Egypt

HEALTH AND WELFARE

Children's immunization campaign promoted by health centers nationwide
Courtesy UNICEF, Sean Sprague

Dayas (traditional birth attendants), with the medical kits received upon completing their training
Courtesy UNICEF, Sean Sprague

Since the 1952 Revolution, the government has striven to improve the general health of the population. The National Charter of 1962 stipulated that "the right of health welfare is foremost among the rights of every citizen." Per capita public spending for health increased almost 500 percent between 1952 and 1976. As a result of this spending, the average Egyptian in 1990 was healthier and lived longer than the typical Egyptian of the early 1950s. For example, life expectancy at birth, only thirty-nine years in 1952, had climbed to fifty-nine years for men and sixty years for women by 1989. The crude death rate, which was 23.9 in 1952, had declined to 10.3 by 1990. Its main component, the infant mortality rate, declined more dramatically in the same period, from 193 infant deaths per 1,000 live births to 85 per 1,000. Nevertheless, major disparities remained in the mortality rates of cities and villages as well as in those of Upper and Lower Egypt. Although mortality and morbidity data were adequate for establishing general trends, they were not reliable for precise measurements. Egypt's official infant mortality rate, for example, was probably understated because parents tended not to report infants who died in the first few weeks of life. Corrected estimates of the infant mortality rate for 1990 ranged as high as 113 per 1,000 live births.

Although mortality rates have declined since 1952, the main causes of death (respiratory ailments and diseases of the digestive tract) have remained unchanged for much of the twentieth century. Death rates for infants and children ages one to five dropped, but children remained the largest contributors to the mortality rate. Nearly seventeen infants and four children under five years of age died for each death of an individual between age five and thirty- four. Children younger than five years of age accounted for about half of all mortality--one of the world's highest rates. During the 1980s, diarrhea and associated dehydration accounted for 67 percent of the deaths among infants and children. Concern about this health problem prompted the government to establish the National Control of Diarrheal Diseases Project (NCDDP) in 1982. With funds provided by the United States Agency for International Development, NCDDP initiated a program to educate health care workers and families about oral-rehydration therapy. NCDDP's efforts helped reduce diarrhea-related deaths by 60 percent between 1983 and 1988. The highest rates of infant mortality were in Upper Egypt, followed by Cairo, Alexandria, and other urban areas; the lowest rates were in Lower Egypt.

The average Egyptian's nutritional status compared favorably with that of people in most middle- and low-income countries. Bread, rice, legumes, seasonal fresh fruits, and vegetables such as onions and tomatoes constituted the daily diet of a majority of the population. Middle- and upper-income families also regularly consumed red meat, poultry, or fish. Caloric intake was adequate, although there were indications of widespread vitamin deficiencies. The most recent surveys of nutrition, undertaken in the late 1970s, revealed that approximately 25 percent of public-school children were either malnourished or anemic. The incidence of poor nutrition was highest in rural areas, where nearly 33 percent of surveyed children were malnourished, compared with only 17 percent in the cities; among low-income families, about 50 percent of all children showed indications of inadequate nutrition.

The major endemic diseases in 1990 were tuberculosis, trachoma, schistosomiasis, and malaria. Schistosomiasis, carried by blood flukes and spread to humans by water-dwelling snails, was a major parasitic affliction. Historically, the disease was most prevalent in the Delta, where standing water in irrigation ditches provided an ideal environment for the snails and other parasites. Those working in agriculture were particularly susceptible; their prevalence rate was nearly three times that of nonagriculturists. Debility owing to schistosomiasis could not be calculated accurately; its severity generally varied depending on the infected organs, commonly the bladder, genitals, liver, and lungs. Treatments for the disease are not always effective, and the main medicines have toxic side effects. The government tried to control the spread of the disease by educating the population about the dangers of using stagnant water. According to Ministry of Health statistics, the incidence of schistosomiasis dropped by half between 1935 and 1966. One of the negative health consequences of the Aswan High Dam, however, was an increase in the incidence of schistosomiasis in Upper Egypt, where the dam has permitted a change from basin to perennial agriculture with its continuous presence of standing water.

The Ministry of Health provided free, basic health care at hundreds of public medical facilities. General health centers offered routine medical care, maternal and child care, family planning services, and screening for hospital admittance. These clinics were usually associated with the 1,300 social service units or the 5,000 social care cooperatives that served both urban and rural areas. In addition, in 1990 the Ministry of Health maintained 344 general hospitals, 280 specialized health care units for the treatment of endemic diseases, respiratory ailments, cancer and other diseases, and dental centers. There were about 45,000 beds in all government hospitals, plus an additional 40,000 beds available in private health institutes. The number of trained medical personnel was high relative to most middle-income countries. In 1990 there were more than 73,300 doctors in the country, approximately 1 physician per 715 inhabitants. There were also about 70,000 certified nurses. Medical personnel tended to be concentrated in the cities, and most preferred private practice to employment in public facilities. Fewer than 30 percent of all doctors and scarcely 10 percent of nurses served in villages.

Although public health clinics were distributed relatively evenly throughout the country, their services were generally inadequate because of the shortage of doctors and nurses and the lack of modern equipment. In both cities and villages, patients using the free or low-cost government facilities expected a lengthy journey and a long wait to see a physician; service was usually impersonal and perfunctory. Dissatisfaction with public clinics forced even low-income patients to patronize the expensive private clinics. In rural areas, village midwives assisted between 50 percent and 80 percent of all births. Even when women used the maternal care available, prenatal care was minimal, and most births occurred before trained personnel arrived.

Further improvements in the health of Egyptians required increasing the effectiveness of the primary health-care system and improving public sanitation and health education. In 1990 approximately 25 percent of the total population, including 36 percent of all villagers, did not have access to safe water for drinking and food preparation. Use of unhygienic water was the major cause of diarrheal diseases. In addition, more than 50 percent of all families lived in homes that lacked plumbing. Sewage facilities throughout the country were inadequate. Increasing the level of women's education would probably help to decrease the infant mortality rate. Studies have found that infant mortality decreases as mothers increase their level of education, even when age and family income are held constant. Surveys undertaken in the 1970s indicated that 78 percent of the infants born to illiterate women survived early childhood. That figure increased to 84 percent for infants born to women who finished primary school and to 90 percent for infants born to women with secondary or higher education.

The government also had established 1,300 social service centers and 5,100 social care cooperatives by 1990. The social service centers provided instruction in adult literacy, health education, vocational training, and family planning. The social care cooperatives had similar services and also provided child care centers for working mothers, aid for the handicapped, and transportation for the elderly and infirm. About 65 percent of the social service centers were in villages; 65 percent of social care cooperatives were in cities. In many villages, the social service centers were associated with the local public health clinic and supplemented the primary health care services. The overall impact of the centers and cooperatives has been limited by the lack of funding since the late 1970s.

The government instituted a social security program in the early 1960s to provide pensions, through forced savings, for employees. Coverage also included unemployment, disability, and death benefits. In 1990 less than half of the work force participated in the program. Self-employed individuals and most private sector workers (including domestics, farm workers, and casual laborers) were not covered by the program. The overwhelming majority of participants were civil servants and employees of government enterprises. Workers in private factories could only participate in social security if their employers chose to make regular contributions to the program.

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Although there is extensive English-language literature on Egypt, few studies treat Egyptian society comprehensively. The most detailed discussion of Egypt's geography is in W.B. Fisher's The Middle East. This research has been updated in the article, "Egypt: Physical and Social Geography," in The Middle East and North Africa, 1989.

A useful overview of contemporary Egyptian society is Anthony McDermott's Egypt From Nasser to Mubarak. Although primarily political science books, Raymond A. Hinnebusch, Jr.'s Egyptian Politics under Sadat, Robert Springborg's Mubarak's Egypt, and John Waterbury's The Egypt of Nasser and Sadat all contain valuable detail about social groups and the impact of the government's social and economic policies on class structure.

Several scholars have written insightful studies of rural society. The classic study of traditional village life, first published in French in the 1930s, is Henry Habib Ayrout's The Egyptian Peasant. Although Ayrout's data are outdated, his descriptions of customs, kinship, and farming techniques still have contemporary relevance. A recent book, Lila Abu-Lughod's Veiled Sentiments, presents equally thorough descriptions of customs and kinship patterns among the beduins. Egypt's land redistribution policies of the 1950s and 1960s have attracted considerable interest from scholars who have reached very different conclusions about the impact of the policies. Iliya Harik's The Political Mobilization of Peasants suggests that the small peasant owners and the landless benefited most from redistribution. However, in In a Moment of Enthusiasm Leonard Binder argues that the land redistribution primarily benefited and helped to consolidate the class of middle peasants. Hamied Ansari challenges the theses of Harik and Binder in Egypt: The Stalled Society. In Family, Power and Politics in Egypt, Robert Springborg argues that the old landlord class retained substantial influence and continued to control substantial land despite official limits on individual holdings.

There are many studies about life in urban Egypt. Among the most interesting is Unni Wikan's Life Among the Poor of Cairo. This book, a case study of the family and friends of one lower-class woman, provides valuable insights into the strength of family ties in the midst of poverty and adversity. Andrea B. Rugh's Family in Contemporary Egypt analyzes the various family adaptation patterns to the social and economic changes that have been occurring since the 1960s.

Articles in many periodicals address the role of religion in contemporary Egyptian society. The most useful studies generally are published in current issues of quarterlies such as the International Journal of Middle East Studies, Middle East Report, and Middle East Journal. Giles Keppel's Muslim Extremism in Egypt is a penetrating study of the role of Islamic political groups in the late 1970s and early 1980s.

Finally, one of the most valuable ways of gaining insight into Egyptian society is through the novels, plays, and short stories of several contemporary writers whose works have been translated into English. The best-known novelist is Naguib Mahfouz, who won the Nobel Prize for Literature in 1988. His novels, including Midaq Alley, The Fountain and Tomb, Mirrors, and The Trilogy, deal with the lives of the poor and the middle class and provide glimpses into the impact of social, political, and economic changes on individuals and families. (For further information and complete citations, see Bibliography.)

Data as of December 1990

Egypt - TABLE OF CONTENTS