Cholera in Egypt and
the Origins of WHO,
1947
Marcos Cueto
Professor
Universidad Peruana
Cayetano Heredia
Part of a larger study on the history of WHO, Global Health Histories
initiative, E. Fee, T. Brown et al.
General theme and questions:
In 1947 the organizers of WHO planned to hold the 1st World Health
Assembly within a few months but the process took longer and faced urgent
problems such as a cholera outbreak
Tension between the need to respond to emergencies and institution
building processes
How to combine relief with prevention?
How to modernize quarantine regulations?
How to work in a conflictive region and period?
(Palestine refugees, the creation of Israel,
the beginning of the Cold War)
John Lennon “Life is what happens to you while you are busy making
other plans”
Background
Between 1882-1920s part of the British Empire
but never officially a colony
In 1922 the UK unilaterally declared
independence
However, British influence continued
(maintaining its control over the
Suez canal)
Occupied by the Germans during most
of the WWII
In the early 20th century an export
economy: cotton
In 1947 the total population of the
country over 19 million
British soldiers at the piramid of Giza, c.
1899
www.artehistoria.com
H.M. Farouk I, King of Egypt and of Sudan.
ruled Egypt between 1936 and 1952.
Undermined by accusations of a lavish royal lifestyle
in a poor country, corruption and pick-pocketing
In 1945 Egypt became a member of the Arab League with
headquarters in Cairo; against UN plan for partition of Palestine
into an Arab and a Jewish state
Egypt was defeated during the 1948 Arab-Israeli War
but maintained control of a strip of territory around Gaza
A country on the threshold of a revolution
A military coup in 1952, directed by Gamal A. Nasser, forced Farouk to abdicate
A year later a republic emerged
Shortly after WWII: about 1000 Arab refugees homeless in Lebanon, Syrian, Jordan and Gaza
Medical and relief programs under WHO`s The Lamp is Light, the Story of WHO, 1951
Medical Modernization
in Egypt during the 20th century
Rene Francis, Public Health in Egypt, Cairo 1951, NLM
Medical Modernization in Egypt
A medical tradition of 5,000 years.
Naguib Pasha Mahfouz, leading gynaecologist and
international lecturer
A Serum and Vaccine Institute
at Cairo
In 1936 a Ministry of Health definitely established
However,
still a country with bilharzia, hookworm, malaria
“Egyptian doctors have an eye for disorder that even a Dutch housewife
cannot equal“
Francis, Public Health in Egypt
1945. United Nations Conference, San Francisco. Souza (Brazil) and Sze (China)
propose to create an international health organization. Both members of the Health
Division of United Nations Relief and Rehabilitation Administration, UNRRA.
A Brief Chronology of WHO, 1946-1948
1946
April: Technical Preparatory Committee prepares a Constitution
1946
July: International Health Conference in NY creates an Interim
Commission, IC
1946
IC absorbs OIHP (Paris) Offices in Geneva and NYC
Between April 1947 and January 1948 IC meets at four months intervals
Also absorbs functions of the League of Nations Health Organization and
UNRRA
1947 September & October: Cholera epidemic in Egypt
1948
24 June-24 July: 1st World Health Assembly, Geneva (65 nations)
Paradox: For its organizers the definitive establishment of WHO was slow because
ratifications took longer than expected; seen from the present it appears as a short
period. It questions the common perception that progress in international health
usually proceeds slowly
Organizing principles
A single specialized agency with a high degree of independence
Link new medical developments and public health needs
Anticipate the major needs on world health. A selection of priorities
Include as many member States as possible
Publications: Bulletin of WHO, Chronicle of WHO; Weekly
Epidemiological Record, Epidemiological and vital statistics report, Official
Records of the World Health Organization, International Digest of Health
Legislation
Work through Internal and External Committees:
Internal; Administration and Finance, Epidemiology and Quarantine,
Headquarters, Priorities, Relations
External: Bacteriological Standardization, Quarantine, Drugs,
Malaria, Pilgrimage & Sanitary Conventions, Tuberculosis,
Venereal Diseases, Pharmacopoeias, Revision of the
International Lists of Diseases and Causes of Death
Network of WHO epidemiological radio-broadcasts in late 1940s
Brock Chisholm, from Canada,
Executive secretary WHO Interim
Commission (1946-1948); 1st Director-
General WHO (1948-1953)
Andrija Stampar, from Yugoslavia,
Chairman WHO-IC; President of
1st World Health Assembly
.
Aly Tewfik Shousha Pasha
“a medical politician” Henry Van Zile Hyde
--One of three vice-chairmen of WHO-IC and later 1st
chairman of WHO Executive Board
--A bacteriologist in the Public Health Laboratories in
Cairo in 1917 and in 1930 director of this institution
--Under-secretary of State for Health in Egypt since 1940
(and during the epidemic)
--Helped to establish the US medical research unit in Cairo
--One of the first foreigners to receive the US Freedom Medal
Joined the WHO staff in 1949 as the First director of the Regional
Office for the Eastern Mediterranean (held position until 1957)
Cholera in Egypt in 1947. Vibrio Cholera
According to a WHO officer:
the most dramatic story of the Interim Commission.
An outbreak on September 22, 1947 in eastern Egypt
El Korein: a village of 15,000 inhabitants
Most cases in rural areas with no sanitation.
The epidemic came from outside but found local propitious
conditions
The peak of the epidemic came in late October with 500 deaths
and 900 new cases in one day
A disease that re-emerged in Egypt after an absence of about
45 years
Fear of spread to Europe
1817-1923 pandemics coming from India spread east and west of India.
However, after 1923 no major western spread of cholera beyond Afghanistan
First responses to Cholera epidemic
Panic and counterproductive police control
According to The Lancet it was a return to the “quarantine of the jungle”
Land quarantines, isolation of the sick, disinfection of houses,
prohibition of public markets and ice-cream
Prohibition
of washing cloths or bathing in the Nile and of open praying-
places on the banks of the Nile
Suppression
of outgoing movements of pilgrims from Egypt to India
(Pilgrim season to Moslem holy places started in early October
and 7,000 pilgrims ready to leave Suez)
Hysteria:
neighboring countries closed their frontiers to passengers, goods (including
cotton) and mail from Egypt
In October, the Greek Government cancelled all flights to Cairo because of the epidemic
DDT used for an “anti-fly campaign”
Possible origin of the epidemic
According to The Lancet, 8 September 1947,
not related to pilgrimage
«...many think that they have traced the origin of the infection to
Egyptian labourers…coming from India to British Army
aerodromes, where the labourers work...There is also a
coincidence between the Egyptian epidemic and that which
started on August 15, 1947, in the Punjab after its partition
between Pakistan and Hindustan and the migration of about 5
million persons that followed it»
WHO (IC) Intervention
Director-General and Expert Committee on Quarantine helped to coordinate
the sending of tons of vaccine and supplies
Supplies sent from the US reached Egypt in less than 3 days
Medical supplies such as:
syringes, hypodermic needles, blood plasma and sodium chloride and glucose,
for rehydration, and sulfonamides
&
WHO warned about “exaggerated” measures taken by bordering countries
Epidemic brought under control within six weeks
In 1902 the cholera epidemic had a death rate of 85 % or 35,595 people.
In 1947 the total of cases was 20,804 with 10,277 deaths (death rate: 50 %)
In 1947 population of Egypt over 19 million
Health campaign linked to health improvements
Health workers before the epidemic were about 1,700. During the epidemic the
figure increased to 3,400
An opportunity for improving water systems. Chlorination. New sanitary pumps
Vaccination perceived as a “magic bullet”
and applied on a large scale.
A second vaccination in February 1948
Over 13 000 swabs taken from deceased persons between Dec. 1947 – Jan. 1948
According to experts, autumn and vaccination ended the epidemic
Only 10 cases in 1948.
None in the next year
According to a study in hospitals, the fatality rate among the inoculated was lower
than among the non-inoculated
In 1973 WHO abolished cholera vaccination for international travel
requirements in the International Health Regulations
The anti-cholera
campaign in full
swing
Francis, Public Health in
Egypt
«Thanks to the colossal efforts of the Egyptian public health
authorities, it had been possible…to circumscribe the
epidemic to Egypt»
Brok Chisholm, cited in Francis
«People discouraged by reports of dissension among different
States may thus become more aware of the tremendous
potentiality of WHO and of the great opportunities of progress
through international cooperation»
A. Shousa
«A new and important element entered into the
bilateral health story in 1947… [that] communism
breeds on filth, disease, and human misery.
Immediately after the enunciation of the Truman
Doctrine of containment of communism, a
Mission was sent to Greece. It contained an
important health component composed of U.S.
Public Health Service officers »
Henry Van Zile Hyde, “International Health: bilateral
international health programs of the United States,” 41 American
Journal of Public Health (1951) p. 1475
«Historians may remember 1948 as the
year in which the peoples of the world lived
alternately between fear and hope: fear of
atomic war, total destruction; hope that the
UN would eliminate this threat. And they
may well conclude that the coming into
force of the UN WHO gave the people
additional reason for hope, when hope was
most needed»
Brock Chisholm, “Nations Unite for World Health,”
United Nations Bulletin 5, 1
(July 1, 1948) p. 529
Conclusions
Control of epidemic a form of validation, WHO not only a “debating society”
A learning experience on how to combine long-term planning and rapid responses
to emergencies
The notion that “disease has no borders” acquired a real meaning
Encouraged the work for improving quarantine systems, international health and
rural health systems
Mixed results in terms of cholera control. Cholera appeared controllable and role of
carriers were established
but traditional methods and discrimination continued
WHO could not avoid being involved in the Cold War
Major challenge for developing countries was to maintain gains and overcome a
history of discontinuity
Cholera in Egypt and the Origins of WHO,
1947
Marcos Cueto,
Professor,
Universidad Peruana Cayetano Heredia
Mcueto@upch.edu.pe
Region Date of Creation First Director First Headquarters
South East-Asia 1 January 1949 Chandra Mani New Delhi
Americas 1 July 1949 Fred. L. Soper Washington, D.C.
(Agreement)
Eastern 1 July 1949 Aly Shousha Alexandria
Mediterranean
Europe September 1951 Norman D. Berg Geneva
Western Pacific 1 July 1951 I.C. Fang Manila
Africa September 1951 François Brazzaville
Daubenton
