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How Tunisia's impoverished southeast remained COVID-19 free

While the isolation and lack of resources may have played a part in keeping cases of the coronavirus from appearing, they've also kept the region's economy in a state of crisis.

In Temezret, a village in the arid land of southeastern Tunisia spread across rolling hilltops, locals passing each other in the khaki stone alleyways greet each other without shaking hands. In a cafe at the summit of the mountain the village is built on, villagers sit at a distance from one another. Even at a wake service for a villager who has died, locals keep a little extra distance while joining to eat couscous.

Temezret is in southeast Tunisia, a historically marginalized region bordering Libya at the gate of the Sahara Desert. Despite the region’s impoverishment, swathes of the southeast have remained totally free of coronavirus, registering zero cases of infection. This while regional neighbors like Egypt and Algeria have been seriously impacted by the virus.

The village is one of the last homes of the Amazigh people in Tunisia, the indigenous inhabitants of North Africa. Amazigh language speakers in Tunisia have traditionally been rebellious and suspicious of outsiders after centuries of invasion by Romans, Arab settlers, French colonizers and others. Amazigh people in the region have thus often been on the lookout for potential invaders — like the virus.

The isolation of their community and the surrounding area, however, has served as a buffer to the coronavirus while the pandemic rages around the world.

Monji Bouras lives in Temezret and runs a museum for Amazigh culture. He explained how locals kept safe.

“When we [in Temezret] heard of the coronavirus, we immediately thought of our tourist projects. By February, I had already stopped letting visitors into my museum.”

He noted that by the time Tunisia’s quarantine shutdown began in mid-March, the only things open in the village were the small corner shops and the bakery.

Bouras spoke about Douz, a town nearly 50 miles to the west of Temezret, whose sparsely populated governorate registered almost 80 coronavirus cases.

“Many from Douz fled their town to Umm Sieh, a spot in the desert nearby Temezret, camping in our agricultural lands and buying groceries from our village. We called the municipality and the police” to keep newcomers from continuing to come into Temezret for fear of spreading the virus.

Rebab Benkraiem, president of the Municipality of Matmata, a formerly Amazigh-speaking town and the administrative center for the surrounding region, seemed proud of the municipality’s response to the coronavirus threat.

“In the mountain villages [including the Amazigh-speaking villages like Temezret], we sent two people from the Health Committee out to disinfect houses, hand out masks, and conduct awareness-raising sessions about washing hands and maintaining distance. They also handed out food.”

“We’re the most vulnerable spot for infection here because we’re on the road between two heavily affected areas,” she said, noting Douz to the west and Toujane, an Amazigh village to the east, which also registered several cases. “But by taking security measures, [the National Guard] helped us close off the town. We set up a checkpoint on both ends of the town so no cases could get in. We were the first municipality to take such strict action.”

Monaam Hakim, a doctor hailing from the major city of Sfax who works in Matmata’s Basic Health Center, says he’s proud of the way in which locals were able to maintain zero coronavirus infections despite the very limited resources. In some ways, he believes, it's precisely the isolation and lack of resources that has protected them.

“In Matmata, there’s a lot of poverty,” he said, “and so people here don’t have the resources to travel outside the area. And there are few to no other people coming in from outside Matmata” since the start of the coronavirus outbreak.

Hakim described the measures taken during the quarantine imposed on Matmata, noting that a tent was set up for suspected cases to take temperatures, check for coughs, check blood oxygen saturation levels and verify where they came from.

In the Basic Health Center, a special room for suspected coronavirus cases in one hallway is kept shut by staff after the occasional patient entering to be checked. The doctor inside passes documents to staff through a small window that he opens and shuts.

Hakim acknowledges that the risks are high for people here should another wave of the virus hit.

“When I go to Temezret, they only have a dispensary. I do consultations there every Wednesday, but I mostly see chronic cases. But there’s no emergency room, so there's no way to treat coronavirus cases” except to send an ambulance over the rough, winding mountain roads and back to Matmata, he said. Even Matmata does not have a hospital, and for the nearest intensive care, they would need to be sent to the city of Gabes another 40 kilometers (25 miles) away.

Tunisia reopened its borders on June 27, partly in an effort to restore the important tourism industry, creating the potential for an influx of the virus. And much of Matmata’s local economy depends on tourism, as the town served as the set of the planet Tatooine in "Star Wars," and its landscape is pocked with unusual Amazigh troglodyte homes dug into the earth.

Hakim is optimistic about the return of tourism. “Tourists going to Douz stay only one night in Matmata and go. It’s just a brief stopping point on the tourist route,” he said, noting what he believes is a minimal risk of transmitting the virus due to brief visits.

Mourad Thabti, a resident in family medicine at Gabes Regional Hospital and a native of Gabes, is less optimistic. He believes the state hasn’t made nearly enough effort to avert the coronavirus crisis in the long-underserved southeast where Gabes, Matmata and villages like Temezret sit.

“It was the civil society that saved Gabes. The Ministry of Health gave almost nothing. Civil society here did fundraising. They collected and donated lacking materials to the hospital here. They gave awareness-raising trainings about the virus in small villages. And since shipping into Tunis was blocked [during quarantine], they produced face masks at home.”

“The government has no plan for how to handle marginalized regions after opening. There has been no plan to give vulnerable people their medicines during lockdown, and some did die,” Thabti said, referring to cases of those with diabetes, hypertension and heart disease who stopped treatment during quarantine.

Unlike Hakim, the doctor in Matmata, Thabti was less optimistic about the borders reopening and tourism returning to Matmata and the Amazigh villages nearby.

“Even a tourist staying for one night would be catastrophic if he’s infected. He would leave the virus on a plate, for example, even after leaving.”

He added, “And here, not everyone will respect distancing rules because they have to work or starve. The summer brings tourists to see camels and the desert, and locals won’t stop working just because of a cough or a fever.”

Thabti said anyone from the area needing higher-level medical treatment for infection must go to the big coastal cities to the north or Tunis. But many locals, he said, don’t have the resources to pay for such treatment.

“We’re in a fragile state here in the south.”

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