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The Spanish flu pandemic and its impact on the Middle East

Sir Mark Sykes would have had an agonising death as his body convulsed and contorted from the ravages of the Spanish flu.

It was 1919 and the British politician, diplomat and all-round swashbuckler was working at the Paris Peace Conference at Versailles when he retired to his hotel room in the French capital and died, on the evening of February 16. He was just 39.

Such was the unusual and virulent nature of this efficient killer that it was often initially misdiagnosed for dengue, cholera or typhoid.

A physician, based in Glasgow, Scotland, grimly described the stages of the virus as it took hold of the body, in a letter dated September 1918: "It starts with what appears to be an ordinary attack of la grippe. When brought to the hospital, [patients] very rapidly develop the most vicious type of pneumonia that has ever been seen… It is only a matter of a few hours then until death comes and it is simply a struggle for air until they suffocate. It is horrible."

Sir Mark was, in many ways, an unlucky victim of the H1N1 pandemic, which struck 100 years ago and claimed 20 to 40 million lives worldwide (current estimates suggest up to 100m), as the globe was still reeling from the horrors of the First World War.

Indeed, the man who was co-architect of the 1916 Sykes-Picot Agreement, which carved up the Middle East into colonial spheres of influence in a post-Ottoman world, may have been one of the very last victims of the virus. It was first recorded at Camp Funston, Kansas, in March 1918, and had largely burnt out by the summer of 1919 – but left vast devastation.

In the region where Sir Mark’s colonial legacy still stirs great controversy, countless people also perished from the deadly effects of the Spanish flu – so-called because the virus was first widely reported in the Spanish press.

Across the Middle East, the flu took lives as mercilessly as elsewhere. The global pandemic came in three waves, but it was the second, more virulent wave, which secured a deathly grip on the likes of the Ottoman province of Greater Syria (encompassing the modern-day states of Syria, Lebanon, Jordan and Palestine/Israel) around September 1918.

Remarkably, very little definitive and authoritative information exists about the impact of the Spanish flu in Greater Syria, but what does exist, paints an intriguing picture of a region buffeted by a conjunction of adverse events.

Kjell Jostein Langfeldt Lind's highly accomplished 2012 thesis, The Impact of the 1918 Spanish Influenza Pandemic on Greater Syria, from London's School of Oriental and African Studies, tells us that, "this mutated and virulent [second wave] presumably embarked on a ship in France or Britain and disembarked in the Egyptian port of Alexandria [in] September".

The Middle East was a region in conflict, with Britain’s Imperial war machine battling Germany’s Great War allies, the Ottoman Turks. Before the entirety of Egypt succumbed to the second wave in November 1918, Lind says the vast and unyielding troop movements in and out the region hastily spread the pandemic, with “Jaffa… in all likelihood the first point of entry for the virus on the Levantine coast [in September], carried by British ships from Alexandria or Port Said”.

Civilians and military troops alike were struck down by the contagion as it spread across Greater Syria’s sun-beaten lands where British legend T E Lawrence had set the desert on fire with his brave band of Ottoman-rebelling Arab irregulars. Troops from both sides of the war – British, Australian, Indian, Turkish and others – fell victim to the Spanish flu. The British Empire military formation of the Egyptian Expeditionary Force (EEF) experienced simultaneous epidemics of malaria and influenza in Palestine in October 1918 as it defeated the Turkish Army in a great cavalry campaign.

Lind also writes that, “Spanish influenza in Damascus, accompanied by malaria, put nearly half the Desert Mounted Corps of the Australian and New Zealand Army Corps (Anzacs) out of action” in the same month.

 Greater Syria’s civilian population fared little better. In a November 6, 1918, diary entry, the Spanish consul of Jerusalem wrote: “There are so many cases of pneumonia lately. The sadly famous flu transforms into pneumonia, and in three days one is making the trip to the next world… A girl only 20 years old… got a temperature of 43°C. She died, so to say, all burned up”.

Indeed, the untimely death of this woman (and that of Sykes, who was not yet 40) was another curious aspect of this killer virus. The young and fit perished at an astonishing rate due to their strong immune systems which, scientists say, went into overdrive and turned against them. The influenza bug also moved inland toward the Gulf, appearing in Arabia by late autumn 1918. Ibn Saud, the first monarch and founder of Saudi Arabia, called for the services of American doctor, Paul Harrison. He arrived in Riyadh and found that one-10th of the city’s 10,000 population had expired.

"The whole town was sick, so much that the bodies were carried out on donkeys and camels, two to a donkey and [illegible] to a camel," Harrison wrote, on January 18, 1919. Prince Turki, Ibn Saud's eldest son, was only in his late teens when he succumbed to the Spanish flu.

Iran was also hit hard during the pandemic – and here some academic research does exist. Amir Afkhami, associate professor of psychiatry and global health at George Washington University in the United States, says that going into 1918, Iran was essentially a "failed state".

This, as well as the fact it was being used as a battleground by various belligerent powers during the Great War, "sets the country up for famine in 1917 after two bad harvests", Afkhami says. "There were particular predispositions that made [Iran's] rural areas particularly vulnerable to the 1918 pandemic," noted Afkhami, author of Compromised constitutions: the Iranian experience with the 1918 influenza pandemic. "And that is primarily malnutrition, malaria and opium use… Biomedically – and this is a complete hypothesis – there's some evidence in the literature that anaemic individuals are more vulnerable to dying of influenza. And malnutrition, malaria and opium use tend to be correlated with anaemia."

Across both rural and urban areas in Iran, Afkhami estimates that the Persian State probably lost between 910,400 and 2,431,000 of its inhabitants. That is between eight and 21.7 per cent of its then-total population – placing it near the top of the Spanish flu mortality table.

Other almost-forgotten victims of the pandemic include Lebanese and Syrian immigrants to the US. Research conducted by the Moise A Khayrallah Centre for Lebanese Diaspora Studies at North Carolina State University, suggests that Syro-Lebanese immigrants suffered greatly from the virus, which claimed between 500,000 and 675,000 lives in the US.

"The fact that most of the [Syro-Lebanese] immigrants were young certainly contributed to the disproportionate number of deaths they suffered, since the Spanish flu attacked young people in particular," says Dr Akram Khater, centre director. "Immigration took a heavy toll on the bodies and minds of the [Syro-Lebanese] who came to the US. Even before the Spanish flu, immigrants were working long hours in hazardous conditions in unregulated textile mills, or peddling wares in towns and countrysides open to the vagaries of the weather and an alien social and ecological environment."

It is clear that people fell victim to the Spanish flu at an appalling rate across the Middle East. Civilian mortality rates in the Greater Syrian region itself were almost certainly high, even if little hard statistical evidence is available. But Lind notes that out of those 500,000 or so people who perished in Greater Syria from starvation or starvation-related diseases in the second-half of the war, a great many were surely victims of the influenza pandemic.

As for Sir Mark, a curious interest in his short life reemerged when his lead-lined coffin was dug up in 2008 in order to try to extract more information about the virus which killed him. Sadly, the coffin had split and scientists had to make do with inferior specimens. Yet, a diary entry on the day of Sir Mark’s death, written by a friend of the controversial colonialist, surely sums up the harrowing nature of the pandemic, which, during its reign of terror, killed anybody, anywhere, at anytime. “… [We] go to the Lotey Hotel to visit the remains of our friend. Wilson is prostrated with weeping. Lady Sykes receives us and thanks us. It is a terrible situation for this unfortunate woman, alone, in a hotel room, without relations or friends.”


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The facts:

For a virus, which most people pick up and go on to survive, the flu has a nasty habit of striking fear into our hearts year after year.

Should you fall prey to a particularly unpleasant strain of the virus – which kills between 250,000 and 500,000 people worldwide every year, according to World Health Organisation (WHO) estimates – fevers, body aches and a whole host of other maladies often bedevil your road to wellness.

The Spanish flu was dramatic in both the number of lives it claimed and the virulence of the strain itself. It touched all continents of the world – equally impacting both the northern and southern hemispheres.

The United Kingdom lost 250,000 people, while the
Pacific islands of Fiji, Tonga and (Western) Samoa were also left counting the cost of the virus. Samoa lost up to 20 per cent of its population in the pandemic. India, too, had an estimated death toll of more than 10 million, while up to two million lives were taken in sub-Saharan Africa.

▶ The 1918-19 killer was, however, not the final chapter of the world’s flu pandemic worries and woes.

▶ The 1957-58 “Asian flu” was an H2N2 virus that caused the deaths of up to two million people globally. The virus was thought to have emerged from a human strain of H2N2 combined with a mutant form in wild ducks.

▶ The 1968-69 “Hong Kong flu” – so-called because it was first reported in the semi-autonomous Chinese territory – was an H3N2 virus that killed about one million people worldwide.

▶ The 1997 “Bird flu” was an H5N1 strain of influenza virus that previously was known to infect only birds but which also caused illness in humans. The first outbreak in Hong Kong killed six of the 18 people infected. Hong Kong took just three days to destroy its entire poultry population of 1.5 million birds.

▶ The 2009 “Swine flu” outbreak was first observed in Mexico, and quickly made its way around the world. It was caused by a new strain of H1N1 and is thought to have claimed somewhere between 151,700 and 575,400 lives globally.

Today, stark headlines
recently proclaimed the arrival of the dreaded "Aussie flu" of the H3N2 variety. Indeed, the 2017 flu season in Australia was the worst the nation had experienced in nearly 10 years.

In the UK, the National Health Service (NHS) – so often under strain as it deals with an ageing population and a need for increased funding – has been struggling to deal with its inbound influenza cases.

At the time of writing, England has recorded 193 deaths this season, while 26 people are known to have perished in Scotland, and 12 in Northern Ireland. Bethany Walker, 18, from Scotland was among those who died after her flu symptoms developed into pneumonia.

So, how do you protect yourself against this season's flu, which has led to hospitalisations across the UAE? Leading experts say that, while it is not a full-proof plan, vaccination is key to reducing your chances of becoming bed-
ridden for weeks on end.

Hygiene is also a crucial tool to dodging the flu. However, should you go down with the flu virus, then stay at home and keep warm and hydrated until you feel well again.

Unpleasant as it is, the vast majority of us will endure this airborne horror-show and live to tell the tale. Just be thankful that you are not 100 years in the past, facing a flu bug with an exotic-sounding name.


Produced: Panorama Studios International

Directed: Abhishek Pathak

Cast: Sunny Singh, Maanvi Gagroo, Grusha Kapoor, Saurabh Shukla

Rating: 3.5 /5 stars