CAIRO, Egypt — A picture may be worth a thousand words, but many Egyptians are speechless over an image that recently hit the streets in this bustling capital city.
Last month, Egypt’s Ministry of Health unveiled their latest weapon in the war on smoking: a graphic warning label of a drooping cigarette, symbolizing the potential for tobacco-induced impotence, plastered on every pack sold throughout the country.
Next to the picture of the limp butt, a statement in Arabic warns, “long-term smoking will affect marital relations.”
It wasn’t the first such graphic message to illustrate the dangers of smoking, but for many Egyptian men, it was the first they had heard of a connection between impotence and tobacco.
And among some of the heaviest smokers, confusion gave way to bravado.
“We know smoking is not good for the health, but I can’t believe this,” said Nadir Abdel Rahim, 40, from the Darb el-Ahmar neighborhood. “I’ve been smoking 22 years, and I work just fine. Very fine, actually.”
But in this male-dominated society, many men were more concerned for Egyptian women, shocked that they could so easily see a reference alluding to sex.
Mohamed El-Gamal, 33, from the working class Sayeda Zeinab neighborhood, said he’d never let his sisters near the warning label.
In a conservative society like Egypt, for both Muslims and Christians, speaking openly about sex in public is frowned upon.
Women, who constitute only a tiny fraction of Egypt’s smoking population, were also embarrassed and offended by the "racy" image.
“What were they thinking to use a picture like this?” said Sally Kandil, 32, a smoker of 13 years. “It’s just too much for a country like ours,” she said, hiding a giggle.
It was a bold move by a government eager to curb a growing phenomenon that seems to be such a routine part of life in Egypt.
Smokers have almost free reign, whether in restaurants, at the cinema, in between train cars or even while waiting at the doctor’s office. Being offered a cigarette from a stranger on the street is as common as an invitation to a cup of tea.
Shisha, a water pipe that burns flavored tobacco, is also popular throughout Egypt’s ubiquitous coffee shops. One long shisha session can expose users to the smoke equivalent to five packs of cigarettes, according to statistics from the World Health Organization.
Egypt’s Parliament started getting serious in 2007, passing an anti-smoking law in conjunction with the country’s signatory status on the WHO’s Framework Convention on Tobacco Control treaty.
The measure banned smoking in many public places, including hospitals, schools and government facilities, according to Hamdy El-Sayed, the lawmaker who wrote and introduced the law.
The law also introduced four graphic warnings for cigarette packs, starting in 2008, rotating every six months.
Shocking the culture with the warnings, however, isn’t necessarily a bad thing if it makes people quit, according to Dr. Fatimah El-Awa, regional advisor on tobacco control at the WHO.
“The issue of fertility is of great importance to Egyptians,” El-Awa said. “And linking this to tobacco will make a big impact on the users here.”
But making even a small impact will be a big challenge.
Egypt is the largest consumer of tobacco in the Arab region.
Nearly 40 percent of adult men are smoking 19 billion cigarettes a year, according to recent statistics by the government. The average household spends almost $20 a month on tobacco, a staggering amount in a country where nearly one-fifth of the population lives below the poverty line.
It can’t be easy when one-third of medical professionals in Egypt smoke.
“Yes, there are many challenges. The level of social acceptance for smoking is very high,” said El-Awa.
Politically challenges persist as well. With a few exceptions, the law banning smoking is rarely enforced, even inside government buildings and hospitals.
Smuggled Chinese cigarettes — without Egypt’s warning label — have also flooded the market, according to El-Sayed.
“We are frustrated. The government is not totally committed to the fight on smoking,” said El-Sayed. “I think they have a lot of other problems and they think this is not something they should be focused on.”
Anti-smoking advocates in Egypt take comfort in the fact that graphic warnings are working in countries like Canada, China, Thailand, Brazil and others with heavy smoking populations.
Certain images may offend people, but sometimes “a little vividness and reality-checking is necessary,” said Dr. Geoffrey Fong, the principal investigator at the International Tobacco Control Policy Evaluation Project.
Still, questions on the warning’s effectiveness in Egypt remain.
A 2008 government report, issued just months after the release of the first graphic warning, found they were having no effect on tobacco sales.
Hamdy El-Sayed worries that Egyptians offended at the limp butt image will continue smoking, covering or tearing off the label. Sales of cheap, cardboard covers with artistic designs spiked immediately following the launch of graphic warnings.
“That picture in a conservative society — I don’t think it was received very favorably,” he said. "I don’t think it will last long.”