Cairo, Egypt

The interviews in Cairo were performed by college students under the direction of Dr. Magda N. Iskander, Health Consultant with the Coptic Evangelical Organization for Social Services (CEOSS), located at the Centre for Geriatric Services. CEOSS is a well established Egyptian Non-Government Organization registered with the Ministry of Social Affairs which addresses problems of health, education, economics, community organization and community interrelationships serving members of all denominations. Older people in four different communities were visited: El-Kolali and Shoubra which are very old crowded areas adjacent to the centre of the city near the railroad station; and Ein Shams and Ezbet El Nakhl which are located 13 km from the centre.

El-Kolali and Shoubra are in a part of old Cairo that is fully and densely developed. It is built on land which has poor soil and subsoil qualities, causing problems in water supply and wastewater drainage. The wastewater network is saturated and overflows regularly in numerous places, responsible for the poor stability of buildings. Air pollution is common to all of Cairo, and water pollution is common in poor crowded areas.

Ein Shams and Ezbet El Nakhl are in a relatively new area. The buildings are small and often built without permit and without proper so connections to water and sewers. However, all dwellings have electric service. All four communities surveyed are characterized by:

1. Overcrowding in cramped buildings that lack proper ventilation, access to sunlight and are subject to dampness.

2. Poor sanitary conditions with inadequate water and waste disposal networks due to old deteriorating pipes and clogged overflowing sewers that may lead to contamination of water supplies, especially in Shoubra and El-Kolali.

3. Deficiencies in the system of garbage collection and disposal which may attract roaches and rodents.

4. Inadequate, crowded transportation facilities with no reduced rates or special provisions for the needs of older persons

5. Difficult access to public health services due to the poor transportation system and inadequate roads (unpaved, no side walks, no crossing lines, etc.).

The home interviews brought out the following: About half the respondents live in one or 2 rooms, and the other half have 3 or 4 rooms. Most lived with spouses and one to 3 other persons. Monthly housing costs are surprisingly low, requiring only 10 to 20 percent of income. (This may be because many of the elderly occupy only one room in extended family households; and also due to government rent control.) Most dwellings have indoor piped water and private baths. However, one third reported having to use group latrines, and a few have only outdoor showers. Public waste disposal services are generally available at reasonable costs.

Slightly more than a majority (58%) of those interviewed were women, as there was a strong representation (42%) of male led households. One-fifth owned their dwellings, including some of the women, but the majority were tenants. Most were in their 60s, with only one-third over 70. They reported only minor health problems. Only a few said they were employed, but less than half reported receiving pensions. The greatest living problem cited was the lack of health services, which is somewhat strange considering that few reported health problems or disabilities, and almost half reported using public transport to visit hospitals or clinics. However, it was mainly those living outside the central area who complained about the transport services. Actually, the described distances to health clinics or hospitals is less than half a kilometre in the central areas and 1 km in the outlying community. Home visits and health care were reported as available in the central areas, but not in the outlying areas. Health services are mainly supplied by local religious (charitable) organizations (mosques and churches) at reduced costs. However, the price of medicines is high. Most old people complained of joint problems due to dampness and lack of exercise. (Some minor complaints were to draw the attention of their families)

Dr. Iskander reported that most poor people work in services or as hired hands around the city, and continue to work for as long as they are able, knowing that once they stop they would have to depend on their extended family for their livelihood. Few receive government social security, which is not adequate in the face of inflation.

The government has plans to meet the increased need for housing and other services. However, the increase in population outstrips these efforts, including the needs of older persons. More assistance from the private sector and particularly NGOs will also be required.