The Dammed Body: - Specialized Research AI at MIT

The Dammed Body:
Thinking Historically about
Water Security & Public Health

Jennifer L. Derr

This essay traces the historical relationship between the construction of the Nile Riv-
er and the prevalence of disease in Egypt in the long twentieth century, with an eye
to the relevance of this history to other regions on the African continent impacted by
the construction of large dams. Beginning in the second decade of the nineteenth
century and stretching through the 1970s, the Nile River underwent a dramatic pro-
cess of transformation. Two large dams–the 1902 Khazan Aswan and the Aswan
High Dam–were constructed on the river. Networks of perennial irrigation canals
facilitated the practice of year-round agricultural production and the High Dam
provided electricity. The remaking of Egypt’s riparian ecologies also had important
implications for the health of Egypt’s population as these ecologies were associated
with new landscapes of disease and approaches to biomedical treatment.

O n March 30, 1977, the legendary Egyptian singer and actor ‘Abd al-Halim

Hafiz died at the age of forty-seven from complications of a chronic and
severe parasitic infection. Few stars in Egypt have been as beloved as
‘Abd al-Halim. His musical career was tightly intertwined with the rule of Egyp-
tian President Gamal Abdel Nasser (1954–1970) and the politics of that period.
Young, charismatic, and inspired, Nasser was fiercely anticolonial and populist.
‘Abd al-Halim helped give voice to these politics. While he sang of love and long-
ing, a subset of his music championed the nation and the struggles of its ordinary
citizens. When Egypt’s “nightingale” died, the crowds who thronged the streets
of Cairo for his funeral were so distraught that it is rumored at least one woman
jumped from her balcony to her death in despair.1

While ‘Abd al-Halim Hafiz lived an extraordinary life, he died the most ordinary
of deaths. Born in 1929 in the village of al-Halawat in the Nile Delta, the singer was
orphaned and grew up poor before moving to Cairo and attending the Academy for
Arab Music. When he was a child, ‘Abd al-Halim was infected with the Schistosoma
mansoni parasite, which causes the disease schistosomiasis, the complications of
which led to his death. In 1937, Rockefeller Foundation parasitologist James Allen

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Scott estimated that approximately 60 percent of Egypt’s population was infected
with the parasites that cause schistosomiasis.2 Despite the fame and fortune that
he attained in his lifetime, ‘Abd al-Halim became a victim of the same disease that
afflicted millions of Egypt’s rural poor in the twentieth century. His body, like all
of ours, had a past, one that had been shaped by the material environment in which
he came of age, the class structures that determined how he interacted with the
world around him, and Egypt’s position in a global capitalist economy.

Egypt’s schistosomiasis epidemic had roots in the agricultural ecologies of the
dammed Nile River.3 The country’s history of dam construction is among the ear-
liest and most storied on the African continent. Its first modern dam, Khazan As-
wan (anachronistically, the Aswan Low Dam), was completed in 1902. In its time,
it was the largest masonry dam in the world. Khazan Aswan was raised twice,
once by the British authorities who occupied the country and again by the quasi-
independent Egyptian government that was in place between World Wars I and II.
In 1960, after the unfolding of a Cold War melodrama, construction began on the
hydroelectric Aswan High Dam, which in its time represented a mark of progress
for Nasser’s regime and those seeking to throw off the yoke of colonialism in oth-
er corners of the globe.

That the parasites that cause schistosomiasis thrive in the ecologies of dammed
rivers was a lesson learned first in Egypt. Khazan Aswan transformed the land-
scape and practice of agriculture and in the years that followed its completion,
ever larger numbers of patients arrived at hospitals and clinics bearing the marks
of severe schistosomiasis infection.4 During World War I, scientists mapped the
life cycle of the parasite, definitively linking it to the practice of perennial irriga-
tion, which had been enabled by the damming of the Nile.5 Knowledge of this
relationship in no way thwarted the erection of other dams on the river; similar
constructions were built in Sudan at Sennar (1926) and Jabal Awliya’ (1937). As
the twentieth century progressed, dams proliferated across the African continent.
Predictably, in many places, their construction meant a dramatic increase in the
numbers of those suffering from schistosomiasis.6 Today, approximately 240 mil-
lion people are infected with this disease. The World Health Organization esti-
mates that at least 90 percent of those requiring treatment for schistosomiasis live
in Africa.7 Schistosomiasis is not the only common trait linking dammed regions
of the continent. In the middle decades of the twentieth century, a shared ethos of
high modernism that championed the power of science and technology propelled
these projects in colonies and independent states alike, displacing millions and
leaving river systems marked by degraded water quality, the emission of green-
house gases from reservoirs, reductions in the diversity of life in riparian ecosys-
tems, and downstream soil erosion.

In this essay, I chart the history of dams and disease in twentieth-century
Egypt with an eye to what we might learn from this historical arc in an era of in-

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Dædalus, the Journal of the American Academy of Arts & SciencesThe Dammed Body: Thinking Historically about Water Security & Public Health

tensifying environmental transformation. As the effects of climate change accu-
mulate, some argue that dams might serve as a form of protection during years of
drought and flood and a relatively “clean” way to produce energy.8 This argument
is reflective of a broader approach that believes solutions to climate change will
come in the form of big technologies that reshape our environments and protect
us from the spiraling effects of ongoing damage. Twentieth-century Egyptian his-
tory serves as a potent reminder that environmental interventions are also bodily,
one manifestation of which is disease, as Julie Livingston’s contribution to this
issue of Dædalus describes from a number of different angles.9 This history also
demonstrates that disease never falls equally on a population as its distribution
and its effects are inevitably structured by questions of race, class, and geography.
This was as true of schistosomiasis in twentieth-century Egypt as it is with respect
to the ongoing COVID-19 pandemic.10

Neither does the comparison of similar forms of technology across time and
space reveal the complexities of their embeddedness and experience. While a
shared body of environmental effects has often marked the construction of dams
in Africa, a closer look demonstrates that technology is not determinative in its
form but rather functions as a material manifestation of specific political econo-
mies and technologies of rule, a point highlighted by Allen Isaacman in this vol-
ume in his discussion of the decades of controversy that have surrounded the Ca-
hora Bassa Dam.11 Comparisons can obscure what is necessarily particular, un-
foreseen, and unfamiliar. In Egypt as elsewhere on the African continent, current
threats to water security and the impact of proposed solutions are specific, con-
textual, and more complex than a simple function of environmental change. The
histories of climate change will be those of social hierarchy, global capitalism
and its local forms, and approaches to governance. As Egypt’s trajectory demon-
strates, change will not (only) be experienced at the scale of the globe or even that
of the nation but also through individual bodies that exist in different sets of rela-
tions with a physical world.

O ne history of ‘Abd al-Halim Hafiz’s early death might begin in the south-

ern Egyptian town of Aswan. In 1898, it was there that construction be-
gan on the first modern dam built on the Nile River, Khazan Aswan.
Thirty-seven meters tall, when it was complete, it formed a reservoir that could
store 980,000,000 cubic meters of water and transformed Egypt’s agricultural
landscape.12 For millennia, Egyptian agriculture had depended on the annual Nile
flood, which cultivators had channeled into large basins where it soaked and fer-
tilized the soils in which crops were sown. Egypt’s major produce had consisted of
crops like wheat, which farmers planted following the evacuation of floodwaters,
tended during winter, and harvested in spring.13 Other crops grew during sum-
mer and the season of the flood but as they had to be watered by hand or animal,

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the surface area that they covered was more limited. Following the completion
of Khazan Aswan, an irrigation frontier divided Egypt. Perennial irrigation and
year-round agricultural production predominated in the Nile Delta and the north-
ern portion of the Nile Valley while the southern regions of Egypt’s Nile Valley
continued to practice basin irrigation.14 In those regions that were perennially ir-
rigated, irrigation canals and drains replaced basins. These waterways helped to
sever with the relationship of agriculture to the temporality of the flood. By 1912,
3.3 of Egypt’s 5.3 million cultivable acres were perennially irrigated.15 Plots of land
that had once grown a single crop grew two and sometimes three each year; these
crops included cotton, sugarcane, and maize, whose widespread cultivation was
impossible with basin irrigation.

Khazan Aswan was built by the British during their occupation of Egypt (1882–
1923). During this time, Egypt developed a colonial economy characterized by the
dominance of cash crop agriculture, cotton in particular, the consolidation of ag-
ricultural land in the hands of the elite, and the continued impoverishment of the
rural working classes. The roots of this economy can be traced to earlier in the
nineteenth century and the policies introduced by the country’s Ottoman rulers.16
When the occupation began, the Ottoman-Egyptian government’s deep debt was
one pretense cited as a justification for British control of Egypt.17 The spread of pe-
rennial irrigation not only promised to fill state coffers with the land tax revenues;
a large proportion of Egypt’s cotton production flowed to textile mills in the north
of England, further fueling British enthusiasm for the dam.18 Large landowners
were also eager to increase the productivity of their estates, the cultivation of lu-
crative cash crops in particular.

While the completion of Khazan Aswan was a boon to Egypt’s ruling classes
and colonial officials alike, it was those who labored in agriculture who experi-
enced its construction and environmental impacts most intimately.19 During the
late nineteenth and early twentieth centuries, the majority of Egypt’s population
lived in the countryside and farmed the land. Some cultivated their own small
plots; many worked for wages or as sharecroppers on large cotton-producing
estates owned by the Egyptian elite. The introduction of perennial irrigation and
year-round production meant more work for the countryside. It also entailed new
forms of environmental contact. Laborers from rural Egypt excavated the canals
and drains that carried water to and from crops year-round and cleared canals
each winter of the silt that threatened to clog them. No longer performed by the
energy of the flood, irrigation became the work of cultivators who waded in canals
to channel water into the pulleys and Archimedean screws that helped lift water
to the fields.20

The water that filled irrigation canals and drains was teeming with life. In ad-
dition to human beings, the Schistosoma haematobium and Schistosoma mansoni par-
asites that cause schistosomiasis thrived in the slow-moving freshwater. So did

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the two species of tiny freshwater snails, Biomphalaria alexandrina and Bulinus trun-
catus, that serve as the parasites’ intermediate hosts. The eggs of Schistosoma par-
asites exit the human body in urine and feces, hatching in freshwater. When this
water also contains their intermediate mollusk host, the parasites undergo a series
of organismal transformations that enable them to penetrate unbroken skin and
infect a human body. Rural populations writ large were vulnerable to infection
as most villages lacked easy access to water and canals became sites at which to
wash, fetch water, and play. Men were particularly vulnerable to repeat and severe
infections with Schistosoma parasites. From their teenage years, the work of irri-
gation saw them wading in the water that filled canals during the time of the year
in which the parasites were most infective.21 While Schistosoma haematobium and
Schistosoma mansoni are endemic in Egypt, rates of infection in regions practicing
basin irrigation were quite low, hovering around 5 percent.22 The introduction of
perennial irrigation caused the prevalence of the disease to skyrocket, averaging
60 percent nationwide and climbing as high as 90 percent in some regions.23

Parasites thrived also in the soils of Egypt’s new agricultural landscape. Before
the construction of the dam and the spread of perennial irrigation, soil had dried
and cracked in the dry season that followed the harvest of crops and preceded the
arrival of the flood. Perennial irrigation meant the near continuous presence of
water on the land, which increased its moisture content. These changed condi-
tions proved conducive to the life cycle of Ancylostoma duodenale parasites, which
cause one form of hookworm disease.24 The eggs of these parasites exit the hu-
man body in feces and, on soil with the right moisture and nutrition, the parasites
hatch and transform, descending a short distance into the soil to await a new hu-
man host. As most Egyptians who lived in the countryside went barefoot, they
were infected with the organism through their feet. While hookworm is endem-
ic in Egypt, the spread of perennial irrigation altered the regional distribution of
the parasite as well as the prevalence of infection among the population.25 In the
early twentieth century, the visible marks of hookworm infection were the most
common cause disqualifying recruits for the Egyptian army.26 By the middle of
the 1930s, Scott estimated that five million of Egypt’s twelve million inhabitants
suffered from the disease.27

The spread of perennial irrigation throughout large portions of the country-
side also changed the diets of rural populations. Historically, Egyptians had relied
for sustenance on grain crops that included barley, millet, and wheat.28 By the ear-
ly twentieth century, corn had replaced other traditional grains to become a staple
in rural diets, especially in the Nile Delta. It was also one of Egypt’s top-ranking
exports. The crop’s growing season resembled that of cotton, meaning that as pe-
rennial irrigation spread, so did the cultivation of corn.29 It was also durable, and
its kernels easily stored. Finally, corn required less labor than other staple grain
crops, important traits when considering the extended calendar of labor associat-

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ed with perennially irrigated agriculture and the prevalence of sharecropping and
agricultural wage labor in the countryside.

The shift to a reliance on corn also had a grave impact on human health. By the
early twentieth century, the symptoms of the disease pellagra were widespread in
rural communities in the Nile Delta. Pellagra results from a niacin deficiency, which
can be caused by an overabundance of corn in the diet. (Corn contains a form of ni-
acin that human beings cannot digest unless the grain is properly prepared.)30 The
appearance of pellagra has historically been common among impoverished com-
munities who lack access to dietary diversity. In Egypt, the disease resulted from
changes in patterns of agricultural production that were linked to perennial irriga-
tion as well as the widespread poverty that marked the country’s colonial econo-
my. While numbers charting the prevalence of pellagra are more difficult to come
by than those measuring schistosomiasis and hookworm, some of its symptoms
were visible and the subject of frequent comment by physicians of the period.31

In the regions of Egypt whose agricultural ecologies were transformed by the
construction of Khazan Aswan and the subsequent spread of perennial irrigation,
the prevalence of disease helped to produce new normative habitations of the hu-
man body. Those who lived in the countryside of the Nile Delta and northern cen-
tral Egypt were likely to suffer the symptoms of schistosomiasis, hookworm, or
pellagra; many suffered a combination of these maladies. While sparse, historical
evidence suggests that rural communities understood the diseases of perennial ir-
rigation not as systemic but rather through their individual symptoms.32 To in-
habit a rural body in the agricultural ecologies supported by the dam–especially
a laboring body–included different combinations of a wide variety of physical
symptoms. Some were seasonal, a photosensitive rash that appeared in spring for
example. Fatigue, fever, aching, and cough were common as were digestive diffi-
culties that included abdominal pain, vomiting, diarrhea, blood in the urine, flat-
ulence, constipation, and weight loss. Children suffered severe anemia, stunted
growth, and, in particular, difficulty concentrating. Severe and advanced cases
could be marked by cancer of the bladder, high blood pressure through the liv-
er, an enlarged spleen, the build-up of fluid in the abdomen, swollen areas in the
esophagus and digestive tract that could rupture and bleed, and disorders of the
nervous system that caused memory loss, depression, and eventually dementia.
While urban populations and the elite were much less likely to suffer these prob-
lems, for the vast majority of the Egyptians who lived in the countryside, the envi-
ronment produced by the construction of Khazan Aswan and the spread of peren-
nial irrigation had deep and sustained effects on their health.

T he year 1928 is another possible point from which one might begin an ex-

planation of ‘Abd al-Halim’s early death. It was that year that the inter-
war-period Egyptian regime began a project to heighten Khazan Aswan

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and enlarge its reservoir and the surface area of land that it irrigated and, by ex-
tension, the proportion of Egypt’s population who suffered the diseases that were
embedded in this landscape. The regime that made this choice was not controlled
by foreign powers but rather comprised of the Egyptian elite. In 1919, a revolt pro-
testing the continued British occupation had erupted. By 1922, Egypt had rene-
gotiated its relationship with the colonial power and while Britain continued to
exercise a decisive role in the country, its government was firmly in the hands of
Egyptian elites.33 Under this regime, Egypt’s economy continued to rely heavily
on export-oriented, cash crop agriculture (cotton in particular), and the social re-
lations of the countryside persisted much as they had during the occupation.

Control of the Nile River was an important tenet of Egyptian nationalism. Be-
fore World War I, the British had begun construction on the Gezira scheme in Su-
dan, an agricultural region that they hoped would be one of the largest cotton-
growing areas in the world.34 In 1919, when the war had ended and the British sought
to construct irrigation works in their possessions to the south of Egypt, a heated de-
bate flared concerning the impact these works would have on the quantity of Nile
water available to Egypt. In what would prove an enduring problem, Egypt felt its
vulnerability as the furthest downstream country. When the British completed the
Sennar Dam, which helped to water the Gezira scheme, tension between the coun-
tries intensified and, in an attempt to stake its claim to the Nile, Egypt invited an
international commission to assess the safety of raising Khazan Aswan.35

The commitment to a dammed Nile River set the country on a particular path.
Egyptian political officials not only understood the Nile River as an important fea-
ture of their landscape, culture, and history, but national development was also
associated with a dammed Nile and water-intensive agriculture.36 While Brit-
ish authorities had made almost no effort to address the epidemic of disease that
raged in the countryside, during the interwar period, national development was
paired with public health outreach. Hookworm and schistosomiasis were of par-
ticular interest. Effective treatment for the former had existed since the late nine-
teenth century; that for schistosomiasis had been introduced to Egypt around the
period of World War I. Beginning in the 1920s, the Egyptian Public Health Depart-
ment established treatment centers for schistosomiasis and hookworm in Egypt’s
cities and throughout the towns of the countryside. While the month-long treat-
ment regimen for schistosomiasis caused considerable discomfort, even pain, by
the 1940s, approximately 400,000 patients were treated for schistosomiasis each
year in these clinics.37

Despite treatment, large numbers continued to suffer from schistosomiasis.
Even when they were cured of the disease, the vast majority were reinfected with
their return to rural life and labor. The lack of infrastructure in Egyptian villages
meant that irrigation canals continued to occupy a prominent role in village life,
and for cultivators, there was no way to avoid the physicality of irrigation and the

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threat of parasitic infection that it posed. While physicians and political officials
alike acknowledged that the efficacy of treatment was limited, there was no sug-
gestion that the dam or the patterns of agricultural production that it supported
might be undone. A particular archetype of national development had been nor-
malized: like the heightening of the dam, mass treatment demonstrated scientif-
ic and bureaucratic sophistication, furthering the cause of national development.

I n 1952, a group of junior army officers orchestrated a popularly supported

coup that forced the Egyptian monarchy from power. Two years later, one of
these young officers, Gamal ‘Abd al-Nasser, became Egypt’s president. Under
his leadership, Egypt became a populist authoritarian state, animated by Nasser’s
fiercely anticolonial politics. Before the coup, Egyptian politicians had debated
the prospect of replacing Khazan Aswan with a hydroelectric dam; the project be-
came a priority in the early days of Nasser’s presidency.38 For funding, Egypt first
negotiated with the United States and Great Britain. When Nasser refused to bow
to the political conditions attached to the aid–specifically to back down from his
conflict with Israel and position Egypt as a quiescent Cold War client state–each
country in turn withdrew its support.39 The Soviet Union stepped in with an of-
fer of financing and soon after, in July of 1956, Nasser nationalized the company
that administered the Suez Canal, announcing his intention to use its profits to
fund the construction of a new dam on the Nile. In an attempt to corral Nasser’s
ambition and quash his regional influence, Britain, France, and Israel attacked
Egypt, withdrawing their forces from Egyptian territory only after pressure from
the United States. While the war was a military defeat for Egypt, Nasser emerged
a hero for his willingness to stand strong in the face of neocolonial aggression. In
1958, Egypt and the Soviet Union agreed on the terms of financing and, in 1960,
construction on the High Dam began.

The potential of the Aswan High Dam to transform Egypt figured prominent-
ly during Nasser’s rule (1954–1970). The period of its construction witnessed the
implementation of reforms that sought to lift Egyptians from poverty and address
the dramatically unequal distribution of wealth that had marked the time of the
British occupation and that of the interwar period. The era of Nasser’s rule saw
the implementation of several land reforms, the championing of the rural poor,
an endeavor to end the country’s dependence on export-oriented agriculture, and
the development of Egypt’s industrial sector. However, like the regime he had
helped topple, Nasser understood the performance of technological mastery and
environmental claim-making as central to nationalist development. This time, it
was not water for cotton but electricity to power Egyptian industry and light the
countryside that fueled enthusiasm for the dam.

When construction was ongoing, Nasser’s regime prepared for the possibility
that an increase in the prevalence of schistosomiasis would follow the dam’s com-

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pletion.40 During the 1950s and 1960s, schistosomiasis treatment was linked to
investments in rural public health. Between 1951 and 1963, the state budget devot-
ed to health care nearly quadrupled.41 The number of rural health care units also
increased, from 382 before the coup to 1,525 by 1965.42 These rural health care units
complemented the existent network of clinics devoted to the treatment of para-
sitic diseases. Schools were also sites of treatment as the rates of infection among
children were high and their attendance at school was more predictable than that
of adults at clinics.43

As many Egyptians were farmers, public health officials wrestled with the
seemingly intractable problem that reinfection represented. One approach treat-
ed the environment in which schistosomiasis was rooted with chemicals in an en-
deavor to root out disease. This strategy, one form of what public health officials
conceived of as “vector control,” garnered the support of the World Health Orga-
nization and governments in the Global North seeking to promote their (national)
chemical companies and pharmaceuticals. In Egypt, large field experiments were
organized to test the efficacy of different chemical compounds that killed snails
in reducing the prevalence of disease. Despite the enthusiasm that surrounded
them, in Egypt, chemical agents never became the total solution that many had
hoped. When considering the impossibly complex networks of canals and drains
that extended from the Nile, their cost was too high as was their toxicity.44

I n 1961, ‘Abd al-Halim Hafiz began performing the song “Hikayat Sha’ab” (sto-

ry of a people), which told the story of the Aswan High Dam as a rejection of
Egypt’s colonial past and a celebration of the path of national self-sufficiency.
That ‘Abd al-Halim sang the song while suffering a disease linked to the ecolo-
gies of the dammed Nile might have produced an air of tragedy, even irony, but in
the singer’s performance, there is only a sense of pride and steadfastness. Many
Egyptians, including those at the highest levels of state, continue to believe that
the country had no choice but to build the dam and that the benefits that have
flowed to Egypt as a result have been considerable. The conversion of the country-
side to perennial irrigation was complete. The cessation of the annual Nile flood
in Egypt and the accumulation of its waters in Lake Nasser ended the threat posed
by high floods and enabled the successful mitigation of drought. Most important,
the dam generates power, which in the 1970s, was used to electrify large swaths of
the countryside and fuel Egyptian industry. Neither did the completion of the As-
wan High Dam exacerbate the schistosomiasis epidemic. From the 1950s, studies
indicated that widespread treatment, the construction of civilian infrastructure,
public health outreach, and urbanization had chipped away at the high numbers
of those suffering from disease and caused rates of infection to decline.45

In the years after the Aswan High Dam was completed, it became evident that
the dynamics of schistosomiasis infection in Egypt had changed but not as antici-

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pated. When Khazan Aswan was built, Schistosoma haematobium had been endemic
throughout Egypt while Schistosoma mansoni had been confined to particular re-
gions of the northern Nile Delta. By the 1970s, this was no longer the case.46 Schis-
tosoma mansoni had spread into new territories, eventually becoming the more
common cause of disease.47 It is likely that this migration began decades before
the High Dam was built. When he conducted his nationwide survey in the 1930s,
Scott wondered whether Schistosoma mansoni had begun to move beyond its his-
torically endemic territories. Residing in the intestinal system, the species pro-
duces a slightly different set of symptoms and sometimes a more severe form of
disease than Schistosoma haematobium. While the geographies of infection shifted,
the profile of who was most vulnerable did not. Among the rural poor, men fell ill
in greater numbers than women and rates of infection were highest from child-
hood through the early years of adulthood.48

In the past several decades, the transmission of schistosomiasis has been elim-
inated or greatly reduced throughout the Middle East and North Africa.49 Its prev-
alence is highest in Yemen, which has been destroyed by a Saudi bombing cam-
paign and is wracked by civil conflict. As of 2014, there were approximately 12.7
million individuals infected with schistosomiasis in the Middle East and North
Africa, about 10 million of them in Egypt and Yemen. In 2016, estimates placed the
nationwide rate of infection in Egypt at 0.2 percent of the population.50

This tremendous reduction can, in large part, be attributed to the development
of a new and effective oral therapy, Praziquantel, in the 1970s. As patients no lon-
ger needed to submit themselves to lengthy courses of injections, treatment could
be administered on a large scale and indiscriminately, especially to high-risk pop-
ulations like children who had not been tested for the presence of the disease. The
use of this drug, in conjunction with snail control efforts, health education, and
sanitary infrastructure improvements, allowed Egypt’s government to gain the
upper hand over an epidemic that had haunted the country for almost a century.
Other less intentional developments also likely altered the course of the disease.
In the 1980s, crayfish were introduced in the Nile Delta for aquaculture and spread
rapidly. These creatures happen to prey on the species of snails that serve as the in-
termediate hosts for Schistosoma parasites.51 In recent years, the end of schistoso-
miasis in Egypt has finally come into view. In 2016, the Egyptian government an-
nounced a plan in cooperation with the World Health Organization to eliminate
schistosomiasis by 2020.52 At the time of writing, the results of this endeavor had
not yet been announced.

While the Aswan High Dam did not have the anticipated effect on the landscape
of environmental disease in Egypt, the harms that have flowed from the dam’s con-
struction have been considerable. Nearly 100,000 members of Egypt’s Nubian
community–and a larger number in Sudan–were displaced and much of the ter-
ritory that was historical Nubia was decimated. Many were moved to a settlement

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in the town of Kom Ombo, relatively distant from the Nile and the life ways that
had once sustained them.53 The dam’s reservoir, Lake Nasser, flooded a number
of archaeological sites in Egypt and Sudan. Some, like Abu Simbel, were moved
to other locations. Others were gifted to museums abroad and a handful are sub-
merged in the waters of the lake.54 The effects of the High Dam on the riparian en-
vironment have also been substantial.55 Deprived of adequate sediment, Egypt’s
northern coastline has eroded; a significant quantity of agricultural land has disap-
peared; the soil is no longer as productive as it once was; and commentators have
long debated the impact of the dam on fish populations in the Mediterranean Sea.
One wonders whether large dams like the Aswan High Dam are one of the
great postcolonial traps, destined to pit those who are concerned about their en-
vironmental effects and cultural erasures against those who are seeking resources
and national development according to the terms that came to predominate in the
twentieth century. As the construction of large dams accelerates, many govern-
ments find themselves faced with a set of dilemmas resembling those confronted
by the Egyptian regime more than sixty years ago. In the short term, agricultural
productivity, protection from the variability of floods, and the provision of elec-
tricity are attractive prospects. So is the national pride and political favor that at-
taches to the construction of infrastructure. However, this thirst for resources and
development often produces a skewed vision of the cost of dam construction, one
that omits the significant price of damage to the environment, public health pro-
grams, and the civilian infrastructure necessary to mitigate their effects.

In Egypt, the long history of damming the Nile has also produced consumption
habits and expectations that are ill-suited for a world in which resources are ever
scarcer. Two of Egypt’s most important crops–rice and sugarcane–are both water
intensive. Recently, the government has made moves to limit rice cultivation, these
policies landing hardest on the farmers who grow the crop. Neither is there a deep
history of water conserving irrigation.56 The current controversy in Egypt that sur-
rounds the construction of the Grand Ethiopian Renaissance Dam (described in
Harry Verhoeven’s essay in this issue of Dædalus) is in part rooted in the govern-
ment’s long-standing concern about the vulnerability produced by its position on
the Nile and the tiny amounts of rain that fall in its fields each year.57 It also stems
from the reality that the government will be forced to confront the country’s water
poverty, which the long history of the dammed Nile has allowed it to avoid.

How Egyptians will experience a future that will be further freighted by the
challenges of climate change, among them water security, will, like the country’s
history of dams, be shaped by questions of political economy and the technolo-
gies of power. Khazan Aswan was built under a colonial regime to support a form
of agricultural production that served the interests of the British Empire, on the
one hand, and Egypt’s wealthy landowners, on the other. Its goods flowed to these
classes while poverty and parasites molded the bodies of the agricultural working

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classes. The Aswan High Dam was imagined as an escape from the geopolitical re-
lationships and material constraints of the past. And yet, like the dam that preced-
ed it, it was a manifestation of environmental authoritarianism. Not only did the
government dictate the pathways of water, power, and displacement; it mandated
the chemical treatment of human bodies and the environment in order to combat
the harms that flowed from the dammed Nile. The strategies that Egypt’s current
regime deploys to respond to climate change will be similarly shaped by its aggres-
sive authoritarianism, the absence of legitimate channels through which to express
dissent, and the interests of the ruling classes, the military primary among them.

If there are lessons to be learned, it is the intractable relationship of human and
environment health and the persistent influence of social and economic struc-
tures in shaping these terms. History accretes in the body. On global as well as
local scales, this accretion is structural as much as it is environmental. A narrow
interpretation of Egypt’s twentieth-century history would read the historical re-
lationship between dams and disease as a specific warning. But a dam or any piece
of environmental infrastructure is not a thing apart but rather a part of a complex
human/nonhuman environment and a system of global power structures. ‘Abd
al-Halim Hafiz inhabited a body that was emblematic of a particular era of Egyp-
tian history. It was a body born into a political economic environment that had
been shaped by colonialism; it came of age and met its end during an era in which
the damming–of the Nile River and the bodies of many Egyptian citizens–were
fundamental tenets of postcolonial national modernity. ‘Abd al Halim accepted
these inevitabilities, so much so that his voice was the voice of the hope and prom-
ise that attached to the High Dam. There exist countless historical examples of
the structural-environmental relationships that expose human bodies to harm,
and they are at present multiplying. Climate change is being lived differently de-
pending on differentiations of race, class, and geography. As we debate the tech-
nological interventions that might mitigate its effects, it is important to remem-
ber that technologies themselves are not salient categories of analysis across time
and space. Moreover, if our solutions to climate change imagine an environment
that is analytically and materially distinct from human bodies, we will continue to
be surprised, sometimes horrified, by the costs borne by these bodies, especially
the most vulnerable among them.

about the author

Jennifer L. Derr is Associate Professor of History and Founding Director of the
Center for the Middle East and North Africa at the University of California, Santa

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Cruz. She is the author of The Lived Nile: Environment, Disease, and Material Colonial
Economy in Egypt (2019) and has published in such journals as International Journal of
Middle East Studies and Molecular and Cellular Biology. Her research is supported by a
CAREER grant from the National Science Foundation (#1848557), entitled the “His-
tory of Science at the Interface of Biomedical and Environmental Concerns.”

endnotes

1 For video footage of the funeral, see “Egypt: Thousands of Mourners Turn Out for Fu-
neral of ‘Halim’ Renowned Egyptian Singer, Abdel-Halim Hafez,” Reuters, April 3, 1977,
https://reuters.screenocean.com/record/652571 (accessed February 15, 2021).

2 James Allen Scott, “The Incidence and Distribution of the Human Schistosomes in Egypt,”
American Journal of Epidemiology 25 (3) (1937): 578, 610, cited in Jennifer L. Derr, The Lived
Nile: Environment, Disease, and Material Colonial Economy in Egypt (Stanford, Calif.: Stanford
University Press, 2019), 105.

3 There is a robust historiography charting the ecological and social effects of damming the
river in Egypt. See, for example, Habib Ayeb and Ray Bush, Food Insecurity and Revolution
in the Middle East and North Africa: Agrarian Questions in Egypt and Tunisia (New York: An-
them Press, 2019); Jessica Barnes, Cultivating the Nile: The Everyday Politics of Water in Egypt
(Durham, N.C.: Duke University Press, 2014); Ray Bush, Counter-Revolution in Egypt’s
Countryside: Land and Farmers in the Era of Economic Reform (London: Zed Books, 2002);
and Timothy Mitchell, Rule of Experts: Egypt, Techno-Politics, Modernity (Berkeley: Univer-
sity of California Press, 2002).

4 Derr, The Lived Nile, 118–119.

5 Robert Leiper, Researches on Egyptian Bilharziosis: A Report to the War Office on the Results of the
Schistosomiasis Mission in Egypt, 1915 (London: John Bale, Sons and Danielson, 1918), 3.
6 See, for example, V. R. Southgate, “Schistosomiasis in the Senegal River Basin: Before
and After the Construction of the Dams at Diama, Senegal and Manantali, Mali and
Future Prospects,” Journal of Helminthology 71 (2) (1997): 125–132; John M. Hunter, “In-
herited Burden of Disease: Agricultural Dams and the Persistence of Bloody Urine
(Schistosomiasis hematobium) in the Upper East Region of Ghana, 1959–1997,” So-
cial Science & Medicine 56 (2) (2003): 219–234; Abiola Fatimah Adenowo, Babatunji Em-
manuel Oyinloye, Bolajoko Idiat Ogunyinka, and Abidemi Paul Kappo, “Impact of Hu-
man Schistosomiasis in Sub-Saharan Africa,” Brazilian Journal of Infectious Diseases 19 (2)
(2015): 200–201; and Susanne H. Sokolow, Isabel J. Jones, Merlijn Jocque, et al., “Near-
ly 400 Million People Are at Higher Risk of Schistosomiasis Because Dams Block the
Migration of Snail-Eating River Prawns,” Philosophical Transactions of the Royal Society B:
Biological Sciences 372 (1722) (2017): 1–12.

7 World Health Organization, Regional Office for Africa, “Schistosomiasis (Bilharzia),”
https://www.afro.who.int/health-topics/schistosomiasis-bilharzia (accessed March
1, 2021).

8 The notion that dams are a clean form of energy is much contested. See, for example, Yves
T. Prairie, Jukka Alm, Jake Beaulieu, et al., “Greenhouse Gas Emissions from Freshwa-
ter Reservoirs: What Does the Atmosphere See?” Ecosystems 21 (5) (2018): 1058–1071.
9 Julie Livingston, “Water Scarcity & Health in Urban Africa,” Dædalus 150 (4) (Fall 2021).

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10 This argument and the data that support it regarding COVID-19 are widespread. See, for
example, Matthew A. Raifman and Julia R. Raifman, “Disparities in the Population at
Risk of Severe Illness from COVID-19 by Race/Ethnicity and Income,” American Journal
of Preventive Medicine 59 (1) (2020): 137–139; L. Ebony Boulware, “Race Disparities in
the COVID-19 Pandemic–Solutions Lie in Policy, Not Biology,” JAMA Network Open 3
(8) (2020); and Cary P. Gross, Utibe R. Essien, Saamir Pasha, et al., “Racial and Ethnic
Disparities in Population-Level Covid-19 Mortality,” Journal of General Internal Medicine
35 (10) (2020): 3097–3099.

11 Allen Isaacman, “Cahora Bassa Dam & the Delusion of Development,” Dædalus 150 (4)

(Fall 2021).

12 William Willcocks, The Assuan Reservoir and Lake Moeris: A Lecture Delivered at a Meeting of the
Khedivial Geographical Society, Cairo, 16 January 1904 (London: Messrs. E. and F. N. Spon,
1904), 7–8; and Murdoch MacDonald, “Aswan Dam: Protection of Downstream Rock
Surface, and Thickening and Heightening,” Minutes of the Proceedings of the Institution of
Civil Engineers 194 (1913): 261.

13 Alan Mikhail, Nature and Empire in Ottoman Egypt: An Environmental History (New York:

Cambridge University Press, 2011), 11.

14 Select regions of southern Egypt had access to perennial irrigation provided by the Egyp-
tian Sugar Company. See Derr, The Lived Nile, 75–98. For a discussion as to the notions
of value and practices of ownership linked to this frontier, see ibid., 57–59.

15 Terje Tvedt, The River Nile in the Age of the British: Political Economy and the Quest of Economic

Power (New York: I. B. Taurus, 2004), 91.

16 For a discussion of the evolution of land tenure regimes and the social relations of the
countryside during the nineteenth century, see (in English) Raouf Abbas and As-
sem El-Dessouky, The Large Landowning Class and Peasantry in Egypt, 1837–1952, ed. Pe-
ter Gran, trans. Amer Mohsen and Mona Zikri (Cairo: American University in Cai-
ro Press, 2012); Kenneth Cuno, The Pasha’s Peasants: Land, Society and Economy in Lower
Egypt, 1740–1858 (New York: Cambridge University Press, 1992); Roger Owen, Cotton
and the Egyptian Economy, 1820–1914: A Study in Trade and Development (London: Clarendon
Press, 1969); Alan Richards, Egypt’s Agricultural Development, 1800–1980: Technical and So-
cial Change (Boulder, Colo.: Westview Press, 1982); and Helen Rivlin, The Agricultural Pol-
icy of Muhammad Ali (Cambridge, Mass.: Harvard University Press, 1961).

17 Robert Tignor, Modernization and British Colonial Rule in Egypt, 1882–1914 (Princeton, N.J.:

Princeton University Press, 1966), 113.

18 Derr, The Lived Nile, 47–49.
19 In addition to the health effects described in this essay, see also Mitchell, Rule of Experts,

19–53.

20 Derr, The Lived Nile, 100–103.
21 Ibid., 107.
22 Scott, “Incidence and Distribution,” 610.
23 Ibid., 578, 610.
24 A. Abdallah, “Ancylostomiasis in Egypt,” in Expert Committee on Helminthiasis (Soil-Trans-

mitted Helminths) (Geneva: World Health Organization, 1963), 4–5.

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25 Muhammad Khalil, “The Pail Closet as an Efficient Means of Controlling Human Hel-
minth Infection as Observed in Tura Prison, Egypt, with a Discussion on the Source of
Ascaris Infection,” Annals of Tropical Medicine and Parasitology 25 (1) (1931): 44; and Abdal-
lah, “Ancylostomiasis,” 4–5.

26 Fleming Mant Sandwith, Medical Diseases of Egypt (London: Henry Kimpton, 1905), 245.
27 James Allen Scott, “The Prevalence and Distribution of Hookworm in Egypt,” American

Journal of Hygiene 26 (3) (1937): 455–505.

28 Mikhail, Nature and Empire in Ottoman Egypt, 10–11.
29 Richards, Egypt’s Agricultural Development, 83.
30 A New World crop, corn had been subjected to the process of nixtamalization in Central
and South America, in which it was soaked in an alkaline solution, washed, and hulled
before it was eaten. One effect of nixtamalization was to render the nutrients in corn
more biologically available to the human body.

31 Fleming Ment Sandwith, “Pellagra When Considered from the Point of View of a Disease
of Insufficient Nutrition,” Transactions of the Royal Society of Tropical Medicine and Hygiene
9 (1) (1915): 10.

32 Derr, The Lived Nile, 114.
33 Egyptian elites had long played important roles in the structures of government. When
the British occupied Egypt in 1882, the Ottoman-Egyptian state possessed a developed
bureaucracy and ministerial system. This state structure was left in place during the oc-
cupation, with British officials appointed to direct and staff the upper echelons of the
different ministries.

34 For more detail, see Victoria Bernal, “Colonial Moral Economy and the Discipline of
Development: The Gezira Scheme and ‘Modern’ Sudan,” Cultural Anthropology 12 (4)
(1997): 447–479; Tony Barnett, The Gezira Scheme: An Illusion of Development (New York:
Routledge, 2019); and Maurits W. Ertsen, Improvising Planned Development on the Gezira
Plain, Sudan, 1900–1980 (New York: Springer, 2015).

35 Tvedt, The River Nile in the Age of the British, 145–146.
36 Derr, The Lived Nile, 61–73.
37 Ibid., 138.
38 See Chapter 3, “Shifting Lines of Power: Egyptian Business Groups and the Electrifica-
tion Schemes of the 1920s and 1930s,” in Robert Vitalis, When Capitalists Collide: Business
Conflict and the End of Empire in Egypt (Berkeley: University of California Press, 1995).
39 For the documentary record of the crisis related to the United States Department of
State, see U.S. Office of the Historian, “Foreign Relations of the United States, 1955–
1957, Suez Crisis, July 26–December 31, 1956, Volume XVI,” https://history.state.gov/
historicaldocuments/frus1955-57v16/comp1 (accessed February 15, 2021).

40 “Proceedings of the First International Symposium on Bilharziasis in Commemoration
of the Centenary of Theodor Bilharz, Organized by the Ministry of Scientific Research
U.A.R., 1962,” 9.

41 Raymond William Baker, Egypt’s Uncertain Revolution Under Nasser and Sadat (Cambridge,

Mass.: Harvard University Press, 1978), 220.

42 Ibid., 219–222.

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43 Egyptian Ministry of Public Health, Annual Report (1951): 155; and “Report on the 5th (last
but one) Big Blanketing (Spring 1971) of the Irrigation and the Drain System of the Fay-
oum with Bayluscide,” Bilharzia Control Project, Fayoum Egypt/German Team, Ar-
chives of the Parasitology Collection, World Health Organization, schisto1-emro-egypt
1970–1971, 6.

44 For reports of toxicity, see José Antonio Jove, “Use of Molluscicides in the Control of
Bilharziasis in Venezuela: Equipment and Methods of Application,” Bulletin of the World
Health Organization 14 (4) (1956): 631; Norman D. Levine, “Integrated Control of Snails,”
American Zoologist 10 (4) (1970): 580; Ronald Eisler, Pentachlorophenol Hazards to Fish, Wild-
life, and Invertebrates: A Synoptic Review, vol. 85 (Washington, D.C.: U.S. Department of
the Interior, Fish and Wildlife Service, 1989), 1; and D. M. Blair, “Dangers in Using and
Handling Sodium Pentachlorophenate as a Molluscicide,” Bulletin of the World Health Or-
ganization 25 (4–5) (1961): 601.

45 Rashida M. R. Barakat, “Epidemiology of Schistosomiasis in Egypt: Travel through

Time,” Journal of Advance Research 4 (5) (2013): 426–427.

46 Ibid., 430.
47 Rashida Barakat, Hala El Morshedy, and Azza Farghaly, “Human Schistosomiasis in the
Middle East and North Africa Region,” in Neglected Tropical Diseases: Middle East and North
Africa, ed. Mary Ann McDowell and Sima Rafati (New York: Springer, 2013), 30–31;
and Thomas G. Strickland, “Liver Disease in Egypt: Hepatitis C Superseded Schistoso-
miasis as a Result of Iatrogenic and Biological Factors,” Hepatology 43 (5) (2006): 916.

48 Ibid., 31.
49 Ibid., 23–24.
50 World Health Organization, “Egypt Leverages Domestic Funding to Eliminate Schistoso-
miasis,” November 29, 2016, https://www.who.int/news/item/29-11-2016-egypt-lever
ages-domestic-funding-to-eliminate-schistosomiasis (accessed March 1, 2021).

51 W. M. Emam and M. T. Khalil, “Population Dynamics and Stock Assessment of the New-
ly Introduced Crayfish (Procambarus clarkii) in the River Nile Egypt,” Proceedings of the Zo-
ological Society A. R. Egypt 26 (1995): 131–143.

52 Ahmed Abdelhalim Yameny, “The Evolving Schistosomiasis Agenda 2017–2020 in
Egypt: Moving from Control to Elimination,” Journal of Bioscience and Applied Research 3
(2) (2017): 52.

53 J. D. Maitland, British Embassy, Cairo, to R. S. Scrivner, North and East Africa Depart-
ment, Foreign Office, May 16, 1964, FO 371–178650, The (British) National Archives.
54 Fekri A. Hassan, “The Aswan High Dam and the International Rescue Nubia Campaign,”

African Archaeological Review 24 (3) (2007): 73–94.

55 Gilbert F. White, “The Environmental Effects of the High Dam at Aswan,” Environment:

Science and Policy for Sustainable Development 30 (7) (1988): 4–40.

56 For an in-depth treatment of the politics and environmental practices surrounding irri-

gation in one region of Egypt, see Barnes, Cultivating the Nile.

57 Harry Verhoeven, “The Grand Ethiopian Renaissance Dam: Africa’s Water Tower, Envi-

ronmental Justice & Infrastructural Power,” Dædalus 150 (4) (2021).

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Dædalus, the Journal of the American Academy of Arts & SciencesThe Dammed Body: Thinking Historically about Water Security & Public Health
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