Celiac disease: the Saharawi epidemic | Planetary Future

It was during his first trip to Spain in 2001 that Gabal Rachid Breh was diagnosed with celiac disease, an immune system reaction to the consumption of gluten, a protein found in wheat, barley and rye. Until then, this Sahrawi refugee had been born and raised in the camps of Tindouf (Algeria) and did not know why her belly was swelling and hurting. “I was five or six years old and I went to Albacete with the Vacations in Peace program. I stayed three more months to get medical attention. I fell ill and in five months I got better. They gave me food. And in the 21 kilos of suitcase that I could bring back, I did not put any clothes, I only brought special food. I needed it. But in two or three months, he was sick again, with vomiting, diarrhea and discomfort, “he recalls.

Like her, 5.6% of Sahrawi children in the Tindouf settlements suffer from this autoimmune disease, a rate “almost ten times higher than in most European countries”, according to a study by the Cantabria Nursing Foundation, of 2018. The phenomenon is not new, already in 1999, an investigation published in The Lancet it gave the same results. Both documents point to genetic inheritance and a very poor diet as possible causes, however, neither gives a categorical answer as to why.

For Rachid, today a 25-year-old RADS TV journalist, suffering from this ailment in the context in which he lives is an ordeal. The food of the Sahrawi refugee population in Algeria has been completely dependent on humanitarian aid since 1975, when Morocco annexed the former Spanish colony of Western Sahara. The basic basket – lentils, flour, sugar, noodles or macaroni, oil and rice (which contains traces of gluten) – is rich in carbohydrates and low in protein, in short, incompatible with the special diet that celiacs must follow. “60% of the food they give us contains gluten, our disease is not taken into account. I think so much celiac disease has to do with our poor diet. We lack variety, what a human body needs. We live on humanitarian aid ”, the young woman analyzes.

During his childhood, Rachid continued to spend summers in Spain. “When I went, I came back better, with more weight, I developed. He arrived with 21 kilos and returned with 26 ″, he assures. “Here in the camps, I was going backwards. It annoys me that month-long children with this disease are going to go through the same process as me because they cannot go out to receive help, ”he is outraged.

He got older and, since 2011, Rachid has no longer returned to Spain. Neither in Algeria, where he studied high school and career, did he have continued access to special food. And, during the pandemic, almost two years in which humanitarian aid has come in a trickle due to border closures, it has been worse. “We have had little food. Almost nothing. From Spain and Italy. One kilo of gluten-free pasta a month is very little for someone who does not eat wheat flour. It lasts you 15 days eating a glass at a time ”, he says. “The difficulty makes me very angry. I have been hungry, I have lived a very hard process ”.

Products suitable for celiacs, which were already in short supply before the COVID-19 crisis, stopped reaching the camps. In the room where they are stored at the National Hospital in Rabuni, only a few bags of flour donated by Oxfam remain. It’s all that patients have. “There is no rice or noodles left,” laments Ali Mohamed Ali, a nurse from the celiac disease unit. The usual thing is that they receive three kilos of flour a month, plus another one of rice and one more of noodles. “The basic basket is of no use to them, almost everything has gluten,” he corroborates.

The celiac population in the Sahara camps in Tiduf, where there is a higher number than the average in other places, resume the project for the detection and control of the affected population that was left without gluten-free supplies during isolation by covid-19 .  Click on the image to see the complete photogallery.
The celiac population in the Sahara camps in Tiduf, where there is a higher number than the average in other places, resume the project for the detection and control of the affected population that was left without gluten-free supplies during isolation by covid-19 . Click on the image to see the complete photogallery. ÓSCAR CORRAL

Nor have they received in that closing time the tests with which the disease is diagnosed. For this reason, in Mohamed Ali’s office they were waiting impatiently for the first flight that landed last October 10 in Tindouf since the pandemic was declared in March 2020. Together with the 264 passengers they disembarked the reagents he needed to detect the ailment.

For two months, since the tests they had ran out, the four toilets in this unit were unable to consult. On the day they open their doors again, at eight in the morning, three-year-old Fatma Moh Ambarek waits in her father’s arms to be cared for. “They have brought it because it does not grow. He has anemia ”, explains Mohamed Ali while taking the data. The nurse explains to the parents that it can be for various reasons, that they have to undergo medical examinations to find out. He prescribes a blood test and, with the results, will evaluate a test. You can now.

I saw a three-year-old girl who looked like she was six months old. It’s a suffering

Gabal Rachid Breh, a Saharawi celiac

Fatimatu Alqauz, 11, weighs 34 kilos. She has arrived accompanied by her father from the Smara camp. “He is underweight and is chronically constipated,” explains the doctor. Mohamed Ali asks the parent if he is celiac himself. “In 70% of the cases, one of the parents is,” he says. Although he has other suspicions: the girl has yellowish skin, which indicates that she may have hepatitis. “You have to analyze.” They will do a complete study to see if she has celiac disease and refer the case to the pediatrician to examine if her liver is working well.

Consultations and tests that are retaken after isolation

Another six people wait outside to be seen. In total, you will see eight cases this day. The medical team visits once a week on Sundays. On the first and second of the month, patients go to the hospital; the third, the sanitarians move to Dakhla, the district further out, with a refrigerator to collect samples. The fourth is to give the results. As a rule, when 90 people suspected of suffering from this pathology are brought together, they do the tests, since it is the amount of reagents contained in a package that, once opened, must be used in its entirety or discarded what is left over. “We cannot open the reagent for a few cases, but 90 or one package per month (and whatever there are). Sometimes there are 30, but we have to do it, “he says.

“We have a very fragile system, dependent on humanitarian aid. And with the closing of borders, everything stopped. We have lost the plan for chronic diseases, such as celiac disease. We have not even been able to comply with the protocol for those admitted for covid-19 because we do not have the treatments indicated by the WHO. We have been doing tests with a device donated to us by the Spanish Association of Pulmonology for the control of tuberculosis ”, laments Hafdala Salem Brahim, president of the medical college and central director of medical assistance. “Chronic ailments depend on medication; celiac disease, a strict diet; However, if that is lost, you no longer have the disease under control and now you have to start over; we lose our jobs for years. Diabetes and hypertension have increased, ”he observes.

Salem Brahim points out that more patients have come to the emergency room with symptoms such as diarrhea, malaise, gastritis. “We have had a bad time these months.” Before the pandemic, three humanitarian caravans arrived a year, during the entire health crisis – 18 months until that first flight landed in Tindouf – two have arrived. “The first one spent months in a port in Spain and many products expired. They were in iron containers not suitable for the cargo they contained. Upon arrival, they were spoiled. “

A trained dentist, Salem Brahim chose this specialty because, when he went to Cuba to study at the age of 12, the image of the yellowish teeth of the Saharawi population was stuck in his mind, due to the excess of fluoride in the water. “I wanted to find a solution.” Now he is frustrated caring for patients he can help. “We don’t have the tools and we send them to another country. We have not studied to do two little things, but, in the end, it is what you can do for lack of means ”.

For Rachid, getting out of the camps, getting a diagnosis and treatment is critical. “More than receiving more food, I would like the children to have opportunities to travel to examine them and access medication for symptoms, for pain, even for a season. Let them eat and have a good development ”, he suggests. “This disease needs to be checked from time to time. When the Holidays in Peace are over, you no longer have ”. The young woman, small and thin, is very indignant at the high number of children who will suffer like her from an ailment that can be controlled. “I saw a three-year-old girl who looked like she was six months old. It is a suffering ”.

This disease needs to be checked from time to time. When the Holidays in Peace are over, you no longer have

Gabal Rachid Breh, a Saharawi celiac

To improve the situation, Rachid proposes a collaboration for Spanish families to especially welcome celiac children and thus guarantee their health. Something that is done with patients for whom there is no possible treatment in the settlements. “When we refer someone abroad, we explain the possibilities and procedures to be able to go through organizations. In Spain, for example, there are five shelters for patients and in this way there is no cost for them ”, explains Salem Brahim.

Emigration is a necessity for mourners and also for doctors, notes the dentist. “The staff here is not stable, they come and go. Some leave because they are offered things outside that we don’t even dream of here: salary and comforts at work, more options to help a patient. Material and medicines. The lack of all that limits what you can do. And even knowledge is atrophied by the lack of practice derived from the lack of conditions. They cannot be judged, it is normal for them to leave. We should include emigration in our list of chronic diseases, but there is no cure ”, he reflects. Next door, Ali Mohamed continues to consult. You have homework.

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George Holan

George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.

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