Smoke Alarm from Afghanistan to Morocco: Fatwas against Cigarettes and a Smoke-Free Mecca Are Two Milestones in the New Effort the Countries of WHO's Eastern Mediterranean Region Are Making towards Lowering the Burden of Disease Caused by Smoking

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There are few things that Jordanian television cameraman Emad Odaileh finds more relaxing than a long smoke at his favourite coffee house in downtown Amman. Bathed in the fragrance of fruit-scented tobacco and the gurgle of Oriental water pipes or narghile as they are known here, Odaileh and his friends chat about the day's events while inhaling the smoke.

It's hard to get away from tobacco smoke in Jordan, or anywhere in the Middle East. Nearly everybody seems to be lighting up.

According to the World Health Organization (WHO), tobacco use is the world's leading cause of preventable death. Smoking is responsible for 5.4 million deaths yearly, with 4 million of those deaths occurring in developing countries--countries that can least afford the health-care burden.

Under WHO's Tobacco Free Initiative (TFI), the 21 Member States of WHO's Eastern Mediterranean Region, are stepping up tobacco-control efforts. The Initiative was launched in 1998 and WHO's Framework Convention on Tobacco Control (WHO FCTC), which is now one of the most widely supported treaties in the history of the United Nations, entered into force in 2005.

The moves can't come soon enough, according to Dr Fatimah El-Awa, the regional adviser for the Tobacco Free Initiative at WHO's Office for the Eastern Mediterranean Region, which is based in Cairo.

"When we talk about tobacco, some people still look at us and laugh, saying, 'Well, people are starving and dying from poverty and you're talking about tobacco.' But they don't understand that tobacco contributes to poverty."

With stronger tobacco control policies, including smoking bans expanding in public areas like restaurants in more parts of the United States of America (USA) and Europe, cigarette manufacturers are dumping their toxic merchandise in other parts of the world such as the Eastern Mediterranean Region, making tobacco control measures even more imperative, says El-Awa. The region comprises 21 Member States, from Egypt, Morocco and Tunisia in north Africa, through the Gulf countries, the Islamic Republic of Iran and the rest of the Middle East to Afghanistan and Pakistan in south Asia. It also includes Djibouti, Somalia and Sudan in sub-Saharan Africa.

"European countries and the USA wouldn't have moved forward with the policy of tobacco-free public places, restaurants and bars without a comprehensive approach that involves all sectors of government," El-Awa says, pointing to the public-area smoking bans in Belgium, France, Germany, Ireland, Italy, Spain and the United Kingdom.

El-Awa argues that until the countries of WHO's Eastern Mediterranean Region (EMR) adopt a comprehensive approach and government ministries work together, the region won't make similar progress to that in European countries. "It is beyond the authority or the capabilities of the ministries of health to work on tobacco control by themselves. They need partners such as the ministries of trade, finance and all other ministries that can help in strengthening tobacco control."

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"Once this is reached in our Member States, tobacco control will jump to a different level. Unfortunately, this is not the case at this time--at least not in all EMR Member States."

Indeed, in the Eastern Mediterranean Region each country displays varying strengths and weaknesses in tobacco control.

For instance, two of the most populous countries--Egypt and Pakistan--are making greater strides in their tobacco control campaigns with the aid of a US$125 million fund set up by New York City Mayor Michael Bloomberg in 2006.

The Bloomberg Initiative to Reduce Tobacco Use targets 15 developing countries where the health burden from tobacco use is the highest.

Egypt and Pakistan were awarded US$ 3 million in grants under the initiative, according to El-Awa. Egypt is using the funds to strengthen tobacco health warnings and to set up a special implementation unit at its health ministry. …