The “Spanish Flu” in Egypt

ترجمة هذه المقال إلي اللغة العربية من هشام فهمي

The article is finally out! Click here to read.

I haven’t said much lately because I don’t have much to contribute to the ongoing panic/dialog around the COVID-19 pandemic. Since there’s so much noise out there, I’ve decided to adopt–well, on this website anyway–a less is more approach.

Within the last week or so, however, as the pandemic has settled in to different contexts worldwide, I’ve found myself recounting the story of the “Spanish flu” pandemic in Egypt. This has partly been because there has been some criticism of the way the current Egyptian government has handled the pandemic, and this has caused some questions about how, previously, such things have been handled in Egypt.

I’ve written an article on it that’s been accepted by the Journal of World History, but it likely won’t appear until 2021. I do have permission to share the article here and on my academia.edu profile once it’s out, but I feel like there’s a limit to how much of my own research I can discuss in public before it appears. (note: the key word here is in public. I can certainly respond to, say, questions that are posed, either below or by e-mail … )

However, the article is ten thousand words long, and a short blog piece about the pandemic in Egypt that addresses the questions I feel like I’ve been asked several times won’t venture too far into spoiler territory!

What was the “Spanish flu”?

So, first off, let’s all remember that it was called the Spanish flu because Spain’s uncensored press was the first to report on the unusual nature of the virus in the spring of 1918. It didn’t originate in Spain nor, as someone tried to argue with me on Twitter a few weeks ago, did it attract the name because more people died of it in Spain than anywhere else.

If you need more background on the global trajectory of the pandemic, I did a podcast about it a couple of weeks ago.

The pandemic lasted globally until 1920, and it went around the world in three waves. The second was the most lethal, although all three waves carried the same unusual mortality curve: in addition to the young and elderly, the highest mortality rates were observed in people aged 15-25.

The virus, a mutated strain of the H1N1 avian influenza, frequently caused victims to cough or spit up blood, their faces to turn purple or black, and, in victims with particularly robust immune systems, it caused their lungs to fill up with fluid. This latter was a frequent cause of death–misidentified as pneumonia early on–because the immune system was triggered into an over-response; fluid was produced in an attempt to counter the virus, and victims essentially drowned.

When did the pandemic hit Egypt?

The first wave of the pandemic appeared in Egypt sometime in late spring–around May or June. It attracted little attention, other than commentary on its appearance at an unusual time of year, and the Department of Public Health (a subset of the Ministry of the Interior) recommended that people should stay home if sick.

It wasn’t until the end of October–right around the time that the Treaty of Mudros was signed, ending Ottoman participation in World War I–that the lethal wave hit. The most lethal period of the pandemic persisted until just after Christmas, resulting in a large number of casualties in the last eight weeks of 1918.

The third wave is mentioned very briefly in the press–right after Sa’ad Zaghlul’s arrest in March 1919. Vital statistics–such as they are–seem to indicate that it was fairly mild, but given the fact that the country exploded into open rebellion and most government ministries were effectively shut down until midyear, it’s impossible to know for sure.

How did the Egyptian government deal with the pandemic?

At the time, Egypt was a British protectorate. The system known as the “Veiled Protectorate,” wherein Egypt was administered by the British but there was lip service given to an official fiction that it remained an autonomous Ottoman province had been done away with upon the mutual declaration of war between Britain and the Ottoman Empire in November 1914. Egypt was declared a British protectorate–it would remain so until 1923–and placed under martial law at the beginning of December 1914 (this was cancelled as a gesture of goodwill by General Allenby in May 1919).

The problem in Egypt, as in other colonial settings, is that colonial officials who held military rank were recalled to duty for the war, and many of them had been sent into Palestine with Allenby’s campaign starting in the fall of 1917, and remained there at the time the pandemic’s most lethal wave arrived a year later. This included much of the leadership of the Department of Public Health as well as most of the district medical officials whose job was to oversee health services for the civilian population.

Simply put, for most of the war, civilian medical needs were a far distant second behind military medical needs (and for this, I’ll refer you to my book that’ll be out sometime in the next decade).

Hence, when the pandemic hit Egypt, the Anglo-Egyptian government was caught with its pants down. Hospitals and clinics were overwhelmed. A meeting of the Alexandria municipality in early November turned into an ad hoc grievance session, with citizens angrily demanding that the head of the Municipal Health Department do more to control the pandemic.

It was mid-November before basic guidelines were issued to the public; schools remained open until early December. Markets, courts, and universities were closed. Cities and provincial governments issued directives, but many seemed haphazard in their approaches: in Cairo, cinemas were closed, but not theaters; bars were closed, but not cafes. In both Cairo and Alexandria, people complained about crowding on the city’s tramways, with local governments feebly admitting they could do little to control the environment.

Physicians–who were mostly Egyptians, Greek, or Syrian–were overworked; at one point the press observed that in Asyut doctors were making constant housecalls and working over 15 hours a day. The next week it was reported that all of the city’s doctors had caught the flu themselves and were unable to see patients.

It was reported that in some rural villages there was “no other business other than to bury the dead,” and that agricultural production had ceased. This is extremely important to note, as the entire economy depended on intensive agricultural production, and most peasants had little savings. Stopping work in the fields would only have happened under the most extreme of circumstances.

Were religious services suspended in 1918 like they are now?

Update: if they were, it happened late. Al-Muqattam reported on December 6 (the height of the second, and most lethal wave) that the Alexandria Municipality’s Sanitary Department had asked the Ministry of Awqaf to make sure mosques were properly ventilated during prayer services, and that the floors were being cleaned with purified water before and after.

This question has come up several times, especially with Ramadan looming now (Ramadan didn’t coincide with the worst of the pandemic in 1918). The issue is suspicious by its absence from the press, in fact, but I don’t know what to make of it (if anyone knows, please leave a comment or message me!).

The Anglo-Egyptian administration was very wary of stepping on toes that should have been handled by the Ministry of Religious Affairs (most colonial administrators had experience working in India, where the 1857 revolt loomed large in memory, and the British tried not to offend Islamic sensibilities). Hence, when Al-Azhar was ordered to close–which it was–this was ordered in its capacity as an educational institution, not as a place of worship.

Public celebrations of Mawlid an-Nabi, the Prophet’s birthday, were cancelled, as were permits for religious processions as well as funeral processions. I have not seen references to mass graves (this had caused uproar during previous pandemics), but people were encouraged to conduct quiet burials as quickly as possible.

How many people died?

The officially calculated death toll was 138,000 people — over 1% of Egypt’s population according to the census conducted in 1917.

That said, Niall P.A.S. Johnson and Juergen Mueller[1] wrote an article in 2002 to try to compile a more accurate global total of the pandemic’s mortality, and they concluded that the method used in Egypt as elsewhere usually produced estimates that were too low, sometimes by as much as half. Hence, it seems more likely that the death toll would be closer to 170,000; the overwhelming majority of these deaths taking place in the last eight weeks of 1918. (To clarify: Johnson and Mueller have said that the method was inaccurate; the estimate of 170,000 is mine.)

The highest mortality rate in Egypt was observed in people between the ages of 10 and 20, with rural areas more heavily affected than urban areas. (I do have a theory about why this is, but you’ll have to read the article).

To put it in context, this would be the generation of young men and women who were left behind to run farms and keep things going while fathers and older brothers went off to work in the Egyptian Labour Corps, the Egyptian Camel Corps, and other work associated with the war effort, as agricultural wages had remained relatively flat even as inflation sent the cost of basic goods upwards by as much as 300%. They would have gotten through the war, and then perished just as it looked like things might return to normal. Socially, this must have been devastating.

I do think this is one of the reasons why rural residents were angry and ready to express that anger when the 1919 uprising began. (In my book, which I am still working on, I argue that people were hungry for most of the war. The influenza–the worst health crisis during World War I in Egypt–came after the end of the war, and made everything worse.) Political organizers from the Wafd and other parties who went into rural areas probably had their work cut out for them.

The influenza has, oddly, been omitted or ignored in most of the histories of early 20th century Egypt. I’m hoping my forthcoming article can start a conversation about some of the non-political events in early 20th century Egypt that have long been set aside in favor of the political narrative that tends to be emphasized in scholarship of the period.

Talk to me!

Even though I’ve got an article coming out, I’m interested in comparing notes with anyone else who’s working on this or similar topics, just because there isn’t much out there. I’m especially interested in hearing family lore–did someone in your family tell stories about the pandemic? Or can you fill in some holes in the narrative? Leave a comment, or e-mail me!

Postscript

I wasn’t expecting this post to be so popular! I’m sorry that it’s not longer. I really wanted to just answer some of the usual questions, but I’m glad so many people are interested in the topic.

The Lecture I gave for Harvard on May 6, 2020 is now online:

https://vimeo.com/423767180

A number of people on Twitter have said that they wished I’d written more about the political effect of the pandemic. I’m afraid that I just don’t have enough solid data to make stronger claims at this point.

I am still working on this, so if you have ideas please let me know.

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1. Johnson, Niall P. A. S., and Juergen Mueller. “Updating the Accounts: Global Mortality of the 1918-1920 ‘Spanish’ Influenza Pandemic.” Bulletin of the History of Medicine 76, no. 1 (2002): 105–15. https://doi.org/10.1353/bhm.2002.0022.

. كريمة حسن .من «الإسبانية» إلى «الخنازير».. تاريخ من الأنفلونزا القاتلة. المصري اليوم، 5 يونيو2009، 14.