings to people.”
In 2007, 12.2 million people lived in 870 slums across this country, according to CAPMAS. With whole families living in narrow rooms and sharing toilets and sewage-filled alleyways, these slums, experts like Amr say, offer fertile soil for the spread of serious diseases like TB.
TB is the third greatest killer in Egypt, after Hepatitis C and Bilharzias, according to Amir Bassam, deputy chairman of parliament’s Health Committee.
Naeema Al-Gasseer, the World Health Organization representative in Egypt, says Egypt is one of nine countries out of 23 in the Eastern Mediterranean Region (which stretches as far as Pakistan), where 95 percent of the region’s TB patients live.
In a recent interview with private TV station CBC, Al-Gasseer linked TB to poverty and malnutrition, which also appears to be rising in Egypt, saying “malnutrition is a big problem for both children and adults.”
Despite the challenges, Egypt has managed to make remarkable progress in TB control, according to the Health Ministry.
Health Minister Fouad Al Nawawy outlined in recent statements to the media huge drops in the effects of TB from 1990 to 2011: TB incidence, the number of new cases every year, fell from 34 per 100,000 to 18 cases per 100,000. TB prevalence, the total number of infections in any given year, fell from 79 per 100,000 to 24 per 100,000; and the mortality rate, the number of people who die from TB every year, fell from 4 per 100,000 to 1.1 per 100,000, he said.
Egypt offers free medical treatment to TB patients in around 32 chest hospitals and the Health Ministry hopes to eradicate the disease altogether by 2019.
But independent experts say the incidence of TB is far higher than the official numbers of 18,000 new patients every year. In a sign of the skepticism that exists in some camps, one lawmaker asked the Health Ministry to give a full breakdown of TB figures in all governorates.
“The public has the right to know all the facts,” said Basel Adel during a session of parliament on 9 April. “The Health Minister has to tell us what preventive measures his ministry has taken to prevent the spread of these diseases,” he said in reference to TB and meningitis. “There must be immediate action to control these diseases or the present government will be repeating the same mistakes of the governments of the former regime.”
The number of patients in the country’s chest hospitals, for instance, seems to belie claims that the disease is on the decrease.
“We have 50 beds at the TB section,” said Mahmud Abdel Aziz, the head of the Abassiya Chest Hospital. “These beds are always full. When a patient is treated, he/she gets out for other people on the waiting list to take their place.”
Experts say Egypt’s ability to make progress in TB control hinges on its success in improving the living conditions of slum dwellers; making its public transport less crowded; and reducing poverty.
“Patients - most of them are poor people from the slums - use public transport, which is always busy, and pass the infection on to others very easily,” the Health Committee’s Bassam said. “The nation’s prisons are also hotbeds for infection.”
Described in numerous human rights reports as being dirty, unfit for human use, and suffering an extreme lack of health care, Egypt’s prisons, according to people like Bassam, send out to society a large number of TB patients.
This is why Health Ministry specialists pay regular visits to the prisons to make sure they do not turn into centres for TB infection, according to Essam el-Moghazi, head of the Tuberculosis Section at the Health Ministry.
“We must take firm action to eradicate this disease,” el-Moghazi said. “This is why we need everybody to contribute to this action, or this disease can spread like wildfire,” he told IRIN.