Marwa Younis, a housewife living in the village of Bahrif in Aswan district, lives in a state of constant fear and anxiety after she and three members of her family came down with acute gastroenteritis at the same time, all suffering from persistent vomiting, high fever and watery diarrhoea. The situation at home worsened after she failed to find care beds at the Friendship Hospital, which forced her to receive treatment at home.
This meant searching for pharmacies that stocked rehydration solutions and the anti-diarrhoea tablets “Antinal” in the village of El-Radwan in Edfu district, after she discovered they were not available in the city of Aswan. A relative helped her obtain the medicines, whose price had doubled because of increased demand; the cost of administering rehydration solutions alone to four members of her family in less than a week came to about EGP 3,000. According to what she told Zawia3, rehydration solution became unavailable in the village, so she had to ask relatives in the village of El-Radwan in Edfu for help to obtain the necessary medicine.
Marwa noticed that her tap water had turned yellow and was no longer fit for use, so she resorted to boiling water to avoid its risks, the common method of disinfecting and purifying water, especially after residents began saying that drinking water was contaminated and that the village’s water filtration plant had mixed with sewage. She was also unable to afford mineral water for drinking and household use, given its high cost at a time when traders exploited increased demand to raise water prices.
Social media turned into a stage for rumours, conflicting opinions and endless debate over whether the cases in Aswan were caused by water contamination or by a bacterial “cholera” infection transmitted by irregular Sudanese migrants after its spread in Sudan. The Egyptian government ended the debate when Minister of Health and Population Dr Khaled Abdel Ghaffar explained, at a press conference held on Monday at the Friendship Hospital after visiting a number of hospitals in Aswan, that the cases were caused by a coliform bacterial infection, “E. coli bacteria, or Escherichia”, following the results of initial tests on a number of samples from patients. The minister explained that this type of bacteria can easily be transmitted to any surface contaminated by contaminated water.
Marwa says the schools in the village of “Bahrif” turned off the drinking water taps and the toilet taps, and required students to bring bottles of mineral water with them, along with their own soap and face towel. Two days after the school’s instructions were implemented, her economic burden had increased along with the potential risk to her two sons, so she stopped them from going to school, she says.
For his part, paediatrician Hany Girgis stresses that infections and viruses spread quickly among children, in addition to children’s weaker immunity compared with adults, which makes them suffer more, noting that children are the group most affected when infections occur. He adds: “I advise washing hands with soap and disinfecting them after using the toilet, because the infection is transmitted from faeces to mouth; mothers must also make sure their hands are clean and disinfected after cleaning their children.”
Drug Shortages and Rising Prices
Fatma Mohamed (30), who lives in the village of Abu El-Rish in Aswan, felt stomach pain and persistent diarrhoea, and on the advice of some people on social media, she went to buy “Antinal” tablets to treat recurrent watery diarrhoea, only to discover that the price had doubled, rising from EGP 26 a box to EGP 32.
Pharmacist Hany Fayez points out that the unavailability of dehydration and diarrhoea medicines in Aswan was to be expected, given an existing crisis in the availability of medicines in general. He adds: “Dehydration medicines and others may be available in Cairo, Qalyubia and other governorates, but not abundantly, and if demand for them increases, we will face a new crisis stemming from the mother crisis, which is the unavailability and severe shortage of medicines.”
According to the State Information Service, Egypt has begun localising the pharmaceutical industry to help reduce the import bill, and has covered 75% of its local medicine needs in value terms. In February 2021, the “Drug Authority” launched an initiative to support exports of Egyptian medicines abroad, and total Egyptian medicine exports that year reached EGP 149 billion, exceeding Egypt’s medicine exports in 2015, which amounted to EGP 62 billion. As of 2022, there were 170 pharmaceutical factories and 700 production lines. According to statements by the head of the medicines and pharmacies file at the Egyptian Center for the Right to Medicine, Yasser Khater, a gap is emerging because of increasing exports despite local medicine shortages, as exports are growing by between 30 and 40% from one fiscal quarter to the next.
Relief and Volunteer Initiatives
Volunteer convoys became active in the Abu El-Rish area, distributing free bottles of mineral water to residents, in addition to fever-reducing tablets, painkillers and some small quantities of rehydration solution, with the aim of helping poor residents and protecting them from exploitation by traders.
Shaimaa Mostafa, a technical secondary school student in Aswan district, says the convoys are stationed next to the El-Sheikh Ali level crossing, the clinics complex and the “Bahrif” association, and the supplies are distributed to residents after registering their names, in an attempt to ease the economic burden on residents.
At the same time, mineral water prices have risen crazily: a small bottle of water now costs EGP 15 after costing EGP 5, and is sold in large shops at four times the original price, while a large bottle of water now costs EGP 45. Shaimaa adds: “We do not know details about those running the convoy; they distribute medicines and water to us, and refused to give any information about themselves.”
The convoy distributes “Flagyl” tablets to residents along with the water, while pharmacist Ayman Ali points out that these tablets are effective only in treating anaerobic bacterial infections, which affect the genital organs and the intestines, and in treating mouth ulcers and dental infections.
The pharmacist believes that distributing medicines in this random way is inappropriate and incorrect; cases must first be examined and diagnosed so they can be treated properly and safely. He adds: “Wrong treatment may cause bigger health problems; the microbe may resist the treatment, so it does not achieve its goal and produces no positive effect on the patient’s health. Wrong treatment also delays correct diagnosis, and consequently patients may die if they are treated unscientifically.”
A Danger to Pregnant Women
Rawan Fathy, who lives in the El-Sahl El-Rifi area east of Aswan, talks about her close friend, a 25-year-old woman eight months pregnant: “Her temperature rose gradually, with persistent vomiting and increasing diarrhoea. She saw her private doctor, who warned her of the seriousness of the situation. Her health condition is very difficult; the doctor told her the foetus had been affected and that she must give it up to save her own life.”
Khaled Abdel Malak, a consultant obstetrician and gynaecologist, explains that severe vomiting and diarrhoea can send a pregnant woman into premature labour, in addition to exposing her to miscarriage because of early contractions, but the infection is not transmitted to the foetus. He adds: “It is essential for pregnant women to avoid using contaminated water and to keep taking vitamins and antibiotics after consulting the specialist doctor.”
For her part, Eman Refaat, an obstetrician and gynaecologist, explains that there are diseases that are transmitted to the foetus if the mother contracts them in the last months of pregnancy, such as chickenpox, or rubella in the first three months, but not all diseases are transmitted. She adds: “If a pregnant woman has persistent diarrhoea and vomiting, the foetus is affected if the mother does not replace the fluids her body loses; if she replaces them, the foetus is not affected.”
Critical Cases and Tests
The middle of this month saw the first case of gastroenteritis recorded in Aswan, and the total number of cases has reached 480 since 10 September. According to statements by Minister of Health and Population Khaled Abdel Ghaffar, the average number of cases visiting hospitals is between 18 and 19 a day across the governorate, which he described as “normal” rates per 100,000 citizens.
A laboratory specialist at a medical laboratory in Aswan, who preferred not to be named, comments that the cases going to hospitals are those in critical condition with persistent diarrhoea and vomiting; these cases are admitted immediately and their tests are carried out inside the hospital.
The laboratory specialist points to the cases that come to the laboratory, referred by internal medicine doctors for a complete blood count and stool analysis to detect disease-causing bacteria, adding: “We have not received any cholera cases, because doctors refer critical cases to hospital so the patient is admitted directly.”
The lack of information led local and international media alike to call the problem of the unknown bacteria in Aswan a mysterious disease, in addition to the spread of rumours, most notably an audio clip of a man warning members of a WhatsApp group against drinking tap water from 3 am until 10 pm the following day, stressing that water during this specific period is unfit for use because a contaminating microbe passes through it, as happened in Aswan.
The clip spread at the speed of light, and an employee of the drinking water company named Osama El-Sayed commented that the information in the recording was incorrect and that the Holding Company for Drinking Water had not issued any statements warning against using water.
Some users of the social media site “Facebook” also circulated false information about drinking water in Aswan causing kidney failure in some people, claiming that damage to kidney function occurred during the recent crisis because of contaminated water. But Nabil Andraous, a consultant in internal medicine, tells us that linking acute kidney failure to the diarrhoea cases in Aswan is exaggerated, stressing that acute kidney failure can easily be treated with proper treatment and several dialysis sessions, unlike chronic kidney failure, which develops gradually.
He adds: “In my personal opinion, there is political propaganda behind the gastroenteritis problem in Aswan, because even if there are microbes or viruses that cause diarrhoea in the environment or the water, every person’s immunity differs, and its spread will ultimately be limited.”
Rising Demand for Filters
The Aswan crisis had a positive effect on companies selling drinking water treatment filters, leading to increased demand for them in Greater Cairo. Mina El-Hennawy, manager of American Pure for drinking water treatment systems, confirms that in the past period his company’s two branches, “Giza and El-Khosous”, saw a rush to buy filters, with sales doubling, an increase of up to 100%.
According to the filter company manager, sales were between 10 and 15 filters a day and have reached 30 filters a day, while the price of a filter with seven stages of purification and treatment is about EGP 2,600, its fixed price since last year, and daily filter sales amount to about EGP 78,000.
Mina tells Zawia3 that most filter traders have seen their sales rise, especially with news circulating on social media about water contamination in Aswan and rumours that it will reach Cairo, noting that the customers most eager to buy drinking water filters are Arabs living in Egypt of Syrian, Sudanese, Yemeni and Libyan nationalities.
According to an official at the Pure Tech filter company in Sohag, despite the continuous online marketing of the water treatment systems the company sells, sales were not affected by the news from Aswan and the link between the current crisis and water; the situation has not changed.
Fears of the Infection Spreading
Fear of the bacterial infection developing and spreading has moved from the south to the capital. According to the secretary of an internal medicine doctor’s clinic, who is not authorised to speak to the media, the clinic has received a small number of cases suffering from the same symptoms as those affected in Aswan, of different nationalities, the latest a patient holding Saudi nationality.
Mona Gamal noticed that her older sister, 45, two weeks after the family returned from a trip to Hurghada, began going to the toilet unusually often, until it reached 18 times a day with persistent vomiting, over three consecutive days. She adds: “We put her on rehydration drips until her health improved, on the advice of the treating doctor. We do not know what happened to her and we do not know how to explain what she is going through. Yesterday she had her last dose of the drips; the vomiting and diarrhoea decreased, but she still suffers from severe stomach pain and constant nausea, as well as fatigue and loss of balance. We did all the required tests, but we have not yet received the results.”
It is worth noting that many people talk of their worry about the infection spreading between cities, but it is striking that the governorates of Upper Egypt see outbreaks of intestinal fevers from time to time: in 2014 a strange virus appeared in the village of Dalga, south-west of Minya, whose symptoms included high fever and loss of balance, and which infected hundreds of people in the village and the neighbouring hamlets and villages; the Ministry of Health at the time also denied the existence of a mysterious virus affecting residents. At the same time, Aswan residents, according to those we spoke with and the complaints Zawia3 monitored on social media pages, suffer from exaggerated jumps in the prices of water and medicines as a result of the rising number of people with gastroenteritis, or what the government called E. coli bacteria.
