“Great misfortune. Great disaster in the country. The messenger of diseases… This is the Medical Examination of Prostitutes… If only they didn’t create you, examination, if only your mother, The Health Affairs, didn’t give birth to you in this horrible, distorted image.”
We spoke in the previous article about the evolution of the relationship between sex work and health and military institutions in Egypt, where we noted the beginning of the health concern associated with sex work with French military campaigns on Egypt and the banning of Franks for sex workshops for fear of causing the spread of the plague1 2and then the role of Clot Beck in consolidating the relationship between sex work and the prevalence of sexual diseases among strangers in the campaigns of Muhammad Ali Ali on the Levant, Early advice to establish centers for periodic screening and treatment of sex workers the advice that Muhammad Ali and his subsequent children ignored and preferred the traditional method of prevention, so sex work shops in the capital were closed several times until the British occupation in 18823 and the issuance of the first regulations for periodic screening and treatment of female sex workers in 1885 and their amendments until their completion by regulations in 1905 (We will mention some of its articles at the end of the article) to regulate sex work in Egypt, and in this article we will expose the health conditions of sex workers in the 20th century in Egypt in the light of these regulations.
Doctor’s Testimony and Sex Work in The 20th Century:
In 1924, Dr. Fakhri Mikhail Faraj, a dermatologist and reproductive pathologist, wrote a report titled “The Prevalence of Prostitution and Reproductive Diseases in Egypt”, describing the situation of sex work in Egypt and its health conditions as revealing an important chapter in the history of sex work in Egypt.4 Dr. Fakhri states that in his time, female workers were divided into several classes and mainly into foreign and Egyptian workers. This distinction in treatment and conditions based on nationality has been rooted in the Western myth of evil Orientals full of diseases and physical and moral epidemics.
Female foreign workers accounted for a large proportion of female sex workers in Egypt, where female foreign workers accounted for approximately 20% of registered workers in Egypt (Total approximately 7000) In 1919, this is without the inclusion of unregistered female workers, who Dr. Fakhri estimates to be between 10,000 of 30,000 female workers, and it may be worth mentioning that 111 -gay- workers were in the official records of 1971.
This division had its social, security and health importance. Foreign workers were circumventing most of the provisions of the 1950 Regulation by turning to consulates. Foreign workers circumvented article 15 on weekly disclosure by sending a certificate from their private physician, which is easy to buy – same as today – and sheltered unauthorized homes or contravenes one of the provisions of the regulation by foreign consulates of the brothel manager.
(Report on the prevalence of prostitution and reproductive diseases in Egypt and some possible ways to combat them. d. Fakhri Mikhail Faraj p25).
Syphilis and gonorrhea were the most prevalent reproductive diseases at the time, and the average number of female workers treated in government hospitals each year in the 20s was 7744, of them 12% (950) were foreign women and the rest were Egyptians who suffered more from syphilis than foreign women, which Dr. Fakhri brings back for lack of care and health attention to Egyptian women. Noting these large figures raises our desire to know how health screening was done, and what was the “cure” they had?
(Report on the prevalence of prostitution and reproductive diseases in Egypt and some possible ways to combat them. d. Fakhri Mikhail Faraj p24).
Medical Examination:
(Yes, it is payday! I saw prostitutes lined up on both sides of the road and a military policeman taking over the road… I felt that this policeman was the ruler of God’s command in this spot, ordering and tyrannizing this, threatening and promising these.)
Dr. Al-Fakhri describes the day of the medical examination, as one of the reproductive doctors, and as per the description we mentioned in the introduction. The medical examination demanded by Klotte Beck in the European style was mixed with organizational indiscriminacy, and a lack of Egyptian resources, producing that “monster.”
Dozens and sometimes more than 100 workers lined up in front of the Medical Examination Center from 8 a.m. were subjected to various harassment from police and military personnel, until the doctor came at 9 o ‘clock and they all entered one room to remove their underwear, and in less than an hour and a half he finished examining all the women workers lined up from the beginning of street to the end! No blood samples are taken, and no diagnostic protocols are observed, but the worker is asked about her disease history, and he looks quickly to see any fluids, which are usually cleaned by infected women workers immediately before detection, if somehow a disease is detected, they are sent to the nearest public hospital to begin the hell journey of treatment.
In Cairo, there were 3 screening offices for female sex workers:
The Nubian Trail Office in Al-Azbakia and Bab Al-She’ria: which has 1,381 registered female workers with an average examination rate of 21 times a year which is less than stipulated in the regulations (once a week equal to 48 per year) and the daily examination rate is 143 female workers a day! Ends in one or two hours.
Abbasiyah Office: with 136 registered workers, an examination rate of 25 per year for each registered worker, and 65 per day daily examination rate! Dr. Fakhri states that the office finishes the examination in less than an hour.
Al-Sayeda Zainab’s office: with 137 registered female workers, with an examination rate of 20 times per female worker per year, at an examination rate of 55 per day.
This low single-worker detection rate has an impact on early detection and therefore treatment of diseases, so the worker transmitted the disease to others before it was detected, which contributed to the further spread of the disease within this system. There is a difference in the rate of detection between foreign and Egyptian women workers. Foreign women workers are exposed to an average of 35 examinations per year compared to 20 examinations per year of Egyptian women workers, which illustrates the social and class disparities between women workers.
(Report on the prevalence of prostitution and reproductive diseases in Egypt and some possible ways to combat them. d. Fakhri Mikhail Faraj p48).
Treatment and Hospitals:
As for treatment, the regulations provide for the treatment of all women working in his public hospital, but some myths spread among Egyptians, including the belief that syphilis – which has names such as the bloodshed or the foreign – it is treated only by wearing red garment, injecting lemon juice or diluted wine into the urethra, using various solutions to treat gonorrhea, having sex with a virgin to heal from gonorrhea and other superstitious beliefs that spread in a fertile environment of ignorance and contributed to the spread of reproductive diseases at that time.
There were two hospitals in Egypt for the treatment of sex workers mentioned by Dr. Fakhri in his era: Al-Hod Al-Marsood in Cairo and Alexandria Hospital, as for the rest of the governorates, the examination and treatment are in its directorate’s hospital, and a foreign hospital that closed 1922. These hospitals had a decrease in the hospital’s capacity. They did not bear this large number of infected women, so that treatment would be short treatment for certain symptoms rather than real treatment. A short and offensive treatment, as expenditure rate was only 5 pennies a day.
As for hospital treatment, Dr. Fakhri describes it as “harder and more humiliating than the treatment of criminal women”. As 5 pennies a day is not enough to food, water, and medication, a sex worker may wash the hospital floor, as a form of societal punishment as they go through every stage of the treatment from detection to discharge from the hospital. The worker usually returns to work two or three days after being detained at the hospital, where few possibilities allow doctors only to treat symptoms rather than actual disease and that penicillin that represented a jump in the treatment of syphilis was not discovered until 1943. Since the worker was not cured, on the next date of examination she is sent to the hospital by the examining physician again, if he was fortunate to detect the disease, the hospital re-does the same cycle and so forth.
As for the prescription of the treatment in the twenties itself, the treatment was done by intravenous injection of a solution of “Neosalvarsan” for seven weeks, followed by 12 weeks of injections with the drug Neutribol, this therapy protocol only works for the early stages of syphilis. The late stages can be treated for years. Gonorrhea was treated with solutions that wash the urethra daily and several other treatments that extend for weeks as well. Women workers themselves were obstructing screening and treatment in various ways due to different economic considerations. One day without work threatens their lives under the exploitation they suffered. Even if the worker enters the shop for tens of pounds, her monthly share may be only a few pounds. Are the State’s 5 pennies spent daily on the patient fit to treat all these? Patients were discontinued in the absence of economic safety throughout the course of treatment. The dropout rates exceeded 40% and reached 100% in one of the clinics in 1941
Cairo Secret Society (1900-1951). Dr. Abdelwahab Bakr p125).
In the light of all these factors, the number of people living with reproductive diseases in Egypt had risen. Dr. Fakhri mentioned the number of patients in the centers in 1920 to be 11,014 with syphilis and gonorrhea, Compared to 1914, when there were 4,438 patients registered at different centers. Dr. Fakhri estimated the number of people infected in Egypt in the 1920s at more than 800,000, increasing by half a million each year. Based on reports of patients treated with reproductive diseases after Dr. Fakhri’s report, the number of patients in hospitals with reproductive diseases increased to over 100,000 in the 1940s and in the latest reports before the criminalization of sex work reached 250,000 patients in the hospitals for reproductive diseases, which is more than 100 times the report in 1920. These numbers represent only those treated in hospitals after the increase in the number of hospitals and treatment and detection centers, and therefore the number of infected people is expected to double these figures, and there was no decrease in these figures until 1946 and the admission of Penicillin Egypt, which represented a qualitative jump in the treatment of sexual diseases.
The rise in the number of people living with reproductive diseases at that time is a foundation of organizational poverty and government neglect of the health conditions of sex workers – as aforementioned – mixed with the exploitation of female workers through pimps whether by overworking them or giving them crumbs from what they gained, and a general decrease in the awareness of both workers and clients with the difficulty and cost of treatment that was achieving success rates of not more than 50% of cases – until the discovery of penicillin – it is possible to understand how the epidemic of sexual diseases emerged in Egypt and how it was associated with sex work.
Cairo Secret Society (1900-1951). Dr. Abdelwahab Bakr p126).
Dr. Fakhri concluded his report with several demands, the first being the establishment of a special hospital for sexual diseases, the establishment of several centers that provide the public with sexual prevention methods at cheap prices – in our time this is condoms – and the addition of sex education in schools and universities, and finally giving attention to statistics on reproductive diseases. The frankness of a large part of these demands is regarded as revolutionary if you ask for it today in Egypt. It can be said that what has been achieved by these demands is hospitals and departments of sexual and reproductive diseases in all governorates. The centers for selling sexual protection tools at a cheap price or even raising awareness of them have not yet happened.
The cancellation of sex work in Egypt is included after several social claims in 1939, the Government issued an administrative order halting any new permits for sex work shops, Followed by a military order in 1942 during World War II to close sex work houses and finally the British delegate’s military order of 1949 to close all sex work shops in Egypt and punish the managers with impunity until 1951, when a law was passed punishing both managers and sex workers, the first time Egyptian law punished women sex workers simply for their work in sex, which continues to criminalize sex work in all its forms today.
As for health conditions, dermatological and reproductive hospitals have spread throughout Egypt. Al-Hod Al-Marsood was transformed into one of the largest hospitals, as Dr. Fakhri wished in 1949. On the other hand, official sex work has disappeared and there is no longer anything but secret sex work. The official statistics disappeared with only a few studies here and there, and HIV and hepatitis C replaced syphilis and gonorrhea as the first sources of concern for sexual diseases. The last statistic in 2014 states that the number of female sex workers in Egypt is approximately 23,0005 and in a 2012 study in Egypt found that 76% female workers had strange vaginal secretions indicative of reproductive diseases since only 30% used condoms in the last two months only 7% of female workers use it every time6 even though condoms are the cheapest and most important means of protection against sexual diseases.
The latest WHO/UNAIDS statistics indicate that the number of people living with HIV in Egypt is about 34,000, up 379% from 2010. In addition, 2015 statistics indicate that only 5% of adolescents and young people had good knowledge of HIV and prevention methods, and sex workers and sexual minorities are subject to legal and community prosecution, which affects the quality of detection and treatment of sexual diseases, Despite the efforts of some civil organizations, no real solutions will occur without serious government intervention. The Egyptian Government has launched a joint program with UNICEF with the expansion of free screening and treatment centers in all of Egypt’s governorates, However, in the absence of awareness-raising campaigns, this news has not yet reached many vulnerable groups.
Regulations for Brothels in November 1905:
Article 13: Any person who belongs to a brothel or is employed in it must be of legal age.
Article 14: Any prostitute who is in a brothel must be in possession of a ticket given to her by the police. This ticket must be renewed annually (Ornik License Number 11).
Article 15: Any prostitute who is present in a brothel must submit for medical examination once a week by the doctor assigned by the examination office, although there is no doctor authorized to do so by the Health Department. The date of the examination and the notes he considers to be on the ticket provided for in the preceding article highlighted by each prostitute. The police have the right to detect prostitutes who are late to appear for examinations without an admissible excuse and to review the sick certificates from which they apply to prove their excuses.
Article 16: Any prostitute who has tested positive for syphilis shall refrain from residing in a brothel.
Article 17: Prostitutes who are subjects of the local government, who are found to have sexual diseases, shall be sent to the hospital and shall not be discharged from the hospital until after their recovery. If there is no government hospital in the city, the diseased women shall be sent to the hospital of the nearest city and the police shall carry out their transfer. The hospital administrator’s testimony of the injured person’s stay is considered to be an enforceable instrument in favor of the administration. Each diseased foreign prostitute is reported by her state’s consulate.
Article 18: The provisions of the preceding four articles shall also apply to women owners of brothels. Those over the age of 50 may be exempted from medical examination.
Article 20: Owners of brothels are responsible for offences against the provisions of articles 13, 14, 15, 16, and 19.
Article 22: A police officer may enter during daytime in brothels in order to detect irregularities in relation to these regulations and, if necessary, are allowed to bring along a doctor.
Article 23: Any breach of the provisions of these Regulations other than 2, 3, and 16 and 27 is punishable by a fine not exceeding 100 pennies. In the event of a second offence or a violation of the provisions of the preceding paragraph, the perpetrator shall be liable to a fine not exceeding 100 pennies and to imprisonment for a term not exceeding one week or one of these penalties only.
Article 25: The closure of the brothel should be ruled in case of a violation of articles 2, 3, 16, and 27. Closure of the brothel may be ordered in other cases.
- Prostitution in Cairo during the Ottoman era (1517-1798). Dr. Hamid Abdul Hamid Mashhour. ↩︎
- Khaled Fahmy, “Prostitution in Egypt in the Nineteenth-Century,” in Outside in: On the Margins of the Modern Middle East, ed. ↩︎
- Cairo Secret Society (1900-1951). Dr. Abdulwahab Bakr. ↩︎
- Report on The Prevalence of Prostitution and Reproductive Diseases in Egypt and Some Possible Ways to Combat Them. Dr. Fakhry Mikhail Faraj. ↩︎
- National HIV Programme Situation and Gap Analysis Egypt April 2015. ↩︎
- Kabbash IA, Abdul-Rahman I, Shehata YA, Omar AA. HIV infection and related risk behaviours among female sex workers in greater Cairo, Egypt. East Mediterr Health J. 2012;18(9):920-927. doi:10.26719/2012.18.9.920. ↩︎
