Social responses – focusing on sanitary conditions

Human habitations and migrations in Cyprus over the last millennia experienced different socio-political and spatial organizations during colonization by the Crusaders, Venetians, Ottomans and British.  For instance, the island experienced several periods of droughts, famine and spread of diseases such as plague epidemics during the Ottoman rule. A period of a severe drought in the 18thc. (1754-1768) led to a rise in bread prices, plague epidemics and massive migration followed by urban riots until 1804 AD. In the earlier times of the Crusaders rule, less-detailed epidemic episodes were reported during the mid-13thc. as well as famines during the early 14thc. at the onset of the LIA period. Bubonic Plague episodes occurred on the island successively in 1348, 1362 and 1364 AD, causing demographic decrease, and failure in agricultural productivity and commercial trade. Indeed, references to epidemics of plague, cholera and fevers abound in historical records in Cyprus. In order to face these diseases, the practice of quarantine that began in Europe during the 14thcwas also established in Cyprus during the Ottoman period. During the British rule, quarantine bulletins and notices were published in the Cyprus Gazette (1878-1960) in which epidemics such as cholera and malaria were listed.

In the CE warmth period, various diseases prevalent in the Near-East stayed endemic in Cyprus (e.g. Leishmaniases, malaria, echinococcosis-hydatid disease). Tuberculosis (TB) associated with living conditions and poverty rates is well-documented since the 20thc. with the establishment of Sanatoria at Pedieos (1909), Athalassa (1926) and Kyperounta (1940) to treat patients. Some of the prevalent fever diseases such as malaria was breaking out on the island aided by higher temperatures suitable for mosquito survival in their goldilocks zones. Indeed, during the early-20thc., Cyprus was considered to have one of the highest rates of malaria and carrier rates of thalassemia in the world. It was endemic during the same period that thalassemia was present on the island. Archaeological excavations have revealed that thalassemia may have existed in Cyprus as early as 7,000 years ago, and malaria was a major natural selection factor that contributed to the establishment of high incidences of thalassemia, sickle cell anemia and glucose-6-phosphate dehydrogenase (G6PD) deficiency among modern Cypriots.
Epidemic Source Period Archives
Plague Books Medieval warming Books
Fevers (typhus, variola, malaria, fevers) Books, records Little Ice Age Monasteries
Cholera Medical records CE warming (19th) Ottoman, British archives
Tuberculosis-TB Medical records CE warming (19th-21st) British, Independent Cyprus
Malaria Medical records CE warming (19th-21st) British archives

Many health situations in human groups are sensitive to both social/built environment and climatic/physical environmental dimensions, making the study of diseases and their social proxies (sanitary conditions, morality/famine, political organization, land use) a suitable indicator for understanding social vulnerability.  Epidemics are considered as indicators of vulnerability, which encompasses many factors, the combinations of which vary across time and space. Epidemics produced specific vulnerable places based on the interactions of populations with the physical, social, and built environments, and with infectious agents. Vulnerability is also influenced by the coping and adaptive capacities of individuals or communities. Even though it may be difficult to trace all factors associated with vulnerability, some specific diseases that may be more determinant in understanding vulnerability are selected throughout the project.

Firstly, infectious diseases such as, for example, Malaria and to a lesser extend Cholera, are more sensitive to heavy rainfall/wet environments and/or high temperatures, especially because their vector-borne transmitters spend part of their lifecycle in this specific environment. Climate/environmental variations on both temporal and spatial scales, affect the transmission of vector-borne diseases. For instance, the effect of ENSO variability on cholera risk in Bangladesh, and malaria epidemics in S. Asia and S. America has been well established with time-series analysis and data series that include more than one event.

Secondly, socio-economic and political dimensions are also associated to sanitary conditions, diseases and epidemics, even with a verified effect of climate/physical environment. A disease such as Cholera is partly associated with degraded social/sanitary conditions in urban areas whereas TB is associated with poor living conditions. Plague transmission is, however, linked more to migrations/commercial networks on both local and regional scales, but also to the transformation of the build environment.

Therefore, understanding the dynamic of disease in history calls for a comprehensive study on several diseases and their social proxies, which appeared at different times throughout the history of Cyprus. As no disease records are kept continuously since the medieval period, several diseases (Bubonic plague, Cholera, malaria, TB, fever) that appeared at different timescales, are investigated for this project under the ‘pathocenosis’ concept, which considers the global dynamic of diseases and their appearance/disappearance in societies at longer timescales. Therefore, a comprehensive understanding of epidemics in Cyprus is proposed by focusing on various types of diseases that characterize the period from 1100 to 2020. Insularity is both characterized by an isolation and opening function which affected Cyprus differently throughout the period. Islands play a significant role for understanding disease spread under epidemic conditions, because they capture specific dynamics within a delimited space.  Islands are also linkage nodes in regional epidemic chains. For instance, invasion by vectors is more pervasive on islands than continental areas. This characteristic may help to better document the colonization by vector species and understand the spatial variations of diseases. However, epidemics can affect island populations with entries through harbours and migrations (e.g. regional diseases). Therefore, islands are receivers for regional and global patterns because they may connect to or disconnect from epidemic courses