A hookah set complete with apple-flavoured tobacco has become compulsory hand luggage for many tourists returning from a holiday in Egypt.
But as trendy hookah lounges are flourishing from Europe to California, the "hubbly bubbly" addiction is also gaining ground in the homeland of shisha-smoking and causing growing concern among health officials.
"Because it goes through the water before you inhale, I think it's better for your health than cigarettes," said a young Dutch tourist, drawing hard on a waterpipe in Cairo's Khan al-Khalili bazaar.
PHOTO: AFP
"I like it and it's a nice object to have in your living room," she added.
Health experts would beg to differ. They argue that the waterpipe makes for a rather macabre souvenir as they try to shatter the harmless image of a habit spreading fast among new categories of society.
"It's not just a trend in the West, it's becoming more and more popular in the region too," said Dr. Fatima el-Awa, from the World Health Organisation's regional office.
"The shisha problem has long been ignored but the facts are startling," said the doctor, in charge of the Tobacco Free Initiative.
"One hour with a shisha is equivalent to something between 100 and 200 cigarettes," Awa said, explaining that for a similar nicotine intake a shisha exposes users to more smoke than cigarettes.
Moreover, a WHO study found that the regular waterpipe smoker is exposed to larger amounts of nicotine, carbon monoxide and certain other toxins than the typical cigarette smoker.
It points out that the force needed to pull the air through the hose allows the smoke to reach much deeper into the lungs.
An Egyptian study headed by former health minister Awad Tageddin also established that waterpipes were largely responsible for reintroducing tuberculosis in the country.
Egypt is one of the countries in the world that is the most affected by tobacco use. "An average of 2.5 percent of household income is spent on tobacco in Egypt, which is more than on health and leisure," said Awa.
Pinned on her office wall is a fatwa by a former Egyptian mufti declaring smoking un-Islamic. "We need all the help we can get," she said.
Health Minister Hatem al-Gabali admitted he was concerned by the trend's devastating potential on the health system and said that a bill would be submitted to the new parliament session for a 10 percent tax on tobacco.
"Twenty million cigarettes are smoked every day in Egypt. There are no accurate figures for shisha but it is becoming a modern trend," he said.
"Shisha was never taxed before. The new tax on tobacco should generate about US$140 million to be directed to health insurance."
Awa also pointed out that shisha tobacco, unlike cigarettes, was not covered by any manufacturing regulation.
"There are very small factories producing. We need a set of specifications to control what people are actually smoking because right now we don't know," she said.
Shisha use is often conceived as a social occasion — during which smokers spend hours in homes or cafes chatting and passing the hose around — rather than a hard addiction.
But health professionals are increasingly concerned that burgeoning shisha smoking among groups where cigarette consumption was declining could produce new generations of lifetime tobacco users.
In recent years, fashionable hookah bars and specialized websites advertising a range of accessories — from the "monster cobra hose" to the "natural lemon wood charcoals" — have mushroomed in Western capitals.
Formerly a favorite pastime among the more modest strata of Egypt's male population, shisha smoking has recently become an integral part of the Cairo hip scene and widely adopted by young women.
"Girls who smoke cigarettes are badly perceived in Egypt but shisha is fun and it doesn't feel like it's that bad for you," said Hoda, a veiled 20-year-old woman puffing on a brightly colored shisha in a trendy cafe which offers cappuccino or cantaloupe flavored tobacco.
Known as "hookah" in India and Pakistan, the waterpipe goes by a number of other names, including narghileh in most other Middle Eastern countries.
The name "shisha" used in Egypt is a transformation of the word hashish, which harks back to the original purpose of the device.
At the Zahret Strand cafe in central Cairo, life appears to have frozen half a century ago and the health awareness campaign being launched across Egypt looks set to make little impact on the clientele.
Mohammed, a 61-year-old widower, dons his best suit and a neatly ironed white shirt to come to smoke his two shishas every night. "I have no doubt that it's bad for my health but it's my daily treat," he said.
"Something else will kill me if this doesn't. It's a matter for God to decide."
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