Five years might be long enough for some people to forget things …quot; or at least for them to fade from their minds. But that's not true of Amm Ahmed, who tearfully recalls every detail of the day his little boy died in 2005. What made it worse was that the father was to blame. Ahmed, a bawwab (a doorman) from Fayyoum in southern Egypt, lives with his wife in a tiny room under the stairs of the building where he works. They were delighted when his wife gave birth to their first baby, Mohamed. "I was so happy," says 40-year-old Ahmed, who, like many other Egyptian, smokes …quot; or rather used to smoke. In fact, he chainsmoked …quot; in the street, at his work and of course in the tiny room where his family lived, as his tiny infant started to open his eyes on the world around him. "One day, I found him motionless on the bed. His eyes were closed and he wasn't smiling as usual. I took him to a hospital, where they told me that my smoking had killed him. I can never forgive myself for killing my child," he told the Egyptian Mail in floods of tears. "In communities where a man is considered the head of the family, wives and daughters have little control over family finances and will also be disempowered from controlling the way in which money is spent on tobacco or the way in which second-hand smoke affects the family," said Dr Rangita de Silva de Alwis, Director of the International Human Rights Policy at Wellesley College, the US. "In a stark example of the way in which essential family needs are often subordinated to tobacco, households in Bangladesh spend more than ten times on tobacco what they spend on education," she added. "When more money is spent on tobacco than on education, it is often the girl child's education that is most neglected. Money spent on tobacco can often be used to cover the 'bare necessities' of life including the girl child's education," she added in a recent seminar held in Cairo entitled ‘Tobacco and Human Rights'. In her study ‘The Human Rights Based Approach to Tobacco Control', which she referred to in the seminar, Dr Rangita says that the integration of international human rights norms into judicial decision-making provides as an important forum to develop frameworks for the application of international norms on tobacco control in domestic jurisdictions. Through public interest ligitation, which has fuelled many social movements and challenged traditional concepts of lawyering, lawyers should use human rights law in the judicial forum to advance the right against tobacco use and tobacco companies. Human rights provide the normative basis for the claim that the right to health involves removing socio-economic obstacles to health and wellbeing. Similarly, the right to health and food can exist only in a context in which social and economic rights, as well as civil and political rights, are respected. These underlying conditions form the basis for the right to health, food and a clean environment, which are threatened by the sale and consumption of tobacco. The explosion of global tobacco markets has also led to greater need for international law and international human rights law to regulate tobacco use. "When I came to Egypt, I was shocked by the number of women who inhale sheesha (a water pipe). This is a regrettable part of Egyptian culture. Many local women consider smoking sheesha to be a kind of liberation," she said. The WHO estimated that the number of women who smoke will grow to over 500 million worldwide, and more than 200 million of them will die from tobacco-related diseases. It's estimated that, while smoking will decrease among women in developed countries, developing countries will exhibit the greatest growth in smoking rates among women. Studies reveal that cigarette smoking is more harmful to women than men. While smoking reduces men's lives by three years, it reduces women's lives by eleven years. Apart from harm caused by direct smoke, Dr Rangita explained, women are often the victims of second-hand smoke. Given that the majority of smokers in the developing world are men, passive smoking has a disparate impact on women's physical health. As a result, she added, women and children in the developing world face severe risks of disease and even fatality due to prolonged exposure to second-hand tobacco smoke. "The Convention on the Elimination of Discrimination against Women [CEDAW], which helps protect women from discrimination and abuse in both the private and public spheres, is a usual lens with which to examine women's rights with respect to exposure to second-hand smoke. "Exposure to second-hand smoke directly increases the risk of fatalities among them and, therefore, it can be analogously redefined as a form of violence against women under CEDAW," Rangita stressed. Undernutrition as an indirect consequence of tobacco deserves as much attention as the direct consequences of smoking on health. In low-income households around the world in countries such as Egypt, surveys show that 5-15 per cent of their disposable income is spent on tobacco. Women's education is an important tool in combating tobacco use in the developing worlds, say experts. "Not only is education a key for development and the most effective way out of the cycle of poverty, it may also be the most powerful vaccine against tobacco. The tobacco industry thrives on those who have limited access to information about the risks associated with tobacco," she said. The effect of passive smoking on children has been well documented by the WHO. Smoking by the mother as well as second-hand smoke has deleterious effects on parental and postnatal health. Tobacco affects the reproductive rights of women and violates the reproductive health guarantees enshrined in the Convention on the Rights of the Child (CRC) and CEDAW. "Infants whose mothers smoke have lower than average birth weight. Sudden infant death syndrome is also common among babies exposed to second-hand smoke. Smokers who breastfeed may find it difficult to produce the same amount of milk as the non-smoking mother," Rangita revealed. The CRC can be read broadly as prohibiting the exposure of children to tobacco as part of the principle of the best interests of the child. Similarly, in a range of cases in the US, smoking of a parent was taken into consideration in custody cases. She gave an example the fact that a court ruled that even a parent's constitutionally protected right may be restricted upon showing that the parent's activity may tend to impair the physical health of the child. In a case where a 13-year-old demanded that his mother quit smoking in his presence, the New York Family Court ruled that the best interests of the child dictated that he was not to reside in or visit or occupy any residence of the parties in which smoking of any type occurs at any time. An anti-smoking bill was passed in Egypt in June 2007 as part of an effort to reduce the number of smokers in the country. The new legislation extended an existing ban on smoking in public to cover more enclosed spaces such as health and educational institutions, youth centres, legislative associations and all governmental buildings and clubs. A ban on smoking by minors was also passed. However, it is not sufficient. "These legislative changes are not strongly enforced in the country, with there being many ways for people to bypass them. Most newsagents/tobacconists sell substantial amounts of tobacco products in their kiosks and do not require identification from customers any more than they did before the smoking ban for minors was passed," said Egypt's Minister of State for Family and Population Moushira Khattab. She added that Egypt was one of the cheapest countries in the world to purchase cigarettes. The prices of tobacco are low enough for children to afford it. "The Egyptian Government can increase the price of tobacco if they want to. In Egypt you can find a packet of Cleopatra cigarettes for the equivalent of 50 cents," said the official. "Even the power of NGOs to raise awareness about the hazards of smoking is weak compared to the giant tobacco companies," Moushira added. Last Ramadan, the holy Muslim fasting month, there were around 60 soap operas screened every evening after Muslims had broken the fast. In every single serial, actors and actress smoked cigarettes or sheesha. "This is no coincidence. After the law prohibited tobacco advertisements, serials watched by millions of Egyptian of all ages have become the ideal way to advertise these products," said Minister Khattab. "The human rights framework has galvanised a powerful women's and children's rights movement which can be cross-fertilised with the tobacco control movement for greater impact to challenge tobacco consumption, second-hand smoke exposure and the unethical marketing of tobacco." In her view, using the human rights framework can revitalise tobacco control and provide broader mechanisms to prevent tobacco. "Moreover, a human rights approach would bring together a broader alliance of NGOs, including ones working on women's rights, environmental protection, poverty rights, employment rights and health rights, as well as those engaged in examining the consequences of globalisation …quot; to engage in combating tobacco," the Minister concluded.
