Egypt's Real Crisis: The Dual Epidemics Quietly Ravaging Public Health

A combination of avian flu and foot and mouth disease risk destroying the protein supply, eroding public trust, and further destabilizing the Arab world's most populous country.

avEgypt may11 p.jpg
Birds fly over the Great Pyramid of Giza, Egypt, as cases of avian flu increase in the Arab world's most populous country. / AP

Lost in the recent political jockeying and protest violence leading up to Egypt's May 23 presidential elections is the unfolding public health disaster there. Avian flu and foot and mouth disease are running rampant, killing people and livestock as well as inflating the price of food. It's a serious health and economic issue, but it has potentially much larger implications for Egypt. This little-discussed crisis is beginning to resemble those that occur in failed states.

The Egyptian state, which was not particularly well-prepared for public emergencies even before the February 2011 revolution brought it into near-chaos, has little capacity to cope with the outbreaks threatening not only Egypt, but also Sudan, Israel, the West Bank, Gaza Strip, and Jordan. Egypt's public health infrastructure barely functions. The sorts of social services that groups like the Muslim Brotherhood have provided over many years fall far short of what is needed to combat the current crisis. Cairo does not have the money to throw at the problem, having burned through more than half of its foreign currency reserves in the 15 months since Mubarak's fall.   

Ground zero for Egypt's public health emergency is Libya, where last year, in the midst of civil war, foot and mouth disease swept through the country, killing more than 10 percent of its sheep and cattle. Smugglers subsequently brought infected sheep across the Libyan border, setting off a foot and mouth disease (FMD) wildfire that Egyptian officials have been unable to slow. 

Within four weeks, FMD killed thousands of cattle, buffalo, sheep, goats, camels, and other livestock across Egypt. In March, the United Nations Food and Agriculture Organization declared a "catastrophe," warning that the epidemic in Egypt was threatening human food supplies for all of the Middle East and North Africa. The particular viral strain responsible for the epidemic, officially called SAT2, is a new one, against which standard FMD vaccines are useless. SAT2 was first found in Sudan in 1977, the same year it was also thought to have been eliminated. It appears to have resurfaced there in 2010, spread to Libya, then Egypt, and now the Palestinian Territory. Consequently, public and veterinary health officials in Israel, Saudi Arabia, Jordan, and elsewhere around the  region are on high alert.

For Egypt, which is reeling from the economic repercussions of last year's revolt against the Mubarak regime and ongoing political instability, the FMD epidemic is a serious blow. The loss of thousands of cattle, buffalo, and camels has resulted in a significant spike in the price of meat from Egypt's remaining livestock, which leaves a relatively poor population with only one unaffected source of protein: chickens. Yet Egypt is also in the sixth year of avian influenza H5N1 epidemic. Despite vaccination and control efforts, the deadly H5N1 virus, which swept into Egypt from Asia, persists. Given the popularity of home-raised chickens in the country, where many households, rural and urban, possess flocks, controlling the infection would be a daunting undertaking for any government. Millions of the animals are estimated to have either died from infection or been killed off by veterinary authorities, according to the UN's Food and Agriculture Organization, in failed control efforts. The World Health Organization now ranks Egypt second in the world, after Indonesia, in human cases of the avian flu, which thus far has reportedly  killed 60 Egyptians and infected about 100 more. Recently, a strain of the virus has spread to Egyptian ducks; this new strain carries mutations that are thought to play a role in enabling transmission between mammals. This is a particularly worrisome development because some Egyptians have caught the flu from their animals but have not yet passed it onto other people. Once the virus begins to spread between humans, an epidemic becomes far, far more likely.

Presented by

Laurie Garrett & Steven A. Cook

Laurie Garrett is a senior fellow for global health at the Council on Foreign Relations, where Steven A. Cook is the Hasib J. Sabbagh senior fellow.

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