Indigenous Medicine Among the Bedouin in the Middle East

Aref Abu-Rabia

• Publisher: Berghahn Books
• Year: 2015
• ISBN:
  9781782386902
• Edition: 1
• Topic: Scienze sociali
• Subtopic: Studi sullo sviluppo globale

Modern medicine has penetrated Bedouin tribes in the course of rapid urbanization and education, but when serious illnesses strike, particularly in the case of incurable diseases, even educated people turn to traditional medicine for a remedy. Over the course of 30 years, the author gathered data on traditional Bedouin medicine among pastoral-nomadic, semi-nomadic, and settled tribes. Based on interviews with healers, clients, and other active participants in treatments, this book will contribute to renewed thinking about a synthesis between traditional and modern medicine — to their reciprocal enrichment.

Chapter 1

Health and Health Services among the Bedouin in the Middle East

This chapter discusses the health situation, the environmental and cultural origins of the prevalence of diseases, and other matters of health and illness among the Bedouin tribes in Middle Eastern countries during the twentieth century. It also examines the topic of access to state health services in contemporary times, country by country.

Historically, the state has traditionally dominated indigenous peoples. This is also largely true in the contemporary world. They may displace or eliminate them, integrating them into the state or compelling them to pay tribute. In countries where documentation is available—even in contemporary times, indigenous people who have been integrated into the state have lower life expectancy, lower income, and poorer health than nonindigenous inhabitants (Kunitz 2000: 1531).

Health policymakers should be responsive to the diverse needs within the population of their country. Health systems should adapt to changing demographic patterns, such as ageing populations in industrialized countries and the movement of migrants between countries (Healy and McKee 2004). In other words, health services should not be the province of the dominant population group only. The right to good healthcare is inalienable and universal, and implies equitable access and use, based on the premise that some people will need more healthcare than others and that inequalities in health outcomes should be kept to a minimum. The primary components of a just healthcare system are universal access, access to adequate and responsive care, and fairness in financing (Benatar 1996; World Health Organization 2000). Health disparities are measured in terms of variances in morbidity, mortality, and access to healthcare among different population subgroupings that are defined by factors such as socioeconomic status, gender, place of residence, and especially race or ethnicity (Dressler et al. 2005: 232). Despite efforts by international health agencies to reduce global health inequalities, indigenous populations around the world remain largely unaffected by such initiatives (Hurtado et al. 2005: 639).

The right to medical services has been recognized as an essential element of “the right to health” by the international community (CESC 2000: 43). State legislation and policies that ensure the right to health in practice must take into account four core elements: availability, accessibility, acceptability, and quality. Availability is defined as the presence of sufficient health and public health facilities, goods, and services. The concept of accessibility to facilities, goods, and services is based on nondiscrimination, physical and economic potential, and access to information. Acceptability relates to issues ranging from respect for medical ethics to respect for cultural differences. Quality refers to the level of medical and scientific services and their suitability to a given population’s needs and culture (CESC 2000: 12).

There are objective obstacles to providing these core elements to pastoral peoples. The long distances between nomadic groups make delivery of healthcare services relatively expensive (Imperato 1974: 443-457). Sedentarization is considered an important catalyst for different types of change (Salzman 1980: 1–20). Indeed, policy advocating permanent settlement of the Bedouin has been pursued by various countries in the Middle East, largely motivated by two goals: (1) the desire to subordinate the Bedouin to the needs, laws, and ordinances of the state, and (2) the desire to improve the Bedouin’s economic, social, health, and educational status (Abou-Zeid 1979: 283–90; Abu-Rabia 2006: 865–82; Awad 1959: 27–60). Bedouin throughout the Middle East, who in the past lived nomadic lives, are now either seminomadic or live in permanent settlements planned by the authorities, or in unplanned, spontaneous settlements composed of temporary dwelling of various types. The permanently settled Bedouin have adopted modern patterns of life, while the seminomadic continue to migrate seasonally with their flocks, returning to their permanent dwellings at the conclusion of the migration season (Abu-Helal, Shammut, and Naser 1984).

Many studies have shown that improving healthcare accessibility to pastoral nomadic communities is problematic due to their movements, mobility, and the fact that some of them live in geographically marginalized, sparsely inhabited areas, while modern health services are located in urban towns and cities (Swift, Toulmin and Chatting 1990; Hampshire 2002); sometimes these services serve relatively wealthy communities while excluding rural and marginalized communities (Philips and Verhasselt 1994). From the 1950s onward, organizations such as the WHO, FAO, ILO, and UNESCO have recommended sedentarization of nomadic Bedouin in order to promote their health, education, and socioeconomic development and integrate their economy into national trading networks (Bocco 2006: 302–30) and in particular to eradicate diseases such as malaria and tuberculosis.

Research on the health of nomadic pastoral communities presents mixed results. Most studies on the health and nutritional consequences of nomadic pastoral sedentarization in Kenya, for example, have reported negative effects including poor nutrition, inadequate and unhygienic housing, lack of clean and sanitary drinking water, and high rates of infectious diseases including anthrax, bilharzia, and malaria despite better access to primary education and healthcare services (Duba et al. 2001; Nathan et al. 1996). Other studies have found, on the other hand, that children and women living in nomadic pastoral communities had significantly lower levels of malnutrition and morbidity than those in settled communities (Roth, Nathan, and Fratkin 2005: 173–208).

Since ancient times, the unique geographic position of the Middle East has affected its development in a host of domains. Throughout history, inhabitants of the region have been influenced by their sociocultural, economic, and political contacts as well as military ties with neighboring civilizations to the north and the south. At the same time, the Middle East has served as a land bridge between the east and the west in the movement of traded goods. As a result of these contacts, from a health standpoint, Middle Eastern peoples have traditionally been unduly exposed to communicable diseases originating beyond their borders (Abu-Rabia 2005c: 383–401). Within this context, pastoral nomadic Bedouin lived difficult lives, and their health and life expectancy were low (Bhattacharya and Harb 1973: 266–69). They suffered from poor health due to diseases and environmental health conditions, inadequate hygiene, malnutrition, and the effect of a herd culture that exposed them to a host of parasites and disease-carrying mosquitoes.

Public health theories claim that poverty leads to poor health (Smith 1990: 349–50). For example, in a self-help settlement in Cairo, studies found that the tighter the household resources, the more disadvantaged the female children were (Tekce 1990: 929–40).

The role of environment in health among pastoral peoples of the Middle East is significant. Ecology in the broadest sense denotes the dynamic interrelationship between a community and its total environment. According to Weiner, “[t]he environment represents the totality of the surroundings in which the community finds itself, and includes physical and living elements, that is, the geology, topography, and climate of the terrain and its communications; the vegetation cover and the insect, animal, and bird life” (1977: 389).

As a result of environmental conditions, the Bedouin in Palestine have suffered from various diseases during the last centuries (Abu-Khusa 1976: 70–71, 1979: 106–13; Levy 1998: 478–512; Karakrah 1992; Reiss 1991; Singer 1996: 189–206). For example, the incidence of eye diseases among nomadic pastoral Bedouin was high (Kay 1978: 29–32; Lipsky 1959: 262–66). Many local climatic factors and environmental conditions favored the spread of trachoma: intense sunlight, high temperatures, and low precipitation, all of which creates a dusty, semiarid-to-arid environment with a limited supply of fresh water, conditions that are exacerbated in spring and fall by seasonal searing-hot southeasterly winds (khamsin) that bring dust from surrounding deserts as far away as the Sahara (Abu-Rabia 2005c: 390). The Bedouin of the Negev and Sinai call this the eastern wind (shargiyih, am-Salih). Among the Rwala¹ tribes (Musil 1928: 10–18) during the winter season, the east wind (shargiyih) generally blows for only three or four days. Towards the end of spring and early summer seasons the east wind is especially strong, blowing for as long as seven days and nights. It is called semum.² It is exceedingly dry and hot, and causes much suffering, especially among women and children. They would all perish if it blew for more than seven days. The debilitating power of such winds is reflected in martial arts: Among the Rwala (Musil 1928: 542) when the first riders arrive the attacked herds must, together with the herdsmen, repel the enemy’s first attack. Which direction the wind blows is a crucial factor in this endeavor: if they have to fight against a wind blowing dust and sand in their faces, they are at a great disadvantage relative to the enemy. But once the cavalry is engaged at close range, they can attack the enemy from the rear as well, and the direction of the wind no longer matters.³

There are cases where there is abundant summer rain, but while this rain can fill both natural and artificial reservoirs, such water soon swarms with frogs, and all kinds of larvae that render it foul smelling and undrinkable within a short time. When winter and spring rain is abundant, everyone bathes, clothes are washed, and parasites of all kinds are destroyed. Young people hasten to the waterholes (ghudran) for their ablutions. Girls and boys bathe in separate locations (Musil 1928: 14–15). Watering of the camels is carried out at various rain pools and reservoirs in the same way as at the wells—at drinking troughs. Only at the large pools (khabra, pl. khabari) can whole herds go right into the water and drink, but the camels defecate while drinking, and consequently such pools are quickly contaminated. Along the edges of the pool, a layer of manure forms; the water smells of urine and turns yellow and brackish (Musil 1928: 340). Musil (1928: 666) tells of diseases that the Rwala suffered from primarily in the months of July and August. The places where they camped, such as Kerayat al-Meleh, were notorious for their ague⁴ (hemma) and malaria. In al-Juba the flies were a real annoyance, likewise the strong winds that blows blew continuously, whirling up fine sand and dust that is injurious to the eyes and nose. Therefore the Rwala prefer to camp in either the Nefud or al-Hamad where the air is both clear and more hygienic.

In the early twentieth century, due to shortages of water or limited water use due to great distances of houses or tents from water sources, hygiene and sanitary conditions among pastoral nomads were very poor. During the British Mandate period in Palestine (1917–1948) and Jordan, the British government made efforts to secure water supplies by drilling wells, but when ample water was found, it was highly saline, and when fresh water was found, the flow was too meager to be useful in changing lifestyle patterns (al-’Aref 1934: 269–83; 1944: 184–86; Shimkin 1936: 315–41). Thus, pastoral nomadic Bedouin continued to rely on and maintain their traditional water sources: wells, cisterns, or thamila⁵ (al-’Aref 1934: 22–34), all of which played a role in the spread of disease.

Historically, pastoral nomadic Bedouin of the Middle East have been highly dependent on their herds for food (Abu-Rabia 1994a: 107–27, 1999b: 22–30). The primary source of protein is their livestock. Low milk production or insufficient herd size due to drought, disease, or economic circumstances constitute a threat to the availability of essential protein (Roboff 1977: 421–28). Malnutrition makes children more vulnerable to whooping cough and measles. Bedouin of all ages during the twentieth century were more susceptible than sedentary populations to parasites and malaria, anemia and vitamin-deficiency diseases, trachoma, venereal disease, mental illness, diarrhea, dysentery and cholera, tuberculosis, and broncho-pulmonary infections (Roboff 1977: 421–28).

In the early twentieth century in Arabia the diet of the Bedouin was tied to socioeconomic status, which ranged from wealthy sheikhs to the very poor (Dickson 1951: 190–200). Diet was based on the following foods and dishes: rice cooked with sesame (semsen), sour milk (leben), dates (tamr), camel, sheep or goat milk; flat bread (including bread prepared from wheat grown locally in the Najd region), okra (bamia), locust,⁶ edible monitor lizards (dab), and wild game of all sorts—from birds to foxes. Seedless sultana raisins (zabib, zibib) are used in cooking. A sweet milk pudding (mahallibi) was made of ground rice or arrowroot cooked in milk, and flavored with cardamom and chopped pistachio nuts or mixed with saffron. Main meals consisted of crushed corn and meat porridge (haris)—a very nourishing dish, and, on rare occasions, rice and a bit of meat. Mushrooms (ftur) and truffles (fagah) were eagerly sought after and eaten in the rainy season, but these were a luxury.

Cooking fires in the early twentieth century used dry camel dung (jallih) or brushwood (‘arfaj).⁷ Bedouin traditionally drank coffee well laced with cardamom (hayl) prepared in coffeepots; a piece of hemp or palm tree fiber (lifa) is stuffed into the spout to act as strainer. Usually the host pours a small quantity of coffee into a cup for himself first and drinks it to demonstrate it has not been poisoned. The best and most expensive coffee beans come from Yemen (Dickson 1951: 200–201). According to Dickson (1951: 416), the hump is the most edible part of the camel, and this is also the Arab opinion. Camel milk is drunk throughout Arabia, and it is extremely nourishing and low in fat content and therefore yields no butter.

Most of the research literature assumes that nomadic populations are generally healthier than neighboring sedentary populations. During periods of drought, however, some nomadic groups become increasingly vulnerable to health problems due to the depletion of their food stores (Greene 1975: 11–21; Seaman et al. 1973: 774–78). Studies that compared health of nomadic, seminomadic, and settled Bedouin in Saudi Arabia have revealed a significant variation in the health status of children under age five. In a study of the Turaba in Saudi Arabia, Sibai (1981) noted that nomadic and seminomadic peoples received little or no healthcare. Nomadic children were more prone to malnutrition and parasitic as well as communicable diseases. When nomadic peoples migrate to urban centers, they face difficulties in acclimating to new patterns of hygiene and sanitation that run counter to “natural methods” of dealing with waste through migration practiced by nomadic peoples. Nomadic peoples are also more prone to epidemics due to overcrowding in the poor neighborhoods and are highly vulnerable due to poor nutrition and low resistance to disease. Low population densities and frequent mobility, on the other hand, significantly reduce the occurrence of epidemic diseases, and natural selection develops high levels of disease resistance. Healthy people are those who survive. Tribal societies maintain public health by emphasizing prevention of illness rather than treatment (Bodley 1994: 124). When pastoral nomadic peoples are forced to leave their homes to adjust to new environments and new livelihoods, they face psychosocial stress that is often amplified by the absence of support groups—close kin and friends who can ease a difficult adjustment—a situation that can result in an increase in health problems (Roboff 1977: 421–28; Sadalla and Stea 1982: 3–14).

During the twentieth century the population of the Middle East changed significantly in terms of urbanization, social development, political structures, economic development, and ethnic borders, as well as the diversity of Middle Eastern ecology due to advances in arid and semiarid agriculture. These changes are reflected in nutritional and health outcomes. While urbanization is usually associated with better health and better food supply, in fact poor urban dwellers in the Middle East may face a worse quality of life than rural dwellers. Health in the Middle East is closely associated with the availability of safe water and sanitary conditions (Galal 2003: 337–43). Health dynamics in the Middle East have shifted, parallel to similar global health trends, towards lower mortality rates and longer life expectancy. At the same time, poor diet patterns during childhood and adulthood continue to expose individuals to illness and premature death due to various types of morbidity. Lack of health services for children in the Middle East is a contributing factor to malnutrition, more than poverty or food insecurity. Lamb is the primary source of meat, but mutton is traditionally consume...