Anti-tobacco campaign met with defiance in smoke-happy Cairo

by Stephanie Rice, August 2008

CAIRO — Like many Egyptians, Amr Khalafallah is rarely without a pack of cigarettes and a lighter. "I smoke three packs a day," Khalafallah said while puffing on a Marlboro cigarette on the patio of a popular downtown cafe. "I know it's a bad habit, but I don't care."

In Egypt, smoking is more than a habit – it's a national pastime. Taxi drivers light up as they swerve through traffic-choked streets and veiled women sit in trendy coffee houses, a cell phone in one hand and a cigarette in the other. In the evenings, it's impossible to escape the smell of flavored tobacco wafting from the crowded cafes where men and women drink sugary tea and smoke tobacco in water pipes.

According to the World Health Organization, Egypt has the highest cigarette consumption in the Middle East, with more than a quarter of the country's 80 million inhabitants smoking. An estimated 60 percent of men and 3 percent of women use tobacco in some form, although the number of female smokers is thought to be underreported because of cultural taboos that make women less likely to admit they smoke. In comparison, about 28 percent of American men and 19 percent of American women use tobacco.

While the smoking rate in the United States has decreased steadily since the 1980s, a 2003 analysis by the World Health Organization found that in Egypt, the number of smokers is increasing at a rate of 8 percent each year.

Lung cancer and heart disease are among the leading causes of death here. According to the same organization, Egypt spends an estimated $545.5 million treating tobacco-related diseases each year.

The government is attempting to reverse that trend with a new nationwide anti-smoking campaign. Since Aug. 1, the Ministry of Health and Population has required cigarette labels to display photos that warn consumers about various health risks. The images are dramatic – one depicts a man lying in a hospital bed with an oxygen mask, while another shows a limp cigarette to symbolize impotence.

"Most people know smoking is harmful but they don't imagine that they may be the one who will catch a disease," said Mohamed Mehrez Mostafa, director of the ministry's Tobacco Control Department. "We hope this will make them think twice."

But in a country where it's rare to find a restaurant with a non-smoking section, Mostafa knows persuading people to give up tobacco is an uphill battle. The new packages have been met with hostility by many smokers who admit they have been unnerved by the provocative images. Most, however, say they have no intention of quitting.

"The picture bothers me, I don't like it," said Hossan Ajlan as he enjoyed a cigarette at a busy coffee house on a downtown alley. "So I rip up the packages as soon as I buy them and use this instead." He picked up a shiny metal tin from his table and flipped it open, revealing a well-stocked supply of cigarettes. "I actually like this better anyway."

Ahmed Abdul Haggag, who sells cigarettes, soda and candy from a small kiosk nearby, said his customers have had similarly creative responses to the new packaging. "Some of them save the old boxes and transfer the new cigarettes into them," he said. "Others are willing to pay a little extra for the old ones without the picture."

A package of the local Cleopatra cigarettes usually runs about 50 cents. When the new labels came out, Haggag and other venders promptly raised the price of the original packs, distributed before the campaign went into effect. Most customers seem happy to pay an extra 5 or 10 cents to savor their nicotine guilt-free.

"I can't enjoy the ones with the picture," said Ayman Abdul Salam, relaxing on a smoke break from his job as a salesperson at a men's shoe store. "I feel like they taste different."

"My cigarettes are 3 pounds (50 cents) but I would pay 10 pounds ($1.80) for a package without the picture," he added, a good-natured grin revealing a mouthful of nicotine-stained teeth. "I don't care how much it costs."

Salam scoffed at the idea that anyone would actually be motivated to kick the habit. "Everyone is like me," he said. "We're all upset about the picture, but no one is actually going to quit."

But Salam's younger friend and coworker, Mohamed Samir, disagreed. "I see that guy on the box, and I imagine it's me," said Samir, who smokes two packs a day. "It's very bad, and I'm thinking of quitting."

At a cigarette stand down the street, Sayid Yakoub, a 36-year-old wearing a traditional white galabiyya, grimaced at the sight of the sickly oxygen-mask-wearing man staring back at him. "Do you have any others?" he asked.

The vender, Mostafa Abdel Hamid, rummaged around behind the stand and handed over a plain red-and-white box of Marlboros. Yakoub happily paid 5 cents extra. "The picture just makes me feel uneasy," he explained. "With these," he held up the coveted photo-free box – "I can sleep easier at night."

While it seems unlikely that diehard smokers like Yakoub will be giving up tobacco anytime soon, proponents of the new campaign point out that at the very least, the graphic warnings are initiating a discussion where anti-smoking campaigns have been nonexistent.

Mostafa, the tobacco control director, said his department, which currently consists of three people including himself, plans to distribute pamphlets warning about the dangers of water pipes and secondhand smoke in coming weeks.

"It's about raising awareness, getting people to think," he said.