Shisha in Cairo

Anyone who has ever spent any time in a Cairo taxicab, restaurant, office, lobby, coffeehouse, cafeteria or university, or even at the zoo, knows just how ubiquitous smoking is. “There is a movement to be tobacco free in the whole world,” said Ehab Assad, a tobacco control officer in the Egyptian Ministry of Health. “We cannot be away from this

Mr. Assad said that as a first step the government late last month banned the shisha, or water pipe, in cafes of the crowded Khan el-Khalili marketplace. But just a few minutes after the government boasted of the ban, hawkers were swarming tourists at the Khan, waving restaurant menus, offering what else but shisha. They were selling apple-, orange-, lemon- and cherry-flavored, tobacco-filled pipes for 10 Egyptian pounds, or about $1.80.

Such is the early fate of the antismoking effort. Shisha is back in the Khan after a brief ban, and all around Cairo there is confusion as to what exactly the government is planning. “The End of Shisha?” read a headline last month on the news Web site Al Masry al Youm. So far, smoking continues unabated.

“It won’t work,” said Ahmed Mabrouk, 28, who took long, slow drags from a water pipe in the historic El Fishawy Cafe, nestled in the winding alleys of the Khan. “People love smoking shisha.”

Egypt, like many developing countries, has a smoking problem. Tobacco is cheap, and pastimes are few. A pack of Cleopatra cigarettes costs 45 cents, making smoking an affordable pursuit in a country where half the population lives on less than $2 a day.Shisha, brought to Egypt by the Ottoman Empire, has been here only about 200 years, a nanosecond for an ancient society, but long enough to have been embraced as part of the culture. Poor people smoke on the street and in alleys; wealthy people sit in cafes and restaurants.

Reliable statistics are notoriously difficult to come by in Egypt, but there is growing sentiment in the government that the political benefits that come from cheap tobacco — keeping people happy and their hands busy — have been offset by a recognition that the health costs associated with smoking are a burden on the state, health officials said.

In 2007, Parliament banned smoking in public places. The law was never enforced. One reason, health officials said, was that it was not clear who had enforcement responsibility. Another was the lack of political will. Yet another was the persistent and institutionalized inability of government agencies to communicate well and work together, health officials said.

“Some say that the population suffers lots of problems, and if we prohibit this, they will reject it,” said Dr. Aisha Aboul Fotouh, a consultant to the Health Ministry.

Health officials warned in 2006 that the communal aspect of smoking shisha — friends sharing the same pipe and shopkeepers reusing the same water between customers — were conduits for passing tuberculosis. The World Health Organization said that in Egypt, 31.6 per 100,000 people had the disease in 2005, and the rate of new cases that year was estimated at 25 per 100,000 people.

The warning, like the law, was ultimately unheeded.

So this year health officials decided to turn to Egypt’s main power: the National Democratic Party, the governing political party of President Hosni Mubarak. Mr. Assad and his supervisor, Sahar Latif, the general secretary of the National Program for Combating Smoking, said they sent a letter to the party asking for political support.

The party delivered.

It set an example by having, for the first time, a smoke-free gathering for its recent annual convention, Mr. Assad said. But it also hit on a way to persuade people to put down their pipes. While the country was in a panic over swine flu, caused by the H1N1 virus, having already shut schools and culled hundreds of thousands of pigs, the government began telling people that shisha was being banned to prevent spread of the flu.

“If you tell them that shisha is harmful, they say ‘See you later,’ ” Mr. Assad said. “But they are so worried about H1N1, if you tell people they can get H1N1 from shisha, they will stay away from it.”

True?

“Eh,” Mr. Mabrouk said, flicking his hand dismissively as he smoked in El Fishawy Cafe.

Not even swine flu could come between Egyptians and their shisha, it seemed.

“This is just going to give some people more authority now to go after those poor citizens who take out their daily worries with the smoke they blow out of their mouth,” said Saad Eddin Muhammad, 48, an electrician, as he stood in a tiny shisha house in the Zamalek neighborhood.

In response to the national party, five governors issued differing orders. In Alexandria, for example, health officials said cafes had one month to make plans before they had to end shisha smoking indoors. In Cairo, the governor banned shisha at the Khan, but relented under pressure from shopkeepers whose businesses were crippled, local merchants said. The compromise was that all water pipes were to be fitted with disposable tubes and mouthpieces, merchants said.

But the ban was reversed and health officials were not notified. The reversal was not the product of a government process, but a top-down decree, said political analysts and social commentators.

“The main issue here is that we don’t have democracy. Accordingly, our responsible ministers are not elected; accordingly, they don’t really care about what they do to their own people,” said Alaa al-Aswany, a best-selling author and social critic.

“I am telling you that the shisha will continue,” he said.

Ms. Latif and Mr. Assad of the Health Ministry are determined to make good on that 2007 law. They said they were training 100 inspectors to begin carrying out the law, first in places like hospitals, where there is apparently still a smoking problem, and then in cafes. Mr. Assad said they would offer incentive pay to prevent the inspectors from taking bribes to look the other way, a problem that plagues enforcement across the bureaucracy.