Alexandria, Egypt: Social, Cultural, and Environmental Factors
April 17, 2020
Alexandria, the pearl of the Mediterranean, is the second largest city in Egypt; its population, which was under half a million in the 1960s, is currently over 10 million. This makes it dense, crowded, and a challenge during a pandemic such as the one we are currently facing. Alexandria represents an urban area in a developing country that is affected by COVID-19.
It is a modern city with many different modes of transportation, including some old ones such as tramways, buses, trains, taxis, and cars, as well as new modes such as Uber, Lyft, and cooperative vans. These are most probably driven by low-income drivers who, along with housekeepers, cooks, and caregivers, may be living in poorer parts of the urban area or in slums. Daily travel from overcrowded slums to the heart of Alexandria may compromise preventative measures in combating the virus. These preventative measures were instituted shortly after it was discovered that a few people who were on a cruise boat in upper Egypt (Luxor and Aswan) were infected. Within one week of the discovery, all cruise boats were halted, and within another week, all airports were closed (on March 19). Shortly thereafter, the Egyptian government closed schools, universities, and all major organizations, allowing only essential services to continue to function. People were asked to shelter at home and a curfew was instituted, preventing people from being outdoors between 7:00 PM and 6:00 AM. To ensure compliance, police fine violators.
Physical and social closeness are integral to the fabric of Egyptian culture. The density of living quarters, the closeness of apartments and buildings, and the way families structure their physical dwellings in proximity to one another provide many challenges as well as opportunities. While many are taking the necessity of physical distancing seriously by refraining from trademark interactions—handshaking whenever individuals meet and same-sex hugging and kissing on cheeks—still, the lived environment and its patterns make distancing, self-isolation, and quarantining a challenge. Even more challenging is social distancing. Social contact is vital for lowering anxiety during these times of uncertainty and fear, for support, for mental health, and for cooperation in meeting daily needs, but it is also a means of spreading the infection. Extended families gather often since living quarters are close, multiple modes of transportation are available, and streets are less crowded. How to maintain these important social connections in high-touch/high-interaction urban areas while honoring physical distance is a challenge.
Another challenge is in accessing healthcare. While daytime access is still available, many private clinics are only open in the evening during curfew hours. Luckily, home visits by physicians are exempt from curfew for emergencies. Home deliveries are practiced more often in developing countries, and more so during a crisis such as this pandemic.
As in many developed and developing countries, the urban poor become even more economically compromised during times of crisis. As streetside merchants, housekeepers, cooks, and drivers, their livelihoods are dependent on activities that are curtailed due to the need for physical distance and curfews. Additionally, they also may be a weak link in disease prevention. Like the homeless living in tents in Los Angeles and those living in favelas in Brazil or in the Ashish in Kuwait, the urban poor in Alexandria may not have what they need to prevent transmission of COVID-19. Running water, sanitation, physical density, and overcrowded quarters may undermine their own health as well as their ability to prevent or mitigate the spread of the virus. Information about hygiene and its role in the transmission cycle may not be reaching them.
Women’s health is also a major issue of concern during crises. During times of isolation, quarantine, and curfews, women’s rights to protection are compromised and their ability to find shelter decreases. Previous findings indicate that during crises, household battering of women and children increases. Questions to be addressed include: When sheltering with extended family members (which is common in countries like Egypt), does the presence of extended family members act as a buffer to prevent battering? Or does it isolate women further and prevent them from receiving help? The vulnerable become more vulnerable during an urban crisis.
It is in times like these, when cities are facing pandemics, that urban research becomes even more vital to understanding how social, cultural, and family structures interact with the lived physical environment to prevent, mitigate, or contribute to health and illness.
Afaf I. Meleis is Dean Emerita and Professor of Nursing and Sociology and a Penn IUR Faculty Fellow.
