Informal settlement in the Greater Cairo Region

A vulnerability assessment in Cairo, Egypt

Rising temperatures and more frequent and intense heat waves will put a growing number of Egyptians at risk of heat-related health problems. A vulnerability assessment conducted in three informal settlements in Cairo explored the sensitivity and adaptability of pregnant women and young children to heat stress.

Egypt’s 88 million residents are highly vulnerable to the effects of climate variability and change. According to the World Health Organization, a growing number of Egyptians will be at risk of heat-related health problems as a result of higher average temperatures and more frequent and intense heat waves. The effects of these changes are already being felt: during a severe heat wave in August 2015, dozens of Egyptians died of heat stroke and more than 500 were hospitalised with heat exhaustion.

Rising temperatures in Cairo’s informal settlements

Typical street scene in Ezbet El-Nasr
Typical street scene in Ezbet El-Nasr

The projected rise in average annual temperatures – by as much as 5.6°C, by century’s end, over 1990 levels – is a particular threat for residents of Cairo’s informal settlements. Approximately 60 percent of Cairenes live in these densely-inhabited areas, which are characterised by substandard physical infrastructure, limited access to social services, and poor environmental conditions. There are few trees or open spaces (e.g. parks) to aid nighttime cooling, which is essential for people to secure a good night’s sleep and to recover from the heat of the day.

During abnormally warm periods, the adverse health impacts of air pollution and heat mutually reinforce each other and lead to worsening of chronic respiratory and cardiovascular diseases, heat stroke, cramps, exhaustion and, in some cases, heath-related deaths. Vulnerable groups, such as women and children, people with chronic illnesses, and the elderly, are among those at greatest risk.

A vulnerability assessment into the effects of heat stress on pregnant women and young children

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Between March and September 2016 German Development Cooperation carried out a local Vulnerability and Adaptation Assessment in three informal settlements in the Greater Cairo Region – Ezbet El-Nasr (pop. 72,200), Khosoos (pop. 700,000) and Markaz El-Abhath (pop. 1 million) – to investigate the sensitivity and adaptability of pregnant women and young children to heat stress. In addition to a desk study and interviews with key stakeholders, the assessment team carried out focus group interviews with 80 pregnant women and mothers of children under the age of five.

The assessment was conducted in cooperation with the Participatory Development Programme in Urban Areas (PDP), an initiative supported by German Development Cooperation, which works to improve environmental conditions and service delivery in nine informal settlements. The purpose of the assessment was to identify possible adaptation measures which could be piloted by the programme to increase the resilience of vulnerable groups in informal settlements to negative heat-related outcomes.

Women’s family responsibilities and their socio-economic conditions aggravate the situation

The assessment found that pregnant women and mothers are aware of heat-related health risks and take steps to protect themselves and their children. During heat waves, for example, they cool their homes using fans and damp towels, drink lots of fluids, wear loose clothing, shower regularly, and try to remain indoors as much as possible during the daytime. However women’s household and family responsibilities – which include shopping, cooking and bringing children to and from school – make it difficult for them to avoid all exposure to severe heat. In focus groups, pregnant women reported experiencing symptoms such as heat-related tiredness, fainting and a feeling of being overheated, but they also expressed that they felt social pressure not to take rest breaks – something that can be dangerous, particularly in the early months of pregnancy.

Waste disposal area
Waste disposal area

Beyond this, there are environmental factors outside women’s direct control which also affect their susceptibility (and that of their children) to heat-related illnesses. Air pollution linked to the widespread practice of burning waste contributes to allergies, respiratory illnesses and gastrointestinal problems and has an intensified impact on health during times of high heat. Power outages are also more common during heat waves, affecting households’ ability to cool their homes using fans or air conditioning. The water supply in some areas is reportedly irregular, while in others it is seen as unsafe to drink: people who can afford to install water filters or buy bottled water do so. The lower a family’s socio-economic status, the greater the impact of these and other contextual factors, including access to health services, good nutrition and education.

Some ways of coping with heat stress are actually harmful

The assessment found that women are protecting themselves and their children to the best of their abilities. However it did identify a few protective actions against heat stress which may, in fact, be doing more harm than good. For example, in focus group interviews mothers noted that skin rashes are more common among their children during heat waves, but they did not seem to be aware that showering frequently can actually exacerbate skin conditions. The widespread consumption of sugary drinks (as opposed to water or other clear fluids) and ice cream to stay cool is also problematic from a health perspective. Finally, the assessment found that, in the absence of good quality, affordable health care services, there is a tendency for residents in informal settlements to seek out health information from family members and neighbours and to consult health professionals only in more severe cases. One consequence of this is the widespread practice of ‘self-medication,’ including with antibiotics.

The findings of the Vulnerability and Adaptation Assessment, including the identification of these common ‘maladaptive’ behaviours, are informing the design of interventions to protect women and children from heat stress. These measures will be piloted in 2017 with support from German Development Cooperation.

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© GIZ / Julia Katzan
© GIZ / Alia ElKadi
© GIZ / Julia Katzan

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