A week ago, Hashem Mohamed, 66, who lives in the village of Abu El-Rish Bahari in Aswan district, developed symptoms of nausea, vomiting and severe watery diarrhoea that lasted four days. His condition deteriorated, and he suffered a sharp collapse and severe dehydration, which required him to be taken by ambulance to the Friendship Hospital last Thursday. He underwent medical tests that revealed a significant drop in potassium and sodium levels in the blood, elements vital for maintaining fluid balance in the body and regulating heart and muscle functions. A deficiency of these elements may lead to serious complications such as respiratory failure, coma or even death. Doctors diagnosed his condition as acute gastroenteritis.
Mohamed was admitted to the hospital’s internal medicine department, where he remains under medical care to this day. Despite the efforts made, doctors have not yet found a direct cause of the infection, but they have not ruled out contaminated drinking water as a main cause, according to what his daughter told Zawia3.
Almost the same condition struck young Menna Mahmoud, 17, who lives in the same village. On Monday evening, she began to suffer symptoms similar to those that struck Mohamed, but her condition quickly worsened, and by dawn the next day she began vomiting blood, which led to her losing consciousness and falling into a coma. She was immediately taken to Aswan University Hospital, where she received first aid and the necessary medical tests. After she regained consciousness, doctors decided to discharge her with a prescription to complete treatment at home, given the severe overcrowding at the hospital, according to what her mother told Zawia3.
The mother, like most of the village’s residents, believes that drinking water pollution is the reason behind these repeated cases of illness. This belief grew after the deterioration of the health of her sister’s daughter, who is still hospitalised after the family’s attempts to treat her at home failed.
A state of panic has prevailed among the residents of Aswan Governorate since 11 September, especially in the villages of Abu El-Rish and some villages surrounding Daraw district north of Aswan, after sudden symptoms spread among many residents, including severe watery diarrhoea, nausea, vomiting and abdominal pain. Many of those affected were taken to the Friendship Specialised, Obelisk, University and Daraw hospitals, where they were diagnosed with gastroenteritis. However, the health of some patients deteriorated seriously, leading to severe dehydration and damage to kidney function, and a number of them were admitted to intensive care units.
In a serious development, seven people died, six of them in a single day, which heightened anxiety in the region and raised questions about the possible causes of these sudden and serious infections.
Blocking the Road
Hoda Abdel Galil, a volunteer charity activist living in the village of “Abu El-Rish Bahari” in Aswan, tells Zawia3 that her teenage daughter and son have been suffering from symptoms of diarrhoea and nausea for four days without a clear reason. Abdel Galil explains that the family did not eat food from outside the home, and did not buy sweets for the Prophet’s Birthday or attend its celebrations, pointing out that one of her young female relatives was struck at dawn on Thursday by severe intestinal colic accompanied by screaming before she lost consciousness, and an ambulance took her to the Friendship Hospital.
She adds that dozens of residents of the village of Abu El-Rish, including 20 of her relatives and friends, have been suffering since last Tuesday from similar symptoms, including severe diarrhoea, nausea and stomach pain, and they were taken to Aswan Teaching Hospital, the Friendship Hospital and the Red Crescent Hospital.
Abdel Galil points out that residents still do not know the cause of these infections, but they are divided between those who believe that pollution of drinking water is the cause and those who think a “cholera” infection was transmitted to them by Sudanese migrants. This concern pushed some of the village’s residents to temporarily block the road in an attempt to pressure officials to act and solve the problem, especially after deaths linked to these infections occurred.
Dozens of residents of the village of “Abu El-Rish Bahari” in Aswan district had blocked the road on Friday in protest at the health conditions many of them have suffered over the last ten days, which they believe are due to drinking water pollution, especially since they suffer from the absence of a sewage system and the dumping of industrial wastewater from the “Kima Aswan” factory, in addition to sewage and the discharge of flood channels, into the Nile. They demanded the completion of the project to connect drinking water from Gabal Shisha to the new Abu El-Rish station, to solve the problem of frequent water cuts and obtain a clean glass of water, to protect the residents of the village of Abu El-Rish. They also demanded the complete closure of the current Abu El-Rish filter, which is close to the “Kima drain”, and the inclusion of the village in the Decent Life project, to introduce sewage and renew the village’s infrastructure, to save the residents of Abu El-Rish from death.
At the same time, a number of residents of the villages of “Abu El-Rish and Bahrif” submitted a collective complaint to the Prime Minister’s Office, bearing number (8678618), in which they explained that they live in a state of panic and fear for their lives and their children’s lives, that they believe drinking water has become a source of disease and danger, and that they suffer in silence, while hospitals are crowded with residents who have nothing but hope of recovery.
Accusations Against Kima Aswan
Since the beginning of the health crisis in “Daraw” district in Aswan, many residents of the “Abu El-Rish Qibli and Bahari” area have pointed the finger at the Egyptian Chemical Industries Company “Kima”, with which they have been locked in a long-running conflict dating back to 2007.
They had organised protests against the company since 2011 for polluting the Nile with industrial wastewater, which led them to file a lawsuit through their legal representative, Hamdy El-Harzawy, deputy head of the Lawyers Syndicate in Aswan, against its chairman and the Governor of Aswan, as well as the President of the Republic, the Prime Minister, the Minister of Irrigation, the Minister of Environment, the Minister of Housing and the Minister of Finance. The court formed an inspection committee to examine about eight kilometres, before the Administrative Judiciary Court in Aswan issued its ruling in 2021 in the two lawsuits (No. 1685 of judicial year 4 and No. 4652 of judicial year 4), obliging the government to take the necessary measures to prevent the discharge of sewage and industrial waste into the flood channel in Aswan and from it into the Nile. However, the government appealed to the Supreme Administrative Court, and no hearing date has been set to this day, according to Malek Adly, the human rights lawyer and director of the Egyptian Center for Economic and Social Rights, speaking to Zawia3, as he has handled the case since the appeal against the ruling in 2021.
The Egyptian Center for Economic and Social Rights stressed in a statement on Sunday that the statements issued by the Ministry of Health and Population and local authorities in Aswan regarding the safety of drinking water in the village of “Abu El-Rish” contradict the previous court ruling, which proved the discharge of sewage and industrial waste in the same area and from it into the Nile, and ordered the government to take the necessary measures, foremost among them the immediate halting and removal of the causes of pollution.
On the other hand, the “Kima” company denied any connection to the pollution of drinking water and the occurrence of some infections, stressing in a statement that it is subject to periodic monitoring by the regulatory bodies for the environment and occupational health, and follows the necessary programmes for treating industrial wastewater, which is directed to the Allaqi sewage station, affiliated with the Aswan Drinking Water and Sanitation Company.
In the same case, lawyer Mostafa El-Hassan, director of the Hisham Mubarak Law Center, has for about 20 years been waging a struggle against the sources of drinking water pollution in Aswan, resulting from the accumulation of waste and sewage, the discharge of the “Kima” factory and the Gamal Abdel Nasser grain mill, in addition to medical waste and the discharge of the Chest Hospital and Aswan University Hospital, into the flood channel that flows into the Nile near the villages of “Abu El-Rish” in Aswan. This led him to file a lawsuit against the sources of water pollution in 1996, explaining that a Ministry of Justice report at the time showed that 120,000 cubic metres of sewage and industrial wastewater were being dumped daily into the Nile in Aswan.
El-Hassan explains to Zawia3 that residents organised protests in 2011 to denounce water pollution, which prompted the Ministry of Environment to announce a programme to address the problem at a cost of about EGP 70 million, but “it was tainted by corruption, which led to its suspension”, and pushed residents to wage a legal battle in which the ruling was issued in their favour; however, the government appealed the ruling, and no hearing date has been set for three years.
The director of the Hisham Mubarak Law Center notes that the residents of the “Abu El-Rish” villages are the most affected by water pollution, and that most of the recent infections were among them, which pushed them to protest and block the road. A number of local officials responded to them and promised to work on completing the project to connect drinking water from Gabal “Shisha” to the new Abu El-Rish station and to establish a sewage system in the village.
Environmental lawyer Ahmed El-Saidi explains to Zawia3 that the authorities are supposed to analyse waterways periodically under the Irrigation and Drainage Law and the Liquid Waste Discharge Law, with the analysis sent to the ministries of health, environment and irrigation and their directorates, to detect cases of diseases and epidemics; however, the results are difficult to access and are kept under wraps, noting that the crisis of waterway pollution is not dealt with through final, sustainable solutions.
The Government Denies
Zawia3 spoke to many Aswan residents, who confirmed that since the beginning of the crisis they have resorted to boiling drinking water and buying mineral water based on the recommendations of some doctors. Charities and volunteers have also begun launching campaigns to raise donations to buy medicines, rehydration solutions and bottles of mineral water for the neediest families, especially those with patients receiving treatment at home.
Zawia3 also obtained photos from some citizens showing a change in the colour of drinking water coming out of taps in some homes in the village of “Abu El-Rish”, where the water turned a yellowish-brown colour. Nevertheless, the authorities insist on denying the water pollution hypothesis. Abdel Sabour El-Rawy, head of the Aswan Drinking Water and Sanitation Company, stressed in a statement that all samples taken from the water station in the “Abu El-Rish” area or from neighbouring areas were “sound and free of any pollution or toxins”. The Governor of Aswan, Ismail Kamal, also announced the upgrading of the chlorination system at the El-Sheikh Ali station in the village of “Abu El-Rish” to ensure the highest levels of safety in drinking water and its conformity with standard specifications.
The Aswan Drinking Water and Sanitation Company said in a statement on Sunday that samples were taken from all stations and lifting stations in Aswan Governorate, a total of 103 stations and lifting stations, by the central bodies specialised in analysing water and its quality, which confirmed the water’s safety from any pollution, and that samples were taken from the networks of the villages concerned by the complaints and from citizens’ homes and were found to be compliant and free of any forms of pollution.
Commenting, MP Ahmed Saleh, representative of the Daraw, Abu Simbel and Aswan districts, told Zawia3 that he was present on Friday at the Daraw district hospital in Aswan Governorate to follow up on the health situation. He confirmed that the hospital received cases of intestinal colic, pointing out that doctors have not yet determined the real cause of the infections but rule out that they resulted from drinking water pollution, and denied that there had been deaths from the infections at the hospital.
For his part, Mohamed Saeed, director-general of health in Aswan, denied in previous statements any cases of poisoning or deaths due to drinking water pollution in the governorate. He explained that if drinking water were contaminated, the infections would be in the thousands, and indicated that the cases suffer from gastroenteritis due to seasonal viruses or eating contaminated food. In a statement issued on Saturday, Minister of Health Khaled Abdel Ghaffar announced that samples had been taken from 103 water stations in Aswan Governorate for testing, and that the safety of drinking water at those stations had been confirmed.
In the first parliamentary move, Senate member for Aswan Governorate Khaled El-Ouny submitted an urgent request to the Governor of Aswan to form a committee from preventive medicine, health and the Poison Institute to verify the causes of the acute gastroenteritis infections, after his visit to Daraw Central Hospital to review developments regarding the patients.
Cholera?
While the authorities stress that drinking water in Aswan is free of pollution, many users of social media applications in Egypt, including doctors and medical workers, circulated posts pointing to the possible appearance of cholera cases in Egypt. Hypotheses also circulated about the infection being transmitted by Sudanese migrants who entered Aswan through the southern desert by irregular routes, or the possible transmission of cholera bacteria via the Nile from Sudan to Egypt.
Hany Gamal, a local resident in Aswan, speaks of daily waves of displacement of Sudanese migrants entering the governorate by irregular routes, and indicates that the number of Sudanese in Aswan has risen noticeably recently.
On another front, cholera spread in Sudan after the recent floods, leading to a health crisis in Al Jazirah State, specifically in the city of “Wad Madani”, where more than 300 infections were recorded, of which more than 16 people died. The village of “Umm Jalloud” also recorded six deaths and 40 infections. In Sennar State, infections exceeded 300 cases, and deaths exceeded 30. In the Manasir area, about 2,000 infections and 80 deaths were recorded. Additional infections also appeared in River Nile State, including 200 new cases, 70 in “Atbara”, 52 in “Berber”, 45 in “Ad-Damer” and more than 10 cases in “Abu Hamad”. Other cases appeared in “Shendi” and “Al-Buhayra”, according to reports from emergency rooms in the Sudanese states and field observations published by Sudanese journalist Dalia El-Taher on her account on the “X” platform (formerly Twitter).
From the beginning of the year to 28 July 2024, 307,433 cholera cases and 2,326 deaths were reported in 26 countries, according to the World Health Organization. However, the Sudanese Ministry of Health did not acknowledge the matter until the epidemic had spread widely, as Sudanese Health Minister Haitham Mohamed Ibrahim revealed in mid-August that the number of cholera infections had risen to 354, announcing the deaths of 22 of those infected and that the states of Kassala and Gedaref in eastern Sudan were the most affected by the epidemic, due to deteriorating environmental conditions and unsafe drinking water.
The World Health Organization defines cholera as an acute diarrhoeal disease that can kill within hours if left untreated. It is a disease of poverty that affects people who lack sufficient access to safe water and basic sanitation, and the organisation estimates the number of annual cholera cases at about 1.3 to 4.0 million, with deaths between 21,000 and 143,000 worldwide.
Egyptian Assistant Minister of Health Hossam Abdel Ghaffar had announced in press statements during August raising the level of alert and intensive surveillance at land ports with Sudan and tightening precautionary measures at airports to confront the cholera outbreak in Sudan.
Positive Cases?
While Ismail Kamal, Governor of Aswan, denied that the tests carried out on gastroenteritis patients in Aswan had proven any case of cholera, some sources among residents and the medical sector told Zawia3 that positive results appeared for some patients’ swabs, but we were unable to obtain any documents or official confirmation of these results.
Mohamed Gomaa, a resident of the village of Abu El-Rish and the husband of patient Mona Saleh, who is in intensive care at Aswan University Hospital, says that his wife, who is three months pregnant, suffered severe watery diarrhoea and loss of consciousness last Tuesday. She was taken by ambulance to the Friendship Hospital, where she received initial treatment and returned home, but she continued to suffer, prompting her husband to take her to a private clinic. There, the doctor saw the need to transfer her to intensive care at Aswan University Hospital.
At the University Hospital, Mona underwent multiple tests across the emergency, obstetrics and gynaecology, and internal medicine departments, where the tests showed deterioration in kidney function. Gomaa said the hospital’s doctors told him they had taken a swab from his wife and reported that she had cholera, but he stressed that he had not received any official proof of this information.
In a similar incident, Zawia3 spoke to a relative of Alaa Nasr, a man in his thirties from the village of El-Gaafra in Daraw district, who was suffering the same symptoms and was taken to Aswan University Hospital after his condition deteriorated, where he died. Nasr’s relative, who preferred not to be named, claimed that the doctors took a swab from him, informed the family of a positive result for cholera, and asked them not to make the matter public.
Zawia3 also spoke with a nurse at Aswan University Hospital, who explained that some infections begin with stomach pain, nausea and diarrhoea, but certain cases deteriorate to acute dehydration and deterioration of kidney function. She indicated that doctors suspected cholera infections after noticing high levels of urea and creatinine in the blood of some patients, which prompted them to send samples to the Preventive Medicine Directorate. She added that four of these cases showed positive results, but the medical staff were asked to keep the matter quiet.
According to the nurse, the disease is believed to be transmitted through contact and contaminated basins, not only through water, which requires taking the necessary precautions such as washing hands constantly and using mineral water. She also indicated that the Friendship and Obelisk hospitals may be turned into isolation hospitals, based on information that has not been officially confirmed.
Zawia3 was unable to verify the information provided by the nurse; however, Al-Wafd newspaper had published, on Sunday evening, a news item stating that the Friendship Hospital would be turned into a health isolation facility within hours, but it deleted the item shortly afterwards.
The testimonies of residents and some medical workers contradict the official account of the Minister of Health, who attributes the infections to acute gastroenteritis.
Asked about the availability and effectiveness of cholera vaccines in Egypt, Amgad El-Haddad, head of the Allergy and Immunology Department at VACSERA, stresses that they do not give long-term immunity and are therefore used only in the event of epidemics or before travelling to infected areas. They are drops placed under the tongue, with three doses given to children aged two to five years and two doses for those over five, at an interval of between two weeks and a month. The vaccine gives 85% immunity during the first six months, and immunity gradually decreases to 50% within two years. He points out that the vaccines are available at the Ministry of Health and health centres, and are not given to everyone or made compulsory, but are linked only to epidemics.
This is not the first time talk of cholera in Egypt has circulated and been denied by the authorities. In 2016, reports circulated about cholera appearing in Aswan Governorate after cases appeared in Sudan; however, the Cabinet’s Information and Decision Support Center considered them mere baseless rumours aimed at stirring confusion among citizens, stressing that hospitals across Aswan Governorate had not received any case of this disease, and that the health authorities had taken all the necessary preventive measures to confront cholera and prevent its transmission from Sudan, with health measures tightened at the entry and exit points of the High Dam port and the Aswan and Abu Simbel airports, and any food or quantities of water coming from Sudan destroyed through quarantine committees.
Egypt saw the first spread of cholera in 1831, and waves of the epidemic recurred in several later years, including 1834, 1850, 1855, 1865, 1883, 1895, 1902 and 1947. The epidemic resulted in the deaths of about 150,000 people during these periods.
Despite the health authorities’ denial of the existence of cholera cases in Egypt, and the absence of conclusive evidence confirming or refuting the testimonies and posts claiming that cholera appeared in Aswan, fears remain among a large segment of Egyptians that the government may be deliberately concealing infections, which could turn into an epidemic as happened in Sudan. Some on social media accuse the health authorities of having hidden the true numbers of COVID-19 infections and deaths at the beginning of the pandemic, which led to the virus spreading further and to an increase in the number of victims.
